A balloon designed for endoscopic variceal sclerotherapy

Abstract

Endoscopic injection of esophageal varices with sclerosing agents is a relatively old technique first reported by Craaford and Frenchner in 1939 and used throughout the 1940s. During its early stages, endoscopic variceal sclerotherapy (EVS) fell into disuse because rigid esophagoscopes required general anesthesia and because of the impression that portacaval shunting was a superior form of therapy. Portal shunting prevents recurrent variceal hemorrhage; however, it is associated with high operative mortality and morbidity from hepatic failure. 4 A resurgence of interest in EVS over the last decade has primarily been due to both the introduction of flexible fiberoptic endoscopy and the unsatisfactory results of surgical intervention. The techniques of EVS vary widely. Currently used balloons range from condoms to modified endotracheal cuffs. Many endoscopists use pneumatic balloons secured to the distal tip of the endoscope in an attempt to improve sclerosant injection and retention time and to enable direct tamponade of varices in the event of bleeding. The use of a balloon in this manner has not been systematically evaluated and has been controversial. One reason for controversy is that no data exist to document the relationship between the measured internal balloon pressure and actual transmission of pressure to the esophageal wall. Variability in pressure transmission may account for variable results. We have measured the actual pressure transmitted to the esophageal wall by balloons and have developed a balloon which transmits pressure on a one-to-one basis.