Techniques in Gastrointestinal Endoscopy
Volume 7, Issue 1 , Pages 8-17 , January 2005

Injection sclerotherapy for the management of esophageal and gastric varices

  • Farees T. Farooq, MD

      Affiliations

    • Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland, Cleveland, OH.
    • ,
  • Richard C.K. Wong, MBBS (FACP, FACG)

      Affiliations

    • Corresponding Author InformationAddress reprint requests to: Richard C.K. Wong, MB.BS., FACP, FACG, Division of Gastroenterology (Wearn 247), University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-5066.

References 

  1. Garcia-Tsao G , Groszmann R , Fisher R , et al.   Portal pressure, presence of gastroesophageal varices and variceal bleeding . Hepatology . 1985;5:419–424
  2. Polio J , Groszmann R . Hemodynamic factors involved in the development and rupture of esophageal varices (A pathophysiologic approach to treatment) . Semin Liver Dis . 1986;6:318–331
  3. Groszman R , deFranchis R . Portal hypertension . In:  Schiff ER ,  Sorrell MF ,  Maddrey WC editor. Schiff’s Diseases of the Liver . (ed 8). New York, NY: Lippincott-Raven; 1999;p. 387–442
  4. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices . Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices . N Engl J Med . 1988;319:983–989
  5. Chalasani N , Kahi C , Francois F , et al.   Improved patient survival after acute variceal bleeding (A multicenter cohort study) . Am J Gastroenterol . 2003;98:653–659
  6. El-Serag H , Everhart J . Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs . Am J Gastroenterol . 2000;95:3566–3573
  7. Crafoord C , Frenckner P . A new surgical treatment of varicous veins of the oesophagus . Acta Otolaryngol . 1939;27:422–429
  8. Hashizume M , Kitano S , Koyanagi N , et al.   Endoscopic injection sclerotherapy for 1000 patients with esophageal varices (A nine year prospective study) . Hepatology . 1992;15:69–75
  9. Zaman A , Hapke R , Flora K , et al.   Changing compliance to the American College of Gastroenterology Guidelines for the Management of Variceal Hemorrhage (A regional survey) . Am J Gastroenterol . 2004;99:645–649
  10. Sorbi D , Gostout C , Peura D , et al.   An assessment of the management of acute bleeding varices (A multicenter perspective member-based study) . Am J Gastroenterol . 2003;98:2424–2434
  11. McCormack T , Smith P , Rose J , et al.   Perforating veins and blood flow in oesophageal varices . Lancet . 1983;2:1442–1444
  12. Hashizume M , Kitano S , Sugimachi K , et al.   Three dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension . Hepatology . 1988;8:1482–1487
  13. Lin CY , Lin PW , Tsai HM , et al.   Influence of paraesophageal venous collaterals on efficacy of endoscopic sclerotherapy for esophageal varices . Hepatology . 1994;19:602–608
  14. Lo GH , Kwok-Hung L , Cheng JS , et al.   Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy . Gastrointest Endosc . 1999;49:428–436
  15. Ryan B , Stockbrugger R , Ryan J . A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices . Gastroenterology . 2004;126:1175–1189
  16. Vianna A , Hayes P , Moscoso G , et al.   Normal venous circulation of the gastroesophageal junction . Gastroenterology . 1987;93:876–889
  17. Sarin S , Kumar A . Gastric varices (Profile, classification and management) . Am J Gastroenterol . 1989;84:1244–1249
  18. Saeed Z , Stiegmann G , Ramirez F , et al.   Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices (A multicenter prospective randomized trial) . Hepatology . 1997;25:71–74
  19. Laine L , Stein C , Sharma V . Randomized comparison of ligation versus ligation plus sclerotherapy in patients with bleeding esophageal varices . Gastroenterology . 1996;110:529–533
  20. The Veterans Affairs Cooperative Variceal Sclerotherapy Group . Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease . N Engl J Med . 1991;324:1779–1784
