[Immediate sclerotherapy of acute hemorrhaging esophageal varices in emergency endoscopy. A prospective study]

During a three-year period 145 consecutive patients with bleeding from oesophageal varices underwent immediate endoscopic sclerotherapy, by para- or intra- and paravascular injection of 4-40 ml 0.5% polidocanol. If the bleeding was not stopped within 15 minutes, a Linton-Nachlas tube was introduced. In case of bleeding recurrences from gastric varices or oesophageal ulcerations a gastro-oesophageal disconnection (after Hassab-Paquet) was performed as an emergency measure or electively. During the bleeding-free interval shunt criteria were examined and, if positive, an elective shunt operation was recommended. Hospital mortality was 16.5%, overall mortality during the period of the study was 29.5%. The results indicate that immediate sclerotherapy of bleeding oesophageal varices improves the prognosis, but it should be undertaken only in centres equipped for emergency endoscopy by an experienced immediately available team.