INFECTIONS COMPLICATING ENDOSCOPIC VARICEAL SCLEROTHERAPY AND ESOPHAGEAL-PERFORATION

Patients with and without esophageal perforation who died following en doscopic variceal sclerotherapy were compared retrospectively. Ninetee n cases from the literature of esophageal perforation following sclero therapy were also reviewed. Esophageal perforation after sclerotherapy was frequently missed, and the diagnosis was established premortem in less than 50% of patients. Sclerotherapy resulted in a range of patho logic changes from ulceration and microabscess of the esophagus to eso phageal perforation. Chest pain and pleural effusion with fever have b een frequently seen within 48 hours of sclerotherapy and are usually t ransient and of benign clinical significance. Leukocytosis did not dis tinguish between patients with and without perforation. Clinical sympt omatology present for more than 3 days following sclerotherapy, exudat ive pleural effusions or pneumothorax developing 1 week or longer foll owing sclerotherapy, and polymicrobial infection with oropharyngeal or ganisms were important features of esophageal perforation.