Techniques for endoscopic obliteration of esophageal varices.

Endoscopic treatment is widely accepted for both initial and subsequent definitive therapy in patients with hemorrhage from esophageal varices. Endoscopic sclerotherapy, once performed with rigid endoscopes in anesthetized patients, is now performed with flexible endoscopes in awake patients, who frequently return home immediately after the procedure. Such treatment does not confer a survival advantage in the early period after variceal hemorrhage, but serial treatment does result in a lower risk of recurrent hemorrhage and probably prolongs life. Primary treatment by endoscopic sclerotherapy appears to be equal or more effective than primary shunt therapy, even with a sclerotherapy failure rate of from 10 to 30 percent. In spite of such results, the incidence of rebleeding and treatment-related complications and the mortality among sclerotherapy-treated patients remain high. Newer forms of endoscopic treatment such as polymer injection and mechanical ligation have emerged in attempts to better the results obtained with sclerotherapy. Refinement of the technique for conventional sclerotherapy and the potential for increased effectiveness of the new techniques may yet result in improved and safer endoscopic therapy for bleeding esophageal varices.