Food impaction and strictures after sclerotherapy of esophageal varices

Esophageal stricture is a common complication of endoscopic variceal sclerotherapy (EVS). The belief was that it could be managed safely and easily by esophageal dilation. Of 103 patients treated at our institution with EVS, 31 developed strictures, and of these, five have presented with food impaction (16.1%), a previously unreported complication. Three of the five had undergone prior esophageal dilation. Our patients received an average of 89 ml of 1.5% sodium tetradecyl in 7.6 sessions, compared with 51 ml in three sessions in an earlier group of EVS-induced strictures without food impaction. Esophageal manometric abnormalities were seen in three of four patients studied, two with markedly impaired peristaltic activity. All patients had successful treatment of both esophageal stricture and bleeding varices. Further sclerotherapy continued in four of five patients without additional problems. Food impaction in EVS-induced esophageal stricture can occur, despite dilation therapy.