Endoscopic sclerotherapy in acute variceal hemorrhage

Injection Sclerotherapy of Esophageal Varices

“…35 Other recent publications have provided indisputable evidence of the value of injection sclerotherapy in the emergency management of esophageal variceal bleeding. 5,9,12,15,16,25,27,28,35 …”

Endoscopic Sclerosis of Esophageal Varices

“…Retrosternal burning with concomitant odynophagia is often described. These symp toms are usually short-lived, dissipating gradually over 24-72 h with complete resolu tion in 7-10 days [39,52,53,56,69]. The cause of postinjection chest pain is unknown, but Gebhard et al [84] have observed a posi tive correlation between severity of pain and radiographic evidence of diffuse esophageal spasm in 12 patients.…”

“…3 cases of portal vein thrombosis have been reported [52,69]. The underlying cause ac counting for this complication is unknown, although it is speculated that retrograde propagation of clot from thrombosed varices is responsible [52,69], 2 fatal cases of esoph ageal intramural hematoma have been de scribed [49,56] and Seidman et al [77] have reported an unusual case of spinal cord paral ysis following sclerotherapy.…”

“…Barsoum et al [41] randomized 100 acutely bleeding pa tients to receive either balloon tamponade or sclerotherapy and demonstrated that injec tion of varices was superior (cessation of bleeding, 74 versus 42%, p < 0.01). Other trials report an impressive success rate in controlling acute variceal hemorrhage (ta ble I); however, most of these studies em ployed the antecedent use of vasopressin alone or in combination with balloon tam ponade [29,31,49,[52][53][54][55][56]. These initial measures were often sufficient for temporary hemostasis, and allowed completion of the injection procedure in patients in whom bleeding had ceased.…”

“…Ulcers resulting from the caustic properties of the sclerosant may appear as early as 36 h after injection. Volume of sclerosant injected and injection technique may be important contributing factors [73], Ulcers can be asymptomatic or cause retrosternal pain, and have occasionally been the source of massive and fatal hemorrhage [32,56,59], Healing usually occurs without untoward effects and is complete by 4 weeks although strictures occasionally develop [59], Ulcerations over a nonthrombosed varix with associated hem orrhage can become a difficult management problem and must be approached with cir cumspection. Repeat sclerotherapy may ex acerbate existing tissue damage, and concom itant esophageal wall necrosis may contrain- Perforation of the esophagus has been re ported with the rigid instrument, but not with the flexible fiberoptic endoscope [29][30][31], Sclerosant-induced necrosis or ulceration can lead to esophageal perforation and secondary mediastinitis or empyema and may ultimately culminate in death [31,32], Tcrblanclw ct al.…”