Twenty-five years of injection sclerotherapy for bleeding varices

Acute injection sclerotherapy has been used in Belfast for 25 years and the results are reviewed. During this period 264 patients had injection sclerotherapy for acute bleeding from oesophageal varices during 396 admissions; a rigid oesophagoscope was used and 447 injections were performed. The series includes 19 children who received 69 injections. Thirty-eight had extrahepatic portal venous hypertension and the remainder had intrahepatic disease. Overall, 81 were Child's grade A (including the 38 extrahepatics), 82 were grade B and 101 were grade C. Of the 396 admissions, acute injection sclerotherapy controlled bleeding in 362 instances (control rate 91.4 per cent); control rate in the children's group was 97.1 per cent and in the adults 90.2 per cent. The hospital mortality was 14.9 per cent (57 adults and 2 children). Nineteen deaths were due directly to bleeding oesophageal varices, two from bleeding gastric varices and seven directly or indirectly from oesophageal leaks. Most of the remaining deaths were due to liver failure. We consider that sclerotherapy is valuable in the control of variceal haemorrhage where bleeding is uncontrolled or recurs after vasopressin or tamponade in any admission.