  21. D’Amico G , Pagliaro L , Bosch J . Pharmacologic treatment of portal hypertension (An evidence-based approach) . Semin Liver Dis . 1999;19:475–505
  22. Sarin S , Lamba G , Kumar M , et al.   Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding . N Engl J Med . 1999;340:988–993
  23. Sclerotherapy after first variceal hemorrhage in cirrhosis: A randomized multicenter trial. The Copenhagen Esophageal Varices Sclerotherapy Project . N Engl J Med . 1984;311:1594–1600
  24. Jenkins S , Shields S , Davies M , et al.   A multicentre randomized trial comparing octreotide and injection sclerotherapy in the management and outcome of acute variceal haemorrhage . Gut . 1997;41:526–533
  25. Escorsell A , Arbol L , Planas R , et al.   Multicenter randomized controlled trial of terlipressin versus sclerotherapy in the treatment of acute variceal bleeding (The TEST Study) . Hepatology . 2000;32:471–476
  26. Besson I , Ingarnd P , Person B , et al.   Sclerotherapy with or without octreotide for acute variceal bleeding . N Engl J Med . 1995;333:555–560
  27. de la Pena J , Rivero M , Sanchez E , et al.   Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage (Prospective randomized trial) . Gastrointest Endosc . 1999;49:417–423
  28. Stiegmann G , Goff J , Michaletz-Onody P , et al.   Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices . N Engl J Med . 1992;326:1527–1532
  29. Lo GH , Cheng JS , Lin CK , et al.   Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices . Hepatology . 1997;25:1101–1104
  30. Lo GH , Lai KW , Cheng JS , et al.   A prospective randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices . Hepatology . 1995;22:466–471
  31. Laine L , El-Newihi H , Migikovsky B , et al.   Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices . Ann Intern Med . 1993;119:1–7
  32. Laine L , Cook D . Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding . Ann Intern Med . 1995;123:280–287
  33. Avgerinos A , Armonis A , Stefanidis G , et al.   Sustained rise of portal pressure after sclerotherapy but not band ligation, in acute variceal bleeding in cirrhosis . Hepatology . 2004;39:1623–1630
  34. Dhiman R , Chawla Y . A new technique of combined endoscopic sclerotherapy and ligation for variceal bleeding . World J Gastroenterol . 2003;9:1090–1093
  35. Garg P , Joshi Y , Tandon R . Comparison of endoscopic variceal sclerotherapy with sequential endoscopic band ligation plus low-dose sclerotherapy for secondary prophylaxis of variceal hemorrhage (A prospective randomized study) . Gastrointest Endosc . 1999;50:369–373
  36. Umehara M , Onda M , Tajiri T , et al.   Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices (A prospective randomized study) . Gastrointest Endosc . 1999;50:7–12
  37. Hou MC , Chen WC , Lin HC , et al.   A new “sandwich” method of combined endoscopic variceal ligation and sclerotherapy versus ligation alone in the treatment of esophageal variceal bleeding (A randomized trial) . Gastrointest Endosc . 2001;53:572–578
  38. Argonz J , Kravetz D , Suarez A , et al.   Variceal band ligation and variceal band ligation plus sclerotherapy in the prevention of recurrent variceal bleeding in cirrhotic patients (A randomized, prospective and controlled trial) . Gastrointest Endosc . 2000;51:157–163
  39. Tajiri T , Onda M , Yoshida H , et al.   Endoscopic scleroligation is a superior technique for preventing recurrence of esophageal varices . J Nippon Med Sch . 2002;69:160–164
  40. Saeed Z , Stiegmann G , Ramirez F , et al.   Endoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices (A multicenter prospective randomized trial) . Hepatology . 1997;25:71–74
  41. Cheng YS , Pan S , Lien GS , et al.   Adjuvant sclerotherapy after ligation for the treatment of esophageal varices (A prospective randomized long-term study) . Gastrointest Endosc . 2001;53:566–571
  42. Westaby D , Polson R , Gimson A , et al.   A controlled trial of oral propranolol compared with injection sclerotherapy for the long-term management of variceal bleeding . Hepatology . 1990;11:353–359
