Pericarditis: a probably overlooked complication of endoscopic variceal sclerotherapy

Two cases of acute pericarditis following endoscopic variceal sclerotherapy (EVS) that were resolved with conservative management are described. This complication arose respectively one and three days after EVS. The possible pathogenesis is the involvement of the pericardium in an inflammatory reaction that develops in the esophageal wall and surrounding tissues. Only five cases have been previously reported in the literature; the authors suppose that this fact may be due to the mild symptoms presented by the patients, which may result in underestimation of this complication. The technical details of EVS in the seven patients with pericarditis were analyzed, but no common etiologic factor was found. The authors strongly advise regular checks for clinical and instrumental signs of acute pericarditis after every session of EVS, so that appropriate management can be undertaken in an early phase and, if necessary, further EVS sessions delayed, in order to avoid cardiac tamponade or constrictive pericarditis.