What does endoscopic sclerotherapy treat?
Endoscopic sclerotherapy is a medical procedure used primarily to treat variceal bleeding and certain types of gastrointestinal (GI) issues. This procedure is particularly beneficial for patients with conditions where blood vessels, especially in the esophagus or stomach, become enlarged or swollen due to increased pressure.
The procedure involves injecting a sclerosing agent directly into the problematic blood vessels using an endoscope. This chemical agent causes the blood vessels to harden, shrink, and close off. As a result, the abnormal blood flow is redirected, and bleeding is minimized or prevented altogether.
The procedure of endoscopic sclerotherapy
Endoscopic sclerotherapy is a relatively straightforward procedure, but it requires careful preparation and execution to ensure optimal results.
Preparation before the endoscopic procedure
Before the procedure, the patient should undergo a clinical evaluation, so they must fast for at least 6 hours. If necessary, a gastric suction tube will be inserted.
In an emergency, the patient should receive intensive care, including establishing an intravenous line for blood and fluid replacement to maintain circulatory volume. Oxygen should be administered, and monitoring equipment set up before the endoscopy.
Patients with respiratory failure or altered consciousness must be intubated, and their breathing stabilized before proceeding with the procedure.
During the procedure
The endoscopic sclerotherapy procedure typically takes about 60 to 90 minutes, with the main steps as follows:
First, the doctor uses an endoscope to assess the size of the esophageal varices and look for any ruptures or damage that might be causing bleeding.
The injection sites are usually located a few millimeters from the junction of the stomach and esophagus, following the circumference of the esophagus. Then the injections are usually done starting from the lower part of the esophagus and working upwards. The doctor prioritizes treating varices that are actively bleeding or at high risk of bleeding.
Once the area is identified, the needle is removed from its sheath and positioned in place. The sclerosing agent is then injected into the varices. The surgical assistant will pull the needle back into its covering and move it about 2 cm toward the endoscope.
Meanwhile, the endoscopist observes and locates other areas that need to be injected, then moves the needle to those positions.
Post-procedure monitoring
Patients who undergo the procedure in an emergency are more likely to experience issues with breathing and circulation, so it is important to closely monitor their condition during and after the procedure.
After the sclerotherapy injection, the patient should be observed for 24 hours. During this time, check for:
- Overall health status like heart and lung function, level of consciousness, signs of gastrointestinal bleeding (such as stomach pain, blood in stool, vomiting blood, bloating…), difficulty swallowing, or chest pain.
- Watch for common complications related to digestive endoscopy, especially if there is a risk of the digestive tract being punctured.
Indications and contraindications of endoscopic sclerotherapy
Although sclerotherapy can be considered safe, this endoscopic therapy is not suitable for every patient.
Indications
Emergency cases: When a patient is actively bleeding from esophageal varices or has undergone other medical procedures (like using tubes to compress ruptured veins or receiving medications to lower portal vein pressure).
Preventive sclerotherapy: For patients who have previously had gastrointestinal bleeding due to esophageal varices to prevent it from happening again.
Contraindications
This procedure may not be suitable for patients who have had recent digestive surgery (within the past month) or those with intestinal blockages. It is also not recommended for patients with blood clotting problems or very low platelet counts.
On the other hand, the procedure should be avoided in patients who may be having a heart attack, severe heart failure, difficulty breathing, acute chest pain, or aortic tears. It is also not recommended for patients with heart rhythm problems, high blood pressure, or injuries like neck fractures, intestinal perforations, or infections in the abdominal cavity.
Additionally, patients with varicose veins in the stomach or upper part of the stomach should not undergo this procedure.
Endoscopic sclerotherapy is a valuable treatment for controlling variceal bleeding, especially in emergency situations. It helps reduce bleeding risks and manage long-term complications in patients with esophageal varices. However, careful patient selection and skilled execution are essential for success.
