Balloon-assisted endoscopic sclerotherapy: a novel technology

Endoscopic injection sclerotherapy is an effective method for treating esophageal variceal hemorrhage [1] [2]. However, owing to the rapid loss of the sclerosing agent, the overall effect of sclerotherapy is weakened. Therefore, increasing the residence time of the sclerosing agent remains a focal point of current investigations. The present study reported a case treated with a novel technology termed balloon-assisted endoscopic sclerotherapy.

A 48-year-old man was admitted to our department following a diagnosis of esophageal varices. An endoscopy revealed the presence of four varices in the esophagus, with a maximum diameter of 1.0 cm ([Fig. 1]). Therefore, endoscopic balloon-assisted sclerotherapy was immediately performed. The balloon was inserted on the front end of the gastroscope and fixed at a distance of 3 to 5 cm from the tip ([Fig. 2]). The inner diameter of the balloon was 1.1 cm, and the outer diameter before and after inflation was 1.3 cm and 1.8 cm, respectively. The endoscope was then used to enter the vicinity of the treated blood vessel, and the balloon was opened up and inflated with 2 ml of air ([Fig. 3]). Following this procedure, the selected blood vessel was subsequently treated with sclerotherapy. Briefly, the sclerosing agent (10 ml polycinnamyl alcohol + 0.1 ml meilan) was injected into the blood vessel and the balloon was used to continuously compress the blood vessel for 10 minutes ([Video 1]). The tee was closed after the air in the balloon was completely deflated. On follow-up 1 month later, the patient’s varicose veins were significantly atrophied ([Fig. 4]), and endoscopic ultrasonography showed no obvious blood flow signal under the varicose vein ([Fig. 5]).

Fig. 1 Endoscopy revealed the presence of four varices in the esophagus, with a maximum diameter of 1.0 cm.

Fig. 2 Components of the device include the balloon, catheter, and tee. The balloon was inserted from the front end of the gastroscope and fixed at a distance of 3 to 5 cm from the tip.

Fig. 3 The balloon was filled with 2 ml of air.

Video 1 A case treated with a novel technology termed balloon-assisted endoscopic sclerotherapy.

Fig. 4 On follow-up 1 month later, the patient’s varicose veins were significantly atrophied.

Fig. 5 Endoscopic ultrasonography showed no obvious blood flow signal under the varicose vein.

In conclusion, balloon-assisted sclerotherapy under endoscopy was discovered to improve the therapeutic efficacy of the sclerosing agent. Compared with Tatsuyuki Kawano’s balloon method [3], the present method was also simpler and more practical.

Endoscopy_UCTN_Code_TTT_1AO_2AD

^* Joint first authors

Publication History

Article published online:
11 November 2020

• References

• 1 Ali SM, Wu S, Xu H. et al. A prospective study of endoscopic injection sclerotherapy and endoscopic variceal ligation in the treatment of esophageal varices. J Laparoendosc Adv Surg Tech A 2017; 27: 333-341
• 2 Kumar S, Asrani SK, Kamath PS. Epidemiology, diagnosis and early patient management of esophagogastric hemorrhage. Gastroenterol Clin North Am 2014; 43: 765-782
• 3 Kawano T, Nakamura H, Inoue H. et al. Endoscopic injection sclerotherapy using a transparent overtube with intraluminal negative pressure (np-EIS) for esophageal varices. Surg Endosc 1990; 4: 15-17