Endoscopic Sclerotherapy: The Value of Balloon Tamponade and the Importance of Disinfection

Summary

Endoscopic sclerotherapy in active variceal bleeding stopped bleeding in 48 out of 67 patients (72 %). Survival of the acute bleeding episode was related to liver function: 6 % mortality in Child A patients vs. 48 % mortality in Child C. Comparing two treatment modalities: 24 h Linton balloon tamponade followed by sclerotherapy vs. sclerotherapy alone, our results in comparable groups slightly, although not significantly, favor tamponade-sclerotherapy treatment: 75 % survival vs. 71 %. As this treatment modality is more convenient and helps to avoid dangerous aspiration pneumonia, we advocate balloon tamponade prior to sclerotherapy in acute variceal bleeding.

In maintenance treatment 65 patients were treated until eradication of varices. The rebleeding risk was 0.034 % per patient per month, with 64 % of the rebleeding within the 2 first months before complete eradication of the varices. The long-term survival depends largely on liver function: one year survival of 88 % in Child A vs. 30 % in Child C.

Using Aethoxysklerol 1 % in intravariceal injection, no stricture occurred. Using a sterile injection needle and a glutaraldehyde-disinfected endoscope, no infectious complications directly related to the procedure occurred, and all hemocultures remained negative.

Key words:

Esophageal varices - Endoscopic sclerotherapy - Balloon tamponade - Disinfection in endoscopy