[Endoscopic sclerosis of esophageal varices]

The increasing popularity of treatment of esophageal varices by endoscopic sclerosis is the result of two factors. First, the principle underlying the procedure, which tends towards selective occlusion of the submucous venous network at the esophagogastric junction, where the risk of rupture is maximal, while respecting other periesophageal bypass pathways of portal blood. Second, the improvement of the apparatus used, thus simplifying the operation and reducing risks, and the improved definition of the limitations of medicosurgical treatment of portal hypertension. Results may be altered by several variables: protocol of injections, particularly intra- or paravascular site of injection, nature of sclerosing agent, type of endoscopy performed, size of varices, etiology of portal hypertension and severity of hepatic lesion and especially the relation between time of operation and the hemorrhagic episode. Hemostasis of a ruptured esophageal varix was obtained in 75 to 100% of cases. Adequate follow up and repeat injections are essential for varicose recurrences (long-term relapse rate = 50%) to avoid hemorrhagic complications.