Injection sclerotherapy-induced esophageal strictures. Risk factors and prognosis.
Injection sclerotherapy (IS) has become an effective modality for the treatment of bleeding esophageal varices. Despite improvements in equipment, sclerosant solutions and operator technique, injection sclerotherapy-induced esophageal strictures (ISES) remain a significant cause of patient morbidity. To analyze the risk factors and prognosis of ISES, the records of 117 patients who underwent IS over a 6-year period at a single teaching institute were reviewed. The predictive value of multiple risk factors including the patient's age, Child's risk classification, previous bleeding episodes, etiology of varices, cumulative amount of sclerosant used, and the number of IS treatments were determined using ANOVA. A P value of less than 0.05 was considered significant. In all cases, a free-hand injection technique, flexible endoscopes and sodium morrhuate were used. During a mean follow-up period of 228 days (1-1,469 days), 41 patients (35%) died and 24 patients (20.5%) developed symptomatic strictures. The cumulative amount of sclerosant used (81.4 +/- 9.5 ml) and the number of IS treatments (6.5 +/- 0.7) required in the stricture group was significantly greater than in the nonstricture group (49.1 +/- 2.7 and 4.0 +/- 0.3, respectively). The risk of stricture formation did not correlate with the volume of sclerosant injected per treatment, cause of varices, number of previous bleeds, or Child's hepatic risk class. A mean of 3.6 +/- 4.5 dilations was required for treatment of established strictures and 18 patients (75%) required r 4 dilations. One esophageal perforation occurred following dilation. Mortality correlated with hepatic risk class as 30/41 (73%) of deaths occurred in Child's C patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Division of Gastrointestinal Surgery, University of Michigan, Ann Arbor.
T P
TP
Guynn
F E
FE
Eckhauser
J A
JA
Knol
S E
SE
Raper
M W
MW
Mulholland
T T
TT
Nostrant
G H
GH
Elta
J L
JL
Barnett
D004940:Esophageal Stenosis / Q000209:etiology* / Q000628:therapy; D004932:Esophageal and Gastric Varices / Q000628:therapy; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015911:Sclerotherapy / Q000009:adverse effects*