A 15-Year Experience of Injection Sclerotherapy in Adult Patients with Extrahepatic Portal Venous Obstruction

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Abstract
Objective The authors report a 15-year experience with injection sclerotherapy in the management of adult and teenage patients with esophageal varices due to extrahepatic portal venous obstruction (EHPVO). Summary Background Data Extrahepatic portal venous obstruction is an uncommon cause of esophageal varices and is associated with normal liver function. Effective control of variceal bleeding is the major factor influencing survival. The results of surgery have been unsatisfactory, and therefore, more conservative management policies have been adopted. Methods Fifty-five patients with proven EHPVO underwent repeated injection sclerotherapy via either a modified rigid esophagoscope under general anaesthesia or a fiber-optic endoscope under light sedation, using ethanolamine oleate as the sclerosant. Results Esophageal varices were eradicated in 44 patients after a median number 6 injections (range 1–17) over a mean of 12.5 months (range 1–48). The mean follow-up was 6.8 years (range 1.1–14.6 years). Eleven patients were admitted on eighteen occasions with bleeding from esophageal varices before eradication and there were seven bleeding episodes in six patients from recurrent varices after initial eradication. Complications related to sclerotherapy included injection site leak (6), stenosis (11) and mucosal ulceration (32) during 362 injection sclerotherapy episodes. Four patients died during the study period. Conclusions Injection scelotherapy is the treatment of choice in most patients with EHPVO.