PROPHYLACTIC ENDOSCOPIC INJECTION SCLEROTHERAPY FOR GASTRIC VARICES : 1. DEVELOPMENT OF A NEW SCLEROTHERAPY TECHNIQUE AND ITS APPLICATION

Abstract

The author designed a direct injection method of endoscopic injection sclerotherapy (EIS) for gastric varices with a newly developed technique for controlling bleeding from the punctured site, and subsequently used it for prophylactic treatment in 10 cases. EIS was performed under X-ray monitoring in the absence of a balloon, and 5% ethanolamine oleate containing 49% Iopamidol was used as the sclerosant. A twenty-five gauge needle wearing an outer tube was used for the puncture. After injection of sclerosant, thrombin was poured into the outer tube while pulling out the needle. After the needle was pulled out, thrombin was sprayed over the punctured site when bleeding was negligible, and if bleeding was still noted, 1-2 ml of ethanol was injected into the varices. Bleeding from the punctured site was successfully controlled by spraying thrombin or ethanol injection. No other serious complications were observed. All varices treated by this technique were flattened or had disappeared after EIS, and since then no recurrent growth or bleeding has been observed. It is suggested that this direct injection method of EIS is a safe, less invasive and effective prophylactic treatment for gastric varices.