Acute Esophageal Varices

In acute esophageal varices sclerotherapy and banding have become the initial prefered treatment. Sodium morrhuate and sodium tetradecyl sulfate are used as sclerosing agents. Each varix is usually injected just above the esophagogastric junction and 5 cm proximal to it. Additional treatments should follow in 5 to 6 days. The success rates of such a procedure in emergent situations has been as high as 85%.' However gastric varices have not shown such promise.5 Sclerotherapy should be considered a failed intervention when two sessions have been completed and hemorrhage has still not subsided. In such cases, mortality rates exceed 60% unless urgent surgery is undergone. Side effects of sclerotherapy include pain, fever, ulceration, esophageal perforation, worsening of bleeding varices, and aspiration pneumonia. In combination these can account for a 1-3% mortality. Some investigators have shown banding therapy to be as effective as sclerosis and have fewer complica-tions.6 It requires fewer sessions and has a lower incidence of rebleed and mortality.

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