Endoscopic Techniques and Complications in Variceal Sclerotherapy

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Abstract
Increasing interest in esophageal variceal sclerotherapy (EVS) for bleeding varices is attested to by hundreds of recent articles on the subject. Hardly a medical journal is published that does not contain a report or editorial opinion about the procedure. Indeed, enthusiastic battle lines have been drawn by those who employ the procedure and skeptics who are awaiting proof of its efficacy. On the sidelines is a fairly large group of medical "fence-sitters," whose agnostic critiques keep the entire question lively and worth dissecting. EVS is not without complications, but it is not very difficult to perform. It can control active variceal hemorrhage and prevent rebleeding in stabilized patients. Its effect on survival seems to be related to the underlying liver disease, the endoscopist's ability to obliterate the varices, and treatment-related morbidity and mortality. Prophylactic EVS may be helpful in carefully selected patients. We review current controversies about EVS and offer technical suggestions to improve efficacy and lower EVS-related morbidity and mortality.

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