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esophageal sclerotherapy
Endoscopic treatment used to control primary bleeding from esophageal varices & to obliterate varices after the initial episode.
Indications:
1) actively bleeding patient with esophageal varices
2) patients with esophageal varices who are not surgical candidates
3) patients with esophageal varices who have failed other forms of therapy
Procedure:
sclerosing agents:*
- sodium tetradecyl sulfate
* Addition of octreotide infusion to sclerotherapy diminishes short-term bleeding & reduces transfusion requirements
Schedule:
-> procedure performed every 1-3 weeks until varices are obliterated then every 6 months thereafter
Complications:
1) recurrent bleeding (up to 50% of patients)
2) ulcerations
3) stricture
4) perforations
5) sepsis
6) pulmonary complications
a) pleural effusion
b) adult respiratory distress syndrome (ARDS)
7) overall rate of serious complications is 10-20%
8) procedure-related mortality is 2-5%
Management:
- a single dose of a 3rd generation cephalosporin is given to minimize risk of infection after sclerotherapy
Related
esophageal varices
octreotide (Sandostatin)
Specific
upper gastrointestinal endoscopy with sclerotherapy for esophageal/gastric varices
General
sclerotherapy (phlebosclerosis)
esophageal procedure
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 302
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 350
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998