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Definition

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

Mouth
Throat
Esophagus
Stomach
Small intestine

Reasons for Procedure

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

Bleeding disorder
Active bleeding
Advanced age
Pregnancy
Recent or chronic illness
Heart or lung problems
Alcoholism

What to Expect

Prior to Procedure

Do not eat for 8 to 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.

Anesthesia

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.

Description of the 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 fiberoptic camera) into your mouth and slowly pass it across your throat and into your esophagus, stomach, and/or small intestine.

Upper GI Endoscopy

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 to 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.

Possible Complications

Chest pain
Painful swallowing
Esophageal stricture (narrowing)
Pneumonia
Bleeding
Esophageal ulceration or perforation
Introduction of bacteria into the bloodstream (bacteremia)

Average Hospital Stay

A hospital stay is not required.

Postoperative Care

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).

Outcome

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

RESOURCES:

American Gastroenterological Association

http://www.gastro.org

American Society for Gastrointestinal Endoscopy

http://www.asge.org

CANADIAN RESOURCES:

Health Canada

http://www.hc-sc.gc.ca/index_e.html

The Canadian Association of Gastroenterology (CAG)

http://www.cag-acg.org/default.aspx

References:

Feldman M, Friedman LS, Sleisenger MH. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 7th ed. Philadelphia, PA: Saunders; 2002.

Sherlock S, Dooley J. Diseases of the Liver and Biliary System. 11th ed. Oxford, UK: Blackwell Science; 2002.

Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 17th ed. Philadelphia, PA: Saunders; 2004.

Yamada T. Textbook of Gastroenterology. 4th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2003.

Zakim D, Boyer TD. Hepatology. 4th ed. Philadelphia, PA: Saunders; 2003.

Last reviewed February 2008 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Esophageal Variceal Injection

(Sclerotherapy for Esophageal Varices, Endoscopic Sclerotherapy)