Esophageal Variceal Sclerotherapy

Epidemiology

  • Use: treatment of esophageal varices (see [[Esophageal Varices]])
  • Agents
    • Sodium Morrhuate
    • Sodium Tetradecyl Sulfate
    • Ethanolamine Oleate
  • Technique: usually, about 1 mL of the agents is injected in and around a varix -> total of 15-20 injections during a single procedure
  • Incidence: CXR was abnormal in 85% of cases post-procedure in one series (but these were rarely clinically significant)

Adverse Effects

  • Pleural Effusion (see [[Pleural Effusion-Exudate]])
    • Epidemiology
      • Occurs in approximately 25% of cases (range reported in literature: 0-50% of cases)
      • More common with larger number of injections and larger amount per injection
    • Diagnosis
      • CXR/Chest CT: pleural effusion
    • Clinical: usually asymptomatic
    • Treatment/Prognosis: usually resolve
  • Mediastinal Widening/Mediastinitis (see [[Mediastinitis]])
    • Mediastinal widening occurs in 33% of cases
  • Atelectasis (see [[Atelectasis]]): occurs in 12% of cases
  • Pulmonary Infiltrates (see [[Pneumonia]]): occurs in 9% of cases
  • Fever (see [[Fever]]): rarely significant
  • Chest Pain (see [[Chest Pain]]): rarely significant
  • Odynophagia (see [[Odynophagia]]): rarely significant
  • Esophageal Perforation (see [[Esophageal Perforation]])
  • Acute Lung Injury-ARDS (see [[Acute Lung Injury-ARDS]])
    • Epidemiology: occurs in <1% of patients

References