Name of the Procedure:

Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices

Common name(s): Flexible Esophagoscopy with Sclerotherapy

Summary

Flexible Esophagoscopy with Sclerotherapy is a minimally invasive procedure where a flexible endoscope is inserted through the mouth to examine the esophagus. During the procedure, a sclerosing agent is injected into esophageal varices (enlarged veins) to reduce their size and prevent bleeding.

Purpose

This procedure addresses esophageal varices, which are enlarged veins in the esophagus that can rupture and cause serious bleeding. The primary goal is to shrink these varices and minimize the risk of bleeding.

Indications

• Presence of esophageal varices, often related to liver diseases such as cirrhosis.
• History of variceal bleeding.
• Unexplained gastrointestinal bleeding where varices are suspected.
• Risk factors making the patient prone to gastrointestinal bleeding.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Adjusting medications, particularly blood thinners, as advised by your doctor.
• Pre-procedure diagnostic tests like blood work or imaging to assess the condition of the liver and esophagus.

Procedure Description

1. The patient receives local anesthesia or light sedation to ensure comfort.
2. A flexible endoscope is gently inserted through the mouth and guided down into the esophagus.
3. The endoscope transmits images to a monitor, allowing the physician to visualize the esophagus and identify varices.
4. Once identified, a sclerosing agent is injected directly into the varices via a needle passed through the endoscope.
5. The agent causes a chemical reaction that hardens and shrinks the varices.
6. The endoscope is carefully withdrawn.

Tools used: Flexible endoscope, sclerotherapy needle, sclerosing agent Anesthesia: Local anesthesia or light sedation

Duration

The procedure typically takes 20-30 minutes.

Setting

Perform the procedure in an outpatient clinic, hospital endoscopy unit, or a surgical center.

Personnel

• Gastroenterologist or endoscopist
• Nurses
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Common risks: Minor throat discomfort, mild bleeding at the injection site.
• Rare risks: Severe bleeding, infection, perforation of the esophagus, reactions to sedation.

Benefits

• Reduces the risk of life-threatening variceal bleeding.
• Provides relief from symptoms associated with varices.
• Enhances quality of life and reduces the need for emergency interventions.

Recovery

• Patients are monitored for a short period after the procedure.
• Instructions include resting for the remainder of the day and avoiding strenuous activities.
• Follow-up care usually involves repeat endoscopies to monitor and possibly treat varices.
• Most patients can resume normal activities within 24-48 hours.

Alternatives

• Beta-blocker medications to decrease the pressure in varices.
• Endoscopic band ligation, which involves placing a band around the varices to cut off blood flow.
• Surgical interventions in severe cases.
• Each alternative has its own set of pros and cons regarding efficacy, risk, and recovery time.

Patient Experience

• Brief discomfort or a sensation of pressure as the endoscope is inserted.
• Mild sore throat after the procedure.
• Pain management includes throat lozenges or mild analgesics as needed.
• Most patients experience minimal discomfort and can return to normal activities quickly.