Esophageal varicose veins injection

It is estimated that up to 50% of cirrhotic patients have complications of esophageal varices. The more severe the cirrhosis, the higher the risk of esophageal varices. Common symptoms of varicose vein rupture are gastrointestinal bleeding, vomiting blood, black or red stools, cardiovascular collapse...

Bleeding from esophageal varices is one of the serious complications of cirrhosis. The esophagus is a tube that connects the throat to the stomach. Esophageal varices are when the veins at the end of the esophagus swell and burst under certain pressure, causing gastrointestinal bleeding, the patient can die if not treated promptly.

There are 2 common treatment methods:
Using drugs to treat varicose veins through endoscopy. Endoscopic esophageal sclerotherapy is a technique to inject scleroderma into the esophageal veins to temporarily stop bleeding or prevent esophageal varices rupture.

Emergency case: When the patient is suffering from gastrointestinal bleeding due to esophageal varices or performed after some other medical methods (squeezing the ruptured vein with different types of catheters, infusion of antihypertensive drugs). portal vein force). Sclerotherapy to prevent recurrence: Apply to patients with a history of gastrointestinal bleeding due to esophageal varices.

Relative contraindications: Patient has just had 1 month of gastrointestinal surgery, has intestinal obstruction. Patients with coagulopathy, severe thrombocytopenia. Absolute contraindications: Patients with suspected myocardial infarction, cardiovascular collapse, respiratory failure, acute coronary syndrome, aortic dissection, complex arrhythmia, hypