Sclerotherapy for Esophageal Varices: A Comprehensive Guide

Introduction and Terminology of the Procedure

Esophageal varices are abnormal, enlarged veins in the esophagus — the tube that connects your throat to your stomach. They are often seen in people with severe liver diseases and can be life-threatening if they rupture and bleed. Sclerotherapy is one of the most common treatments for esophageal varices in the United States.

In Sclerotherapy, a chemical (sclerosant) is injected into the varices during an endoscopy procedure. This causes the varices to harden and shrink, reducing the risk of bleeding. An endoscope is a flexible tube with a camera at the end, allowing doctors to see and treat varices directly. The word “sclerotherapy” comes from the Greek “skleros”, meaning hard, and “therapeia”, meaning healing.

Indications for Sclerotherapy

The primary indication for Sclerotherapy is the presence of bleeding or high-risk esophageal varices. Esophageal varices are commonly found in people with significant liver disease, such as cirrhosis, and other conditions that cause portal hypertension — increased pressure in the portal vein, the large vein that carries blood from the intestines to the liver.

The following factors may indicate a need for Sclerotherapy:

• Active bleeding from esophageal varices
• Previous bleeding from esophageal varices
• Esophageal varices with red signs or spots, which indicate a higher risk of bleeding
• Patient’s inability to take or non-responsiveness to beta-blockers, the first-line treatment to prevent initial bleeding
• Patient’s refusal or contraindications to other therapies such as band ligation

Your healthcare provider will conduct a thorough examination, which includes an endoscopy, to confirm the need for Sclerotherapy. It’s important to discuss your symptoms, medical history, and concerns with your healthcare provider to make the best treatment decision.

Pre-Op Preparation

Preparation for sclerotherapy involves several key steps. Your healthcare provider will provide specific instructions, but here are general guidelines:

• You will likely be asked to fast — no food or drink — for 6-8 hours before the procedure.
• Some medications may need to be adjusted or stopped before the procedure. Your healthcare provider will provide personalized guidance based on your medications and condition.
• Pre-operative labs or imaging may be required to evaluate your health status.
• You may need pre-clearance authorization from your insurance company.
• Arrange for transportation as you may be sedated for the procedure and unfit to drive yourself home.
• Work or school notes may be needed if you require time off post-procedure.

Please note that these are general guidelines and individual circumstances may warrant different approaches. Always consult your healthcare provider for exact instructions.

Our telemedicine primary care practice can assist with pre-operative clearances and ordering of pre-op labs and imaging. Feel free to reach out to us to help you navigate your preparation for Sclerotherapy.

Procedure Technique for Sclerotherapy

Sclerotherapy for the treatment of esophageal varices is a highly specialized procedure. While it involves a number of complex steps, we will break it down in a way that is easy to understand. Please remember that while this guide provides a broad overview, your individual experience may vary slightly depending on your personal medical circumstances and the specific practices of your healthcare provider.

Firstly, your doctor will prepare you for the procedure by administering a sedative to help you relax and potentially a local anesthetic to numb your throat. These will help ensure your comfort during the procedure.

The main tool for this procedure is an endoscope – a long, flexible tube equipped with a light and a tiny camera on one end. The endoscope will be carefully inserted through your mouth and down your throat, allowing your doctor to visualize the esophagus and stomach.

Your doctor will then locate the esophageal varices (the enlarged veins) using the endoscope. Once identified, the doctor will advance a smaller tube, known as a catheter, through the endoscope to the site of the varices.

The next step involves the actual sclerosing or hardening of the veins. A sclerosant – a special type of medication designed to irritate the inner lining of the varices – is injected directly into the veins through the catheter. This causes the varices to contract and eventually close, thereby preventing future bleeding.

During the procedure, your doctor may need to inject sclerosant into multiple varices to fully treat the condition. The number of injections depends on the number and size of the varices present. Also, it is common for the procedure to be repeated in the future, as new varices can develop over time.

The procedure usually lasts between 30 minutes to an hour, although this may vary based on the number of varices needing treatment and how your body responds to the procedure.

Once your doctor is satisfied that the varices have been adequately treated, the catheter and endoscope will be removed. The sclerosant will remain within the treated varices, where it will continue to work to seal off these vessels.

After the procedure is completed, you will be moved to a recovery area. Here, your healthcare team will monitor you as the sedative wears off. It is important to note that because of the sedative, you will need someone else to drive you home after the procedure.

Remember, sclerotherapy is a highly effective treatment for esophageal varices. However, it’s not a cure for the underlying condition causing the varices, such as liver disease. Thus, it’s crucial to continue working with your healthcare provider to manage your overall health.

It’s important that you ask your healthcare provider any questions you may have before the procedure. Understanding the steps involved can help to alleviate any anxiety you may be feeling and help you feel more comfortable and prepared on the day of the procedure.

