Post sclerotherapy esophageal ulcers: a prospective analysis of their behaviour

The reported incidence of post sclerotherapy esophageal ulcers has shown marked variation, possibly due to lack of uniform criteria for their diagnosis. Using fixed criteria (size greater than or equal to 5 mm, duration greater than or equal to 2 weeks), we prospectively studied 82 patients with portal hypertension, who underwent four or more sessions of endoscopic sclerotherapy (EST), for the occurrence and behaviour of these ulcers. Post sclerotherapy ulcers occurred after 43 (9.2%) of 465 EST sessions in 30 (36.6%) of 82 patients. Ulcers were significantly associated with two complications: rebleed during the course of sclerotherapy (33% of ulcers bled compared to 3% from variceal rupture; p less than 0.001) and esophageal stricture formation (66.7% of strictures occurred in patients who had ulcers; p less than 0.05). Ulcers occurred more frequently in patients with poor liver function (61.5% in Child's C grade compared with 31.9% in Child's A or B grades; p less than 0.05) and after injection into larger varices (83.7% in varices grades 3 and 4, 16.3% in lower grades; p less than 0.005). Severe persistent chest pain (p less than 0.001) and pyrexia (p less than 0.01) after sclerotherapy were clinical pointers of ulcerogenesis.