Clinicopathological study of sclerotherapy of esophageal varices. I. A review of 26 autopsy cases.

Twenty six autopsy cases treated by endoscopic injection sclerotherapy (an intravariceal injection method) using ethanolamine oleate were examined for morphological changes in relation to the time intervals following injection. Red thrombi obliterated in the varices were recognized within 20 days of the treatment, and after a month, organization and shrinkage had occurred. Neutrophil infiltration of the esophageal wall was present within four days, and hemorrhage within six days. Edema and necrosis, the degree of which tended to decrease gradually with time, were observed within 20 days. Granulation tissue was first seen 10 days after treatment, followed by increased transformation of fibroblasts into fibrocytes. After two and a half months, an almost cell-free fibrotic-sclerotic stroma was recognized. The results obtained suggest that this treatment creates not only thrombi in vessels which are at risk of bleeding but also fibrosis which prevents rupture of the varices when a sclerosant is leaked or injected into the interstitial tissue. The results might furthermore serve as a basis for a prospective morphological study of patients with varices treated with ethanolamine oleate.