The Influence of Endoscopic Injection Sclerotherapy on Organs Surrounding the Esophagus

Endoscopic injection sclerotherapy (EIS) is widely accepted as a means of treating esophageal varices. However, various complications of EIS have been reported. To investigate the cause of chest complications after EIS, chest CT and bronchofiberscopy (BF) were carried out in patients undergoing EIS. A contrast medium was added to the sclerosant in a 1: 4 ratio, and a chest CT examination was performed 30 minutes after the EIS procedure. BF was performed before and after EIS. CT findings were classified into four types, i. e., Type I : ring‐enhanced esophageal wall, Type II : ring‐enhanced paraesophageal wall, Type III : locally enhanced esophageal wall, and Type IV : beltlikeenhanced parietal pleura. The CT findings depended on the frequency of EIS rather than the total volume of sclerosant. After injection into the Paravariceal wall, the sclerosant unexpectedly moved beyond the local injection site during the first or second EIS procedures. During the third or subsequent procedures the sclerosant tended to abide locally in the esophageal wall. Before EIS, bronchial venous dilatation, present mainly in the left main bronchus, was noted and its degree was correlated with the form and location of the esophageal varices. Bronchial venous dilatation decreased in three patients after EIS. The change in venous dilatation seemed to reflect alterations in the esophageal variceal blood flow. After EIS bronchial ulceration was found in the main bronchus in 3 patients. This phenomenon was attributed to both the direct effects of the sclerosant and the physical effects of the endoscopic examination itself : Minor complications such as pleural effusion, chest pain, and fever were not associated with either CT or BF findings. Patients undergoing EIS should be carefully monitored to facilitate the early detection and management of potential chest complications.