Studies on various esophageal lesions due to paravariceal injections of 5 percent ethanolamine oleate during endoscopic injection sclerotherapy of esophageal varices
Gastroenterological Endoscopy 28(10): 2257-2267
In endoscopic injection sclerotherapy, 5% ethanolamine oleate (5% EO) is an effective sclerosing agent when used intravariceally, though it produces deep esophageal ulceration when failed in intravariceal injection. Endoscopic changes of esophagus after paravariceal injection of 5% EO containing meglumine amidotrizoate (5% EOMA) were examined in 35 patients who underwent endoscopic embolization of esophageal varices under X-ray monitoring. All of the paravariceal injection have been done unexpectedly because of reasons such as sudden peristaltic movement of esophagus or smaller size of varices. Determination whether the injection was paravariceal or intravariceal has been made by retrospective examination of X-ray films. Occurrence rate of esophageal ulceration was elevated from 14% to 62-100% when the amount of 5% EOMA exceeded 2.0 ml per one paravariceal injection. Major complications due to paravariceal injection of 5% EOMA were massive bleeding from esophageal ulcer (1 case), broad sublation of esophageal mucosa (2 cases), obstruction of esophagus by giant hematoma (1 case), and delayed perforation to pleural cavity (1 case). The last one was dead, others were treated conservatively and cured. As an experimental study, submucosal injection of 1%, 2.5%, and 5% EO have been done in the esophagus of dog (10 dogs) under the direct vision of endoscope. After one week, dogs were sacrificed after esophagofiberscopy. Esophagus was fixed in the 10% formaldehyde, and processed to histology. Occurrence rate of esophageal ulceration was increased according to the concentration and the volume of injected EO. Histologic examination revealed furthermore widely spread submucosal lesion with edema, inflammatory cells infiltration, bleeding and necrosis, surrounding the area of undermining esophageal ulcer.