Early and late complications of endoscopic oesophageal varices sclerotherapy

Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation

OBJECTIVES

The aim of this study was to compare the incidence and endoscopic management of esophageal stricture formation, significant ulcer bleeding, massive esophageal hematoma, and perforation resulting from endoscopic band ligation or sclerotherapy of esophageal varices.

METHODS

Consecutive esophagogastroduodenoscopies in which band ligation or sclerotherapy was performed for acute or obliterative therapy were entered into a computerized endoscopy database during a 7-yr period. Patients were excluded if they died within 72 h of treatment session from complications unrelated to the procedure. Sclerotherapy was performed using a 25-gauge needle with 1.5% sodium tetradecyl sulfate and banding was primarily performed with a Wilson-Cook 6 or 10 shooter. Complications were assessed at scheduled endoscopy and outpatient clinic visits, review of quality assurance data tallied on a monthly basis, and patient records.

RESULTS

Two hundred twenty-one cases of sclerotherapy were performed in 59 patients compared to 110 cases of band ligation in 52 patients. Five patients were excluded because of death within 72 h of the procedure. The incidence of complications from sclerotherapy:banding on a per patient basis included: esophageal stricture formation 25.6%:1.9%, ulcer bleed 25.4%:5.7%, esophageal perforation 2.2%:0%, and massive esophageal hematoma 1.6%:0%. A significant difference in complications between sclerotherapy and band ligation was noted for both stricture formation (p < 0.0005) and ulcer bleeding (p < 0.0001). The majority of ulcer bleeds required no therapeutic intervention, whereas stricture formation required multiple dilation sessions.

CONCLUSIONS

Band ligation has a significantly lower incidence of stricture formation and ulcer bleeding compared to sclerotherapy. The majority of complications can be managed with endoscopic interventions.

Eleven-year survey of safety and efficacy of endoscopic injection sclerotherapy using 2% sodium tetradecyl sulfate and contrast medium

We conducted a retrospective 11-year survey to evaluate the post-treatment course in 285 patients with esophagogastric varices following administration of endoscopic injection sclerotherapy as an emergency, elective, or prophylactic procedure using freshly prepared 2% sodium tetradecyl sulfate not containing benzyl alcohol. These agents were injected into the varices and the supplying veins under fluoroscopic observation, usually in a single treatment. In all patients the variceal size was greatly reduced following one treatment. The amount of sclerosant necessary to fill the varices and the supplying veins varied widely among the patients. Acute variceal bleeding was controlled in 80 (96.4%) of the 83 patients, and the risk of rebleeding during the first month was 0.0548 in the emergency procedures. The serious complication of perforation was observed in one patient. The cause of death was established in the 122 patients who died and included esophageal variceal bleeding in eight (6.6%) and gastric variceal bleeding in one (0.8%). The overall 50% survival period was 5 years and 4 months. Multivariate analysis disclosed that the factors with the greatest negative effect on survival were poor hepatic status and the presence of hepatocellular carcinoma. The method of preparation and the procedure itself may be considered safe and effective in the treatment of esophagogastric varices.