Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with injection sclerosis of esophageal/gastric varices. Commonly referred to as an EGD with variceal sclerotherapy.

Summary

An EGD with variceal sclerotherapy is a procedure where a flexible scope is inserted through the mouth to visualize the esophagus, stomach, and the upper part of the small intestine. During this procedure, a substance is injected to harden (sclerose) esophageal or gastric varices, which are abnormally enlarged veins, to prevent or stop bleeding.

Purpose

This procedure is designed to address bleeding or potential bleeding from varices, which can occur in patients with liver cirrhosis or other conditions causing increased pressure in the portal vein. The goal is to reduce the risk of life-threatening bleeding by strengthening the variceal walls.

Indications

• Presence of esophageal or gastric varices.
• History of variceal bleeding.
• Symptoms of gastrointestinal bleeding such as vomiting blood or black, tarry stools.
• High risk of variceal bleeding diagnosed through imaging or endoscopy.

Preparation

• Patients are usually instructed to fast for at least 8 hours before the procedure.
• Some medications may need to be adjusted or paused, especially blood thinners.
• Pre-procedural diagnostic tests may include blood work, imaging, and consultation with a specialist.

Procedure Description

1. The patient is sedated to ensure comfort during the procedure.
2. A flexible endoscope is gently inserted through the mouth and guided down the esophagus, into the stomach, and the duodenum.
3. The doctor identifies varices and injects a sclerosing agent directly into them.
4. The substance causes the varices to shrink and harden, reducing the risk of bleeding.
5. The endoscope is carefully withdrawn.

Tools & Equipment:

• Flexible endoscope
• Sclerosing agents (e.g., sodium tetradecyl sulfate)
• Injection needle

Anesthesia: Conscious sedation or general anesthesia may be used, depending on the patient's condition and the extent of the procedure.

Duration

The procedure generally takes about 20 to 40 minutes.

Setting

This procedure is typically performed in a hospital, outpatient clinic, or surgical center equipped with endoscopy facilities.

Personnel

• Gastroenterologist
• Nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

Common Risks:

• Mild sore throat post-procedure
• Nausea and bloating from the air used to inflate the stomach

Rare Complications:

• Bleeding
• Perforation of the gastrointestinal tract
• Infection
• Adverse reactions to sedation

Benefits

The primary benefit is the reduced risk of variceal bleeding, which can be life-threatening. Patients may notice a reduction in symptoms like vomiting blood or black stools, shortly after the procedure.

Recovery

• Patients are monitored until sedation wears off, usually a few hours.
• Post-procedural instructions typically include rest, fluids, and avoiding certain activities.
• Full recovery is usually expected within 24-48 hours.
• Follow-up appointments may be necessary to assess varices and overall health.

Alternatives

• Beta-blockers to reduce blood pressure in the portal vein.
• Endoscopic band ligation to tie off varices.
• Transjugular intrahepatic portosystemic shunt (TIPS) to divert blood flow and reduce variceal pressure.

Pros and Cons:

• Medications are less invasive but may not be as immediately effective.
• Band ligation is similarly effective but carries its own risks.
• TIPS is highly effective for severe cases but is invasive and complex.

Patient Experience

During the procedure, patients may feel pressure or slight discomfort from the insertion of the endoscope, but sedation typically minimizes these sensations. Post-procedure, a sore throat and minor bloating are common. Pain management and comfort measures are provided to ensure a smooth recovery.