Morphological Alterations of the Esophagus after Endoscopic Sclerotherapy of Varices

Abstract

With the combined peri- and intravascular sclerosing technique esophageal varices can be completely eliminated in an average of three treatment sessions. In order to check the success of the procedure, endoscopic and histological findings at the various stages of treatment after sclerosing with 1% Polidocanol were compared. Clinical and autopsy findings are in agreement. After sclerosing, necroses of the mucosa and intramural inflammations occur regularly in the first week. The varices are thrombosed. Later, the inner wall of the esophagus is cicatricially changed. Histologically the fibroses extend transmurally and in some parts even reach the musculature.

Long-term effects of repeated injection sclerotherapy on esophageal motility and mucosa

“…Both decreased distal esophageal sphincter pressure and abnormal peristaltic waves in the esophagus have been reported [4,8,10,11].…”

“…Esophageal strictures may require dilatation. Besides this, there may also be motility disturbances of the esophagus [4,7,10,14]. The incidence and severity of these disturbances vary in different reports.…”

Manometric evaluation of esophageal motility in patients submitted to prophylactic variceal sclerosis

“…We carried out a clinical study on 15 patients (9 males and 6 females; average age, 45 + 12 years) with liver cirrhosis categorized as Child A and endoscopic evidence of degree II-IV esophageal varices with red spots but no history of bleeding [1,3,7,15,16].…”

Endoscopic Sclerosis of Esophageal Varices

“…Soehendra et al [50] observed mild esophageal stenosis in 33 of 414 patients (8%) following combined paravariceal and intravariceal injection with polidocanol. Us ing the same sclerosant and a paravariceal technique, Kjaergaard et al [54] reported strictures in 13 of 61 patients (21%).…”

“…Intravariceal injec tion is favored by most endoscopists al though some advocate the paravariceal tech nique [43][44][45][46][47][48]. Concomitant use of both methods has been described [41,49,50]. The limited data available suggest that intravari ceal injection may be the preferred technique.…”