Thoracic manifestations after esophageal variceal sclerotherapy

Endoscopic esophageal variceal sclerotherapy (EVS) is often used in the treatment of upper gastrointestinal hemorrhage due to esophageal varices. We retrospectively reviewed the Mayo Clinic experience with EVS between 1980 and 1989 to determine the incidence of thoracic manifestations and chest roentgenographic abnormalities associated with this procedure. The study population consisted of 223 patients who underwent 390 EVS procedures. In all patients, chest roentgenography was done before and after EVS. Ethanolamine oleate or tetradecyl sulfate was used as the sclerosant. Fever, chest pain, and odynophagia were frequent findings after EVS and tended to be short-lived. Local complications at the site of injection, such as esophageal perforation (in 1% of EVS procedures) and abscess (in 0.3%), were infrequent but associated with substantial mortality. Esophageal stricture was noted as a late complication in less than 10% of patients, and clinically recognized aspiration pneumonitis was rare. Respiratory insufficiency developed after 14 EVS procedures. Chest roentgenographic abnormalities, which were commonly detected (after 85% of EVS procedures) but were rarely of clinical significance, included retrocardiac or mediastinal widening or densities (in 35%), pleural effusions (in 27%), atelectasis (in 12%), and pulmonary infiltrates (in 9%). Most thoracic manifestations after EVS are likely due to a local inflammatory response to the sclerosant.