Venous complications of sclerotherapy for esophageal varices.
Although endoscopic sclerotherapy is effective in controlling bleeding from esophageal varices, the effects of sclerosing agents on the extrahepatic portal and splenic veins have not previously been investigated. This study of 21 men with portal hypertension and variceal bleeding compares the morphology of the portal and splenic veins in 11 who had received endoscopic sclerotherapy versus 10 patients who did not. The mean number of injections per patient was 11 +/- 5, the mean volume of 1.5 percent sodium tetradecyl injected was 23 +/- 15 ml, and the interval between the last injection and surgery was 15 +/- 6.5 days. Among the 11 patients who had endoscopic sclerotherapy, portal vein thrombosis occurred in 4 (36 percent). Two of these patients died from acute liver failure; the other two had shunt procedures. Histologic changes included intimal thickening and medial fibrosis in seven patients, thrombus in four patients, and destruction of the venous architecture in two patients. Of the 10 patients with portal hypertension who did not have endoscopic sclerotherapy, all had medial fibrosis of the portal vein, with thrombus and intimal thickening present in only 1. These findings suggest that endoscopic sclerotherapy for esophageal varices should be used cautiously in patients who may later require a shunt. Moreover, further studies are necessary to evaluate the long-term effects of injecting sclerosing agents into the portal circulation before widespread use of prophylactic sclerotherapy can be recommended.
Hunter
G C
GC
Department of Surgery, Veterans Administration Medical Center, Martinez, California.
Steinkirchner
T
T
Burbige
E J
EJ
Guernsey
J M
JM
Putnam
C W
CW
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D005947:Glucose / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008297:Male; D008875:Middle Aged; D019814:Myristic Acid; D009227:Myristic Acids / Q000009:adverse effects* / Q000627:therapeutic use; D011169:Portal Vein / Q000187:drug effects* / Q000473:pathology; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000009:adverse effects* / Q000627:therapeutic use; D013162:Splenic Vein / Q000187:drug effects* / Q000473:pathology
D009227:Myristic Acids; D012597:Sclerosing Solutions; D019814:Myristic Acid; D005947:Glucose