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Clinical study of endoscopic injection sclerotherapy for esophageal varices with special reference to complication

Clinical study of endoscopic injection sclerotherapy for esophageal varices with special reference to complication

Journal of Tokyo Medical College 43(3): 479-487

Injection sclerotherapy with 5% ethanolamine oleate was performed a total of 87 times in 51 cases with esophageal varices. The result was excellent in 18 cases (38.3%) and good in 21 cases (44.7%), thus 83% being categorized as having a therapeutic benefit. An excellent result was obtained relatively more frequently and a poor result less frequently in those cases receiving the nonoperative treatment twice or more times. After the treatment hemorrhage from esophageal varices occurred in 9 cases (17.6%), being due to an ulcer caused by the therapeutic intervention in 2 and fatal in 2 others of these 9 cases. Although complete disappearance of varices is the most desirable therapy, from an analytical study of cases with posttreatment variceal hemorrhage it seems that disappearance of red color sign would suffice for clinical good effect. Complications of the injection sclerotherapy encountered in the present series were: (1) thoracic oppression (61%), (2) fever (46.3%), (3) esophageal ulcer (29.9%), (4) chest pain (22%), (5) emergence or aggravation of ascites (9.4%), (6) hepatic encephalopathy (5.3%), (7) backache (3.7%), (8) headache (3.7%), (9) pleural effusion (3.7%), (10) dysphagia (3.7%), and (11) bleeding (2.5%). However all of these complications were removed by symptomatic treatment. Of these complications, esophageal ulcer, ascites, hepatic encephalopathy, pleural effusion and hemorrhage were the most clinical important symptoms. Esophageal ulcer and pleural effusion appeared to have some causal relationship with extravascular injection of the sclerosant and spread of inflammation to periesophageal structures, respectively. Pulmonary embolism was seen in not a single instance in the present series. In this study to investigate the possibility of this complication, PO2 and PCO2 were measured following injection of 5% ethanolamine oleate in varying doses (maximum : 0.5 cc/kg) on 25 occasions in 20 patients, however, the results indicated no definite relationship between the dosage of the sclerosant and levels of these two gases pressures. In conclusion, the endoscopic injection sclerotherapy with sclerosant is a useful nonoperative treatment method for esophageal varices.

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Accession: 004972891

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