Injection sclerotherapy of oesophageal varices with the freehand technique: Experience in Hong Kong

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Abstract
A prospective study of the efficacy of injection sclerotherapy with the freehand technique for acute bleeding oesophageal varices was conducted, to evaluate its use in the control of acute variceal bleeding and to assess long-term sclerotherapy as the definitive treatment. Between July 1981 and January 1985, a total of 108 patients (96 men, 12 women with mean age of 54·4 years) had intravariceal injection of 5 per cent ethanolamine oleate. The majority had non-alcoholic cirrhosis and alcoholism accounted for only 18·5 per cent. There were 22 Child's A, 42 Child's B and 44 Child's C patients. During the 411 sessions of injection, major complications occurred in 12 patients (11·1 per cent) with 3 deaths. Of the 145 episodes of acute variceal bleeding 91·7 per cent were successfully controlled. In episodes which required more than one injection to control the bleeding, there was a high mortality of 75 per cent. Over the three and a half year period, 33 out of the 93 patients on long-term sclerotherapy had re-bled (35·5 per cent). Varices were obliterated in 27 patients with a mean of 5·4 injections. From our experience, the procedure is safe and effective. However, its status as a definitive treatment when compared with conventional surgical treatment requires further controlled evaluation.