  43. Villanueva C , Balanzo J , Novella M , et al.   Nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rebleeding . N Engl J Med . 1996;334:1624–1629
  44. Sanyal A , Freedman A , Luketic V . Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage . Ann Intern Med . 1997;126:849–857
  45. Cello J , Ring E , Olcott E , et al.   Endoscopic sclerotherapy compared with percutaneous transjugular intrahepatic portosystemic shunt after initial sclerotherapy in patients with acute variceal hemorrhage . Ann Intern Med . 1997;126:858–865
  46. Sarin S . Long term follow-up of gastric variceal sclerotherapy (An eleven-year experience) . Gastrointest Endosc . 1997;46:8–14
  47. Oho K , Iwao T , Sumino M , et al.   Ethanolamine olerate versus butyl cyanoacrylate for bleeding gastric varices (A nonrandomized study) . Endoscopy . 1995;27:349–354
  48. Chang KY , Wu CS , Chen PC . Prospective, randomized trial of hypertonic glucose water and sodium tetradecyl sulfate for gastric variceal bleeding in patients with advanced liver cirrhosis . Endoscopy . 1996;28:481–486
  49. Lo GH , Lai KH , Cheng JS , et al.   A prospective randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices . Hepatology . 2001;33:1060–1063
  50. Greenwald B , Caldwell S , Hespenheide E , et al.   N-2-butyl-cyanoacrylate for bleeding gastric varices (A United States pilot study and cost analysis) . Am J Gastroenterol . 2003;98:1982–1988
  51. Huang Y , Yeh HZ , Chen GH , et al.   Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection (Long term efficacy and safety) . Gastrointest Endosc . 2000;52:160–167
  52. Sarin S , Kumar A . Sclerosants for variceal sclerotherapy (A critical appraisal) . Am J Gastroenterol . 1990;85:641–649
  53. Tatemichi M , Nagata H , Sekizuka E , et al.   Differences in hemostasis among sclerosing agents in endoscopic injection sclerotherapy . Dig Dis Sci . 1996;41:562–570
  54. Iwase H , Suga S , Shimada M , et al.   Eleven year survey of safety and efficacy of endoscopic injection sclerotherapy using 2% sodium tetradecyl sulfate and contrast medium . J Clin Gastroenterol . 1996;22:58–65
  55. Sung J , Yeo W , Suen R , et al.   Injection sclerotherapy for variceal bleeding in patients with hepatocellular carcinoma (Cyanoacrylate versus sodium tetradecyl sulphate) . Gastrointest Endosc . 1998;47:235–239
  56. Chiu KW , Changchien CS , Chuah SK , et al.   Endoscopic injection sclerotherapy with 1.5% sotradecol for bleeding cariac varices . J Clin Gastroenterol . 1997;24:161–164
  57. Jutubha R , Jensen D , See J , et al.   Randomized controlled study of various agents for endoscopic injection sclerotherapy of bleeding canine gastric varices . Gastrointest Endosc . 1995;41:206–210
  58. Jacobsen B , Franz R , Hurly E , et al.   Mechanism of thrombosis caused by sclerotherapy of esophageal varices using sodium tetradecyl sulphate . Surg Endosc . 1992;6:4–9
  59. Neeman A , Leiser A , Kadish U . Treatment of esophageal varices (Low versus high dose of 5% ethanolamine oleate) . Am J Gastroenterol . 1991;86:1182–1184
  60. Thakeb F , Salama H , Raouf T , et al.   The value of combined use of N-butyl-2-cyanoacrylate and ethanolamine oleate in the management of bleeding esophagogastric varices . Endoscopy . 1995;27:358–364
  61. Lux G , Retterspitz M , Stabenow-Lohbauer U , et al.   Treatment of bleeding esophageal varices with cyanoacrylate and polidocanol, or polidocanol alone (Results of a prospective study in an unselected group of patients with cirrhosis of the liver) . Endoscopy . 1997;29:241–246
  62. Balanzo J , Sainz S , Espinos J , et al.   Efficacy of ethanolamine and polidocanol in the eradication of esophageal varices (A prospective randomized trial) . Endoscopy . 1989;21:251–253
  63. Kochhar R , Goenka M , Mehta S , et al.   A comparative evaluation of sclerosants for esophageal varices (A prospective randomized controlled study) . Gastrointest Endosc . 1990;36:127–130
