Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler

Background: The current standard treatment of bleeding esophageal varices i s band ligation. Although endoscopic sclerotherapy has largely been supplan ted by band ligation, there are still clinical situations in which injectio n methods are useful. Endoscopic ultrasound (EUS) may allow for a more comp lete evaluation of esophageal varices and perforating veins and may allow f or more effective delivery of sclerosant. Our aim was to evaluate the use o f color Doppler EUS-guided sclerotherapy for the obliteration of esophageal varices. Methods: Five patients with esophageal varices (Child's A = 1, B = 2, C = 2 ) underwent dynamic EUS-guided sclerotherapy with color flow Doppler. EUS s clerotherapy was performed using Varijet (2.5 mm catheter) injector needles and sodium morrhuate directed at the perforating vessels until flow was co mpletely impeded (2 to 4 mL per injection site). Data collected included (1 ) sessions to obliteration, (2) episodes of recurrent bleeding, (3) complic ations, and (4) mortality. Results: Patients undergoing EUS-sclerotherapy required 2.2 sessions to ach ieve obliteration of varices. No patient had a recurrence of bleeding and n o deaths occurred, One patient developed an esophageal stricture that respo nded to balloon dilation. Conclusions: Dynamic EUS-guided sclerotherapy with color flow Doppler may b e safely and effectively used for the treatment of esophageal varices. It a llows for effective delivery of sclerosant with favorable outcomes. Prospec tive, multicenter, randomized trials are warranted.