Sclerotherapy
Also referred to as endoscopic injection sclerotherapy, this procedure primarily treats bleeding esophageal varices by injecting the swollen veins or surrounding tissue with a sclerosant (a strongly irritating solution). The injection causes thrombosis of the mucosal and submucosal veins. Injection into the tissue beside the distended vein produces a fibrotic area and local edema that compresses the vessel. Eradication of the varix stops the variceal bleeding and prevents rebleeding.
Following the initial treatment to control an acute bleeding episode, the patient is usually scheduled for elective repeat sclerotherapy treatments. These treatments are usually scheduled at intervals of a few weeks, depending on the patient’s risk level and healing rate. Prophylactic sclerotherapy aims to prevent rebleeding of the varices.
A similar procedure also successfully treats leg varicosities and hemorrhoids by injecting a sclerosant into the distended vein. The sclerosants generally used in the United States are sodium morrhuate (5%), sodium tetradecyl sulfate (1.5% to 3%), and ethanolamine oleate.
Procedure
After the patient is given I.V. conscious sedation (usually diazepam), and his throat is sprayed with a topical anesthetic, the physician performs sclerotherapy in conjunction with esophagogastric duodenoscopy. Following oral passage of the endoscope, the physician locates and identifies the bleeding varix or varices. He then injects about 2 ml of a sclerosing agent through a flexible needle injector into the varix or varices. He withdraws the needle into the sheath and observes the site. Bleeding should stop within 2 to 5 minutes. If bleeding continues, the physician makes a second injection below the bleeding site. Prophylactic sclerotherapy may then be done on other distended, nonbleeding varices to sclerose potential bleeding sites.
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