  64. Meirrelos-Santos J , Carvalho A , Callejas-Neto F , et al.   Absolute ethanol and 5% ethanolamine oleate are comparable for sclerotherapy of esophageal varices . Gastrointest Endosc . 2001;51:573–576
  65. McClave S , Kaiser S , Wright R , et al.   Prospective randomized comparison of esophageal variceal sclerotherapy agents (Sodium morrhuate vs. sodium tetradecyl sulfate) . Gastrointest Endosc . 1990;36:567–571
  66. Suga T , Akamatsu T , Saegusa H , et al.   Actual behaviour of N-butyl-2-cyanoacrylate (Histoacryl) in a blood vessel (A model of a varix) . Endoscopy . 2002;34:73–77
  67. Sarin S , Nanda R , Sachdev G , et al.   Intravariceal versus paravariceal sclerotherapy (a prospective, controlled, randomized trial) . Gut . 1987;28:657–662
  68. Horigome H , Nomura T , Nakao H , et al.   Endoscopic injection sclerotherapy for esophageal varices using a transparent hood . Am J Gastroenterol . 2000;12:3679–3680
  69. Grobe J , Kozarek R , Sanowski R , et al.   Venography during endoscopic injection sclerotherapy of esophageal varices . Gastrointest Endosc . 1984;30:6–8
  70. Lahoti S , Catalano M , Alcocer E , et al.   Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler . Gastrointest Endosc . 2000;51:331–333
  71. Westaby D , Melia W , Macdougall B , et al.   Injection sclerotherapy for oesophageal varices (A prospective randomized trial of different treatment schedules) . Gut . 1984;25:129–132
  72. Sarin S , Sachdev G , Nanda R , et al.   Comparison of the two time schedules for endoscopic sclerotherapy (A prospective randomized controlled study) . Gut . 1986;27:710–713
  73. Johnson P , Campbell D , Antonson C , et al.   Complications associated with endoscopic band ligation of esophageal varices . Gastrointest Endosc . 1993;39:181–186
  74. Matloff D . Treatment of acute variceal bleeding . Gastroenterol Clin North Am . 1992;21:103–118
  75. Wong R , Van Dam J . Complications of balloon tamponade, sclerotherapy, endoscopic variceal ligation, and transjugular intrahepatic portosystemic shunts (TIPS) . In:  Taylor MB ,  Gollan JL ,  Steer ML , et al. editor. Gastrointestinal Emergencies . (ed 2). Baltimore, MD: Williams & Wilkins; 1997;p. 925–943
  76. Shoenut J , Micflikier A . Retrosternal pain subsequent to sclerotherapy . Gastrointest Endosc . 1986;32:84–87
  77. Snady H , Korsten M . Esophageal acid-clearance and motility after endoscopic sclerotherapy of esophageal varices . Am J Gastroenterol . 1986;81:419–422
  78. Sauerbruch T , Wirsching R , Holl J , et al.   Effects of repeated injection sclerotherapy on acid gastroesophageal reflux . Gastrointest Endosc . 1986;32:81–83
  79. Isaksson B , Johnsson F , Jeppsson B . Long term effects of repeated injection sclerotherapy on esophageal motility and mucosa . Surg Endosc . 1997;11:663–667
  80. Evans D , Jones D , Cleary B , et al.   Oesophageal varices treated by sclerotherapy (A histopathologic study) . Gut . 1982;23:615–620
  81. Tabibian N , Smith J , Graham D . Sclerotherapy associated esophageal ulcers (Lessons from a double-blind, randomized comparison of sucralfate suspension versus placebo) . Gastrointest Endosc . 1989;35:312–315
  82. Roark G . Treatment of postsclerotherapy esophageal ulcers with sucralfate . Gastrointest Endosc . 1984;30:9–10
  83. Garg P . Role of omeprazole in prevention and treatment of postendoscopic variceal sclerotherapy esophageal complications. Double-blind randomized study . Dig Dis Sci . 1995;4:569–574
  84. Johlin F . Omeprazole heals mucosal ulcers associated with endoscopic injection sclerotherapy . Dig Dis Sci . 1992;37:373–376
  85. Bacon B , Camara D , Duffy M . Severe ulceration and delayed perforation of the esophagus after endoscopic variceal sclerotherapy . Gastrointest Endosc . 1987;33:311–315
  86. Barsoum M , Mooro H , Bolous F , et al.   The complications of injection sclerotherapy of bleeding oesophageal varices . Br J Surgery . 1982;69:79–81
