Radiological control of injected sclerosant for esophageal varices by endoscopic varicography during injection sclerotherapy

Abstract

Embolization of both varices and their feeder lowers the recurrence rate than that of varices only. Endoscopic varicography was carried out in 23 cases and compared with percutaneous transhepatic portography before and after injection sclerotherapy to evaluate the extent of embolization of varices and their feeders. A balloon attached to the tip of an endoscope was blown at the time of injection of sclerosant-contrast mixture to prevent out-flow into the systemic circulation. Endoscopic varicography showed cephalic flowing up of the mixture when it was not inflated at the injection site. Left gastric vein without major shunts such as gastro-renal shunt, splenorenal shunt et alin 17.4% (4/23), with shunt in 34.8% (8/23), fundic plexus without shunt in 34.8% (8/23) and with shunt in 13.0% (3/23), were the main feeder to the varices. Intravariceal injection of the mixture under fluoroscopy was stopped before it escaped into the portal vein or other unrelated areas so that only the varices and their feeders could be embolized.