Endoscopic Injection of Esophageal Vein Sclerosing Agent for the Treatment of Esophageal Varices

Endoscopic Injection of Esophageal Vein Sclerosing Agent for the Treatment of Esophageal Varices

Do you know another important application of injection needle in GI disease?

Esophageal vein rupture and hemorrhage caused by portal hypertension is a serious complication of liver cirrhosis and the main cause of death in patients with liver cirrhosis. Endoscopic injection of esophageal vein sclerosing agent for the treatment of esophageal varices has effective application in ample clinical cases.

Since January 1st, 2009 to December 31, 2009, Shanxi provincial people's hospital has performed endoscopic treatment of 94 cases of esophageal varicose veins, with satisfactory results. The analysis is as below:

Clinical background:

A total of 94 patients with esophageal varicose veins (70 males and 24 females, aged from 12 to 72 years old) visited the hospital during the year 2009. Among them, there were 1 case of immune hepatitis, 15 cases of alcohol hepatitis, 68 cases of viral hepatitis and 10 cases of unknown cause. All cases had blood vomit and subsequent tarred stool. Two male patients had bleeding again the next day due to activities, and the bleeding was stopped after the second treatment.

Clinical treatment

FU-JI410HR 410 electronic gastroscope and OLYMPUS injection needle were used. The diameter of the injection needle was 0.5mm, the length of the needle was 4mm, and the total length was 1,650mm. The injection was poly cinnamyl alcohol (manufactured by Shaanxi Tianyu Pharmaceutical Co., LTD.).

Preoperative blood routine examination, liver functions were examined.  Preoperative 12 hours fasting and 4 hours prohibition of taking liquid were conducted. The patient was placed in the left lateral position, with monitoring blood pressure, electrocardiogram, blood oxygen saturation, etc., Prepare blood, blood oxygen and first-aid facilities when necessary, establish venous channel, to ensure emergency work can be carried out.

Sclerosing injection has three methods: paravascular, intravascular and extravascular. Currently, intravascular injection is usually adopted. Through the endoscope, the prepared sclerosing injection was prepared with the injection needle and targeted at the bleeding site of varicose vein. Two points were taken from both sides of the bleeding point, and appropriate amount of poly cinnamyl alcohol was injected under the guidance of the physician. Each injection was performed at 2 ~ 3 points, and 4 ~ 10 mL was injected on each point, with a total amount of 8 ~ 30 mL(average 18 mL).

8 mg% norepinephrine saline and hemagglutinin 2 TU were locally sprayed, and no bleeding was observed at the injection site. If there were a small amount of bleeding at the injection site,  norepinephrine saline could be used to wash the bleeding point. After the clear field of vision is got, local wash with thrombin was applied for hemostasis.  Make sure no bleeding can be observed.

After the surgery, the bite block was taken out, ecg and blood pressure were monitored, the vital signs were observed closely, and the patient fasted for 24 hours. Cold fluid could be taken in if there were no bleeding, and soft food was taken in after 2 weeks.

Postoperative bed rest should last for 1 to 2 weeks, with absolute rest required in 24 hours. Hemostatic agents, acid inhibitors, antibiotics and mucosal protestants were used. Observe if there were any relative complications.

Result and Conclusion

All the 94 patients who received treatment were stopped with bleeding, without complications or adverse reactions, except 2 patients had bleeding the next day and were improved immediately after retreatment. The patients left hospital after 2-4 weeks.

Endoscopic sclerosing agent injection is an effective method for the treatment of esophageal varicose bleeding, which can shorten the time of upper gastrointestinal bleeding, reduce the amount of bleeding, and significantly reduce the rate of open surgery.  Endoscopic sclerosing agent injection therapy is a safe, economical and effective method for the treatment of upper gastrointestinal hemorrhage. In the process of endoscopic sclerosing agent injection, sufficient preparations should be made before operation, especially the cooperation of patients and their families. Intraoperative medical staff should closely cooperate with the operation, gentle manipulation, careful observation, injection precisely; Postoperative patients should be strictly managed with diet, closely observe the changes of their vital sign, and make timely treatment of complications.

Massive hemorrhage of upper digestive tract is a common emergency in internal medicine. Although endoscopic sclerosing agent injection therapy has the disadvantages of complications caused by interventional therapy and the disadvantages of limited treatment scope, it is not only suitable for patients with elective treatment, but also for patients with acute bleeding, so the prospect of this rapid and effective endoscopic operation is optimistic.

Published by Journal of SHANGXI Medical College for Continuing Education Vol.20, No.4, Nov, 2010.