Oesophageal varices (endoscopic sclerotherapy)

Oesophageal varices can be very effectively treated by targeted sclerosis.

A flexible endoscope is manipulated to the site in the oesophagus where the varices are visualised. Using a dedicated needle, 1-3ml of sclerosant is injected into each varix, working from the widest area of expansion and moving in small steps proximally.

No compression of the site is required - radial force may actually disperse sclerosant. Eye protection against the sclerosant - sodium tetradecyl sulphate or ethanolamine oleate - must be worn by the operator and assistant.

Sclerosis is usually repeated at an interval of a week until obliteration is evident.

Evidence shows that the use of a vasoactive drug (e.g. somatostatin or octreotide) in combination with endoscopic treatment is more effective than either alone in controlling the initial variceal bleed (1).

Reference:

• Drug and Therapeutics Bulletin (2000), 38 (5), 37-40.