Management of bleeding esophageal varices by repeated endoscopic injection sclerotherapy--4 years' experience

Endoscopic injection sclerotherapy (EIS) is successful in arresting bleeding from esophageal varices and has been used increasingly in recent years. Repeated EIS results in eradication of esophageal varices. Fifty patients were treated by emergency EIS and then by repeated elective injections; 177 EIS procedures were performed, with a mean follow-up period of 12.6 months. Most patients had nonalcoholic cirrhosis; 56% were in Child's Class C. Emergency EIS arrested variceal bleeding in 88% of patients, with a hospital mortality of 22%. In nine patients, bleeding persisted or recurred and was treated by repeated EIS or surgery. Complications occurred in five patients, all of whom recovered with conservative treatment. Patients in Child's Class C had a poor prognosis after EIS. Gastric varices were found frequently in patients classified as Child's C, but rarely in Child's Class A or B patients. Thus, the presence of gastric varices may be a marker for poor prognosis. Long-term observations demonstrate the effectiveness and safety of EIS in patients with bleeding esophageal varices.