Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler.
BACKGROUND
The current standard treatment of bleeding esophageal varices is band ligation. Although endoscopic sclerotherapy has largely been supplanted by band ligation, there are still clinical situations in which injection methods are useful. Endoscopic ultrasound (EUS) may allow for a more complete evaluation of esophageal varices and perforating veins and may allow for more effective delivery of sclerosant. Our aim was to evaluate the use of color Doppler EUS-guided sclerotherapy for the obliteration of esophageal varices.


METHODS
Five patients with esophageal varices (Child's A = 1, B = 2, C = 2) underwent dynamic EUS-guided sclerotherapy with color flow Doppler. EUS sclerotherapy was performed using Varijet (2.5 mm catheter) injector needles and sodium morrhuate directed at the perforating vessels until flow was completely impeded (2 to 4 mL per injection site). Data collected included (1) sessions to obliteration, (2) episodes of recurrent bleeding, (3) complications, and (4) mortality.


RESULTS
Patients undergoing EUS-sclerotherapy required 2.2 sessions to achieve obliteration of varices. No patient had a recurrence of bleeding and no deaths occurred. One patient developed an esophageal stricture that responded to balloon dilation.


CONCLUSIONS
Dynamic EUS-guided sclerotherapy with color flow Doppler may be safely and effectively used for the treatment of esophageal varices. It allows for effective delivery of sclerosant with favorable outcomes. Prospective, multicenter, randomized trials are warranted.
Lahoti
S
S
St. Luke's Medical Center, Pancreatic Biliary Center, Milwaukee, Wisconsin, USA.
Catalano
M F
MF
Alcocer
E
E
Hogan
W J
WJ
Geenen
J E
JE
D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000379:methods*; D012976:Sodium Morrhuate / Q000627:therapeutic use; D018615:Ultrasonography, Doppler, Color
D012597:Sclerosing Solutions; D012976:Sodium Morrhuate