esophageal sclerotherapy

Introduction

Endoscopic treatment used to control primary bleeding from esophageal varices & to obliterate varices after the initial episode.

Indications

• actively bleeding patient with esophageal varices
• patients with esophageal varices who are not surgical candidates
• patients with esophageal varices who have failed other forms of therapy

Procedure

sclerosing agents:*

• sodium tetradecyl sulfate

* Addition of octreotide infusion to sclerotherapy diminishes short-term bleeding & reduces transfusion requirements

Schedule:

• procedure performed every 1-3 weeks until varices are obliterated then every 6 months thereafter

Complications

• recurrent bleeding (up to 50% of patients)
• ulcerations
• stricture
• perforations
• sepsis
• pulmonary complications
  • pleural effusion
  • adult respiratory distress syndrome (ARDS)
• overall rate of serious complications is 10-20%
• procedure-related mortality is 2-5%

Management

• a single dose of a 3rd generation cephalosporin is given to minimize risk of infection after sclerotherapy

More general terms

• sclerotherapy (phlebosclerosis)
• esophageal procedure

More specific terms

• upper gastrointestinal endoscopy with sclerotherapy for esophageal/gastric varices

Additional terms

• esophageal varices
• octreotide (Sandostatin)