Esophageal Variceal Injection
(Sclerotherapy for Esophageal Varices, Endoscopic Sclerotherapy)
Esophageal varices are abnormal blood vessels (veins) that develop in the esophagus. They have abnormally thin walls, and the blood pressure within them is very high. This combination makes esophageal varices very dangerous because they can rupture and cause life-threatening bleeding.
Esophageal variceal injection is a procedure done to either prevent future bleeding or stop active bleeding. During the procedure, medication is injected into or alongside esophageal varices. When injecting into the vein, the medication causes blood clots to form, blocking the vein from bleeding. When injected alongside the vein, the swelling in the area compresses the vein, preventing it from bleeding.
Parts of the Body Involved
Reasons for Procedure
- Small intestine
Esophageal varices can be life threatening. Esophageal variceal injection is a procedure that can make them less likely to bleed. The procedure is also used to stop active bleeding from esophageal varices.
Risk Factors for Complications During the Procedure
What to Expect
Prior to Procedure–
- Bleeding disorder
- Active bleeding
- Advanced age
- Recent or chronic illness
- Heart or lung problems
- Do not eat for 8-12 hours before the procedure.
- If you have diabetes, discuss your medications with your doctor.
- If you are on blood thinning medications, discuss them with your doctor.
- Arrange for transportation after the procedure (you should not drive for 24 hours after the procedure).
Description of the Procedure–
- Your throat may be sprayed with a medicine to make it numb.
- You will be given intravenous (IV) medications to help you relax.
- If you are having active bleeding, it may be necessary to use general anesthesia for your procedure.
For this procedure you will lie on your left side. Your doctor will place a mouthpiece in your mouth to help keep it open. An assistant will be in the room to monitor your breathing and heart beat. Your doctor will insert an endoscope (a long, flexible fiber-optic camera) into your mouth and slowly pass it across your throat and into your esophagus, stomach, and/or small intestine.
While your doctor inserts the endoscope, he or she will watch the images on a video monitor. Your doctor will also pass air through the scope to get a better view. Once the tip of the endoscope is near the varices, your doctor will pass a flexible needle into the endoscope and out the end of the scope. He or she will use the needle to inject medication into the varices. This is called sclerotherapy. If necessary, your doctor may do many injections during one procedure.
Instruments can also be passed through the scope to apply rubberband-like devices which serve to tie-off the varices, preventing future bleeding. This is called band ligation.
How Long Will It Take–
The procedure will take 30-60 minutes.
Will It Hurt–
During the procedure, you may feel discomfort in your throat. After the procedure, your throat may be sore for a few days. In addition, you may feel bloated, and need to belch. You may also have painful swallowing for a couple of days after the procedure.
Average Hospital Stay –
- Chest pain
- Painful swallowing
- Esophageal stricture (narrowing)
- Esophageal ulceration or perforation
- Introduction of bacteria into the bloodstream (bacteremia)
- Do not drive for at least 24 hours.
- Rest the remainder of the day.
- Resume your normal diet, unless told otherwise by your doctor.
- Resume your medications, unless told otherwise by your doctor.
- Ask your doctor when it is safe to resume anticoagulation medications (such as ibuprofen, aspirin, or warfarin).
After this procedure, you will have less chance of bleeding from your esophageal varices. However, it is still possible to bleed from varices even though they have been injected. More than one procedure may be required to get complete treatment.
Call Your Doctor If Any of the Following Occurs
- You vomit blood
- You pass black tar-like stools
- You have difficulty breathing
- You experience severe abdominal pain
- You have trouble swallowing