The role of injection sclerotherapy in the emergency and definitive management of bleeding esophageal varices
J. G. Allison
Acute esophageal variceal hemorrhage remains a catastrophic event with a
high mortality from either exsanguination or hepatic coma precipitated by
shock and the stress associated with massive blood transfusion, increased
protein load in the gut, and the trauma of various procedures employed in
an effort to arrest the bleeding. Survival from such an episode is followed
by an increased risk of recurrent hemorrhage and a poorer prognosis than
that of a patient with portal hypertension who has not sustained a variceal
bleeding episode. Endoscopic injection sclerotherapy, especially if
performed via the flexible instrument, would seem to be the treatment of
choice for the acute variceal hemorrhage. It may prove to have a role in
the subsequent management for the prevention of recurrent hemorrhage in
certain categories of patients, although its exact place has yet to be
defined.