Incidence and management of complications after injection sclerotherapy: a ten-year prospective evaluation

Abstract

The incidence and management of complications of injection sclerotherapy are reviewed in 304 consecutive patients with esophageal varices followed up prospectively for a 10-year period. The 304 patients were injected on 1336 occasions. Three hundred eleven local esophageal complications occurred in 140 patients (complication rate, 23% per injection and 46% per patient). Esophageal mucosal slough, which was diagnosed by endoscopy, occurred on 250 occasions in 126 patients but did not require specific treatment. An injection site leak occurred in 25 patients, was managed conservatively, and was associated with a mortality rate of 28%. Stenosis of the esophagus was found in 32 patients, but only five patients required dilatation for relief of symptoms. Rupture of the esophagus occurred in four patients, three of whom had surgical treatment, and was associated with a mortality rate of 50%. Serious complications were more frequent with the rigid esophagoscope. An injection site leak occurred more frequently after acute sclerotherapy via the rigid esophagoscope. All four patients with rupture of the esophagus were injected electively via the rigid esophagoscope. Although the incidence of serious complications after injection sclerotherapy in this series appears acceptable, complications have been noted to be cumulative with time.