  87. Jensen D . Sclerosants for injection sclerosis of esophageal varices . Gastrointest Endosc . 1983;29:315–317
  88. Cohen L , Korsten M , Scherl E , et al.   Bacteremia after endoscopic injection sclerosis . Gastrointest Endosc . 1983;29:198–200
  89. Sauerbruch T , Holl J , Ruckdeschel G , et al.   Bacteriaemia associated with endoscopic sclerotherapy of oesophageal varices . Endoscopy . 1985;17:170–172
  90. Snady H , Horsten M , Waye J . The relationship of bacteremia to the length of injection needle in endoscopic variceal sclerotherapy . Gastrointest Endosc . 1985;31:243–246
  91. Lo GH , Lai KW , Shen MT , et al.   A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices . Gastrointest Endosc . 1994;40:675–679
  92. Hou MC , Lin HC , Liu TT , et al.   Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage (A randomized trial) . Hepatology . 2004;39:746–753
  93. Hirota W , Petersen K , Baron T , et al.   Guidelines for antibiotic prophylaxis for GI endoscopy . Gastrointest Endosc . 2003;58:475–482
  94. Dajani A , Taubert K , Wilson W , et al.   Prevention of bacterial endocarditis (Recommendations by the American Heart Association) . JAMA . 1997;277:1794–1801
  95. ASGE Guidelines (Infection control during gastrointestinal endoscopy) . Gastrointest Endosc . 1999;49:836–841
  96. Soriano G , Guarner C , Tomas A , et al.   Norlfoxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage . Gastroenterology . 1992;103:1267–1272
  97. Selby W , Norton I , Pokorny C , et al.   Bacteremia and bacterascites after endoscopic sclerotherapy for bleeding esophageal varices and prevention by intravenous cefotaxime (A randomized trial) . Gastrointest Endosc . 1994;40:680–684
  98. Tam F , Chow H , Prindiville T , et al.   Bacterial peritonitis following esophageal injection sclerotherapy for variceal hemorrhage . Gastrointest Endosc . 1990;36:131–133
  99. Barnett J , Elta G . Bacterial peritonitis following endoscopic variceal sclerotherapy . Gastrointest Endosc . 1987;33:316–317
  100. Baydur A , Korula J . Cardiorespiratory effects of endoscopic esophageal variceal sclerotherapy . Am J Med . 1990;89:477–489
  101. Bacon B , Bailey-Newton R , Connors A . Pleural effusions after endoscopic variceal sclerotherapy . Gastroenterology . 1985;88:1910–1914
  102. Gertsch A , Mosimann R . Chylothorax complicating sclerotherapy for bleeding esophageal varices . Br J Surgery . 1983;70:562–566
  103. Monroe P , Morrow C , Millen J , et al.   Acute respiratory failure after sodium morrhuate esophageal sclerotherapy . Gastroenterology . 1983;85:693–699
  104. Huizinga W , Keen J , Marszalek A . Sclerotherapy for bleeding oesophageal varices (A fatal complication) . S Afr Med J . 1984;65:436–438
  105. Alwmark A , Bengmark S , Borgesson B . Emergency and long-term transesophageal sclerotherapy of bleeding esophageal varices . Scand J Gastroenterol . 1982;17:409–412
  106. Edling J , Bacon B . Pleuropulmonary complications of endoscopic variceal sclerotherapy . Chest . 1991;99:1252–1257
  107. Paterlini A , Salmi A , Buffoli F , et al.   Heart failure and endoscopic sclerotherapy of variceal bleeding . Lancet . 1984;2:1241
  108. Imperiali G , Terruzzi V , Spotti D , et al.   Heart failure as a side effect of polidocanol given for oesophageal variceal sclerosis . Endoscopy . 1986;18:207
  109. Sarin S , Shahi H , Jain M , et al.   The natural history of portal hypertensive gastropathy (Influence of variceal eradication) . Am J Gastroenterol . 2000;95:2888–2893
  110. Eleftheriadis E , Kotzampassi K , Aletras H . The microcirculatory status of portal hypertensive gastric mucosal in normal and postsclerotherapy patients . Am J Gastroenterol . 1990;85:1538–1539

PII: S1096-2883(04)00103-2

doi: 10.1016/j.tgie.2004.10.003

Techniques in Gastrointestinal Endoscopy
Volume 7, Issue 1 , Pages 8-17 , January 2005

Article Tools

* Image Usage & Resolution