Sclerotherapy for esophageal varices

Endoscopic injection sclerotherapy (EIS) frequently is used for patients with esophageal varices, both for controlling acute hemorrhage and for prophylaxis. An old technique, interest in EIS increased when other methods did not improve patient outcomes. Clinical trials of EIS for acute hemorrhage demonstrated efficacy and improved outcome, although some researchers disagree with these findings. Recent data on prophylaxis with EIS fail to support the value of EIS for this indication. Ethanolamine oleate compares favorably with other sclerosing agents, and is the only one currently approved for EIS. The intravariceal method is used more frequently than the paravariceal method because it has better efficacy and can be performed more rapidly. The percentage of patients developing significant complications from EIS may be as high as 15 percent; common complications include retrosternal pain, pyrexia, and sepsis. EIS is currently an important clinical tool in the management of esophageal varices.