Duration of Sclerotherapy

The actual sclerotherapy procedure typically takes between 30 minutes to an hour, depending on the number of esophageal varices being treated. However, additional time should be anticipated for preparation before the procedure and recovery afterward.

Post-Op Recovery from Sclerotherapy

After sclerotherapy, you will be moved to a recovery area and monitored until the effects of sedation wear off. This can take up to a couple of hours. Most patients are discharged the same day once they are fully awake and stable.

Following the procedure, you may experience mild throat discomfort and bloating, which typically resolves within 48 hours. It is also recommended to take the day off from work or school. If needed, our practice can provide work or school notes same day up until 9pm on weekdays and 5pm on weekends.

Regular follow-up appointments with your healthcare provider are essential to monitor the effectiveness of the treatment and to decide if additional treatments are required. Generally, the first follow-up appointment is scheduled 1-2 weeks post-procedure, and then regularly thereafter based on your healthcare provider’s recommendations.

No specific rehabilitation or physical therapy is needed after sclerotherapy. However, lifestyle modifications, including limiting alcohol consumption, eating a healthy diet, and managing liver disease if present, can help prevent new varices from forming.

Full recovery times can vary, but most patients are able to return to normal activities within a few days. However, it is important to note that recovery from sclerotherapy refers to healing from the procedure, not the underlying condition that caused the varices.

Effectiveness of Sclerotherapy

Sclerotherapy has been shown to be an effective treatment for esophageal varices. It can significantly reduce the risk of bleeding, which is the major complication of varices.

According to studies, sclerotherapy successfully controls acute bleeding in about 80 to 90 percent of patients. It also decreases the risk of recurrent bleeding. However, repeat treatments are often necessary as new varices can form over time.

The effectiveness of sclerotherapy can be influenced by several factors. The procedure tends to be more successful in patients with smaller varices. Conversely, the presence of large varices or severe liver disease can lower the effectiveness of the procedure and increase the risk of complications.

While sclerotherapy is effective at treating existing varices, it does not treat the underlying condition causing the varices. Therefore, managing conditions like liver disease is crucial for preventing new varices from forming.

Additionally, adhering to your healthcare provider’s recommendations for lifestyle changes, medications, and follow-up appointments can help improve the effectiveness of sclerotherapy and overall management of esophageal varices.

Remember, each patient is unique and these statistics may not reflect your individual experience. It is important to have a detailed discussion with your healthcare provider about what to expect from sclerotherapy in your specific case.

Adverse Events with Sclerotherapy

Sclerotherapy is generally a safe procedure but, like any medical treatment, it does carry some risk of complications. Some possible adverse events include:

• Pain or discomfort in the esophagus (10-20%): This typically occurs soon after the procedure and usually subsides within 48 hours. Pain is caused by the irritation of the esophageal lining due to the sclerosant agent used.
• Bleeding (10-15%): Bleeding may occur if the sclerosant agent damages the esophagus or stomach lining. It is usually minor and stops on its own, but severe bleeding may require further treatment.
• Perforation (2-3%): This rare but serious complication involves the creation of a hole in the esophagus wall. It can lead to severe infection and requires immediate treatment.
• Stricture formation (5-10%): Scar tissue formed in the esophagus after sclerotherapy can lead to narrowing or stricture. This can cause difficulty swallowing and may require further treatment.
• Infection (less than 1%): This is a rare complication that can occur if bacteria enters the esophagus during the procedure.

The overall mortality rate associated with sclerotherapy for esophageal varices is less than 1%.

Alternatives to Sclerotherapy

Several alternatives to sclerotherapy are available for treating esophageal varices, including:

• Endoscopic band ligation (EBL): This procedure involves placing rubber bands around the varices to stop bleeding.
• Medications: Certain medications can reduce pressure in the portal vein and help prevent bleeding from varices.
• Lifestyle changes: Limiting alcohol consumption, eating a balanced diet, and managing liver disease can help reduce the risk of esophageal varices.
• TIPS (Transjugular Intrahepatic Portosystemic Shunt): This procedure creates a new pathway for blood flow in the liver, reducing pressure and decreasing the risk of varices.

Each treatment has its own benefits and risks, so it’s important to discuss these with your healthcare provider.

Experimental or Emerging Technologies

Research into new treatments for esophageal varices is ongoing. One promising technique is called cyanoacrylate injection, which involves injecting a medical-grade ‘super glue’ into the varices. Early studies suggest this could be an effective treatment, particularly for larger varices, but more research is needed to confirm its safety and efficacy.

Conclusion

Sclerotherapy is a proven, effective treatment for esophageal varices, helping to prevent the major complication of these varices – bleeding. Like all procedures, it carries some risk of complications. Alternatives to sclerotherapy are available and should be discussed with your healthcare provider. New treatments are also being investigated, which may offer additional options in the future. Ultimately, the goal is to manage your condition and improve your quality of life, and our dedicated team is here to support you every step of the way.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.