Multiplicity of Endoscopic Sclerotherapy

Abstract

Endoscopic injection sclerotherapy (EIS) of esophageal varices was first described by Crafoord and Frenckner in 1939 [1]. However, enthusiasm for EIS faded during the 1950's, amid glowing reports of portocaval shunting as a mode of therapy for esophageal varices. During the last decade investigators have demonstrated renewed interest in EIS for treatment of esophageal varices, due to both the rapid growth of endoscopic skill in gastroenterologists following the introduction of the flexible fiberscope and to the high incidence of hepatic encephalopathy and hepatocellular failure associated with portal-systemic shunt [2-5] in cirrhotic patietns. Sclerotherapy has been shown to effectively control active variceal bleeding [6-8], and some controlled, randomized trials found that EIS reduced the frequency of rebleeding from varices and significantly improved survival [9,10]. however, the technical perform ance of EIS varies from study to study (Table 1). Studies differ in the urgency of the procedure (emergent, elective, prophylactic), in the nature of the endoscope (rigid or flexible, different models and modifications), in the type of anesthesia (general, local, sedative), in the site of injection (intra-and/or paravariceal), in the nature of the sclerosant substance (ethanolamine, polidocanol, tetradecylsulfate, sodium morrhuate, various mixtures), in the number and volume of the injections, in the use of tamponade (overtube, balloon, endoscope), and in the frequency of subsequent injection, (every 3 to 5 days, weekly, variable, pm). The many variables that may affect the success of EIS are summarized in the following description of the method that we use.