Esophageal Variceal Injection
En Español (Spanish Version)

Definition
Esophageal varices are abnormal blood vessels that develop in the esophagus. They have abnormally thin walls and the blood pressure within them is very high. This combination makes esophageal varices dangerous, because they can burst and cause life-threatening bleeding.

Esophageal variceal injection is a procedure to either stop active bleeding or prevent future bleeding. During the procedure, medication is injected into or alongside esophageal varices. When injecting into the vein, the medication causes blood clots to form, blocking the vein from bleeding. When injected alongside the vein, the swelling in the area compresses the vein, preventing it from bleeding.

The procedure is also known as sclerotherapy.

Reasons for Procedure
Esophageal varices can be life-threatening. Esophageal variceal injection is a procedure that can be done to stop active bleeding from esophageal varices and prevent rebleeding.

Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Painful or difficult swallowing
  • Esophageal narrowing
  • Bleeding
  • Esophageal damage
  • Infection
  • Lung injury
Some factors that may increase the risk of complications include:

  • Alcoholism
  • Bleeding disorder
  • Active bleeding
  • Increased age
  • Heart or lung problems
What to Expect
Prior to Procedure
  • Do not eat for 8 to 12 hours before the procedure.
  • If you have diabetes, discuss your medications with your doctor.
  • Arrange for transportation after the procedure. You should not drive for 24 hours after the procedure.
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
Anesthesia
  • Your throat may be sprayed with a medication to make it numb.
  • You will be given IV medications to help you relax.
  • If you have active bleeding, it may be necessary to use general anesthesia. You will be asleep.
Description of the Procedure
For this procedure, you will lie on your left side. A mouthpiece will be placed to help keep your mouth open. An assistant will be in the room to monitor your breathing and heart beat. You may also be given oxygen through your nose. A suction tube will be used to clear the saliva and other fluids from your mouth.

A lubricated endoscope will be placed into your mouth. It will be passed down your throat and into your esophagus. The scope will have a small light and a camera. Images will display on a video monitor. Air will be passed through the scope to help your doctor see your esophagus. The enlarged vein will be located. If needed, the endoscope can be passed all the way down into the stomach and upper intestines.

Upper GI Endoscopy

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When near the varices, a flexible needle will be passed through the scope. The needle will be used to inject medication into the varices. If needed, your doctor may do many injections during one procedure.

Instruments can also be passed through the scope to apply rubber band-like devices. The rubber band ties off the varices. This will prevent future bleeding. This is called band ligation.

How Long Will It Take?
About 30-60 minutes

How Much Will It Hurt?
During the procedure, you may feel discomfort in your throat. After the procedure, your throat may be sore for a few days. In addition, you may feel bloated and need to belch. It may also be painful to swallow for a couple of days after the procedure.

Post-procedure Care
After the procedure, be sure to follow your doctor's instructions, which may include:

  • Do not drive for at least 24 hours.
  • Rest the remainder of the day.
  • Resume your normal diet, unless told otherwise by your doctor.
  • Resume your medications, unless told otherwise by your doctor.
  • If you stopped your medication before the procedure, ask your doctor when it is safe to start taking it again.
After this procedure, you will have a smaller chance of bleeding from your esophageal varices. However, it is still possible to bleed from varices that have been injected.

Follow-up as directed by your doctor. More than one procedure may be required.

Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Bleeding from the mouth
  • Increasing pain
  • Nausea and vomiting
  • Bloody vomit
  • Difficulty swallowing
  • Cough, shortness of breath, or chest pain
  • Lightheadedness
  • Bloody or dark black stools
  • Severe abdominal pain
If you think you have an emergency, call for medical help right away.




RESOURCES:
American Gastroenterological Association

American Society for Gastrointestinal Endoscopy

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology (CAG)

References:
Berry PA, Wendon JA. The management of severe alcoholic liver disease and variceal bleeding in the intensive care unit. Curr Opin Crit Care. 2006;12:171-7.

Garcia-Tsao G, Sanyal AJ. Prevention and management of gastroesophageal varicies and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102(9):2086-2102.

Gastroesophageal varices. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated May 13, 2013. Accessed July 12, 2013.

Technology Assessment Committee, Croffie J, et al. Sclerosing agents for use in GI endoscopy. Gastrointest Endosc. 2007;66(1):1-6.
Park WG, Yeh RW. Injection therapies for variceal bleeding disorders of the GI tract. Gastrointest Endosc. 2008 Feb;67(2):313-23.

Last Reviewed June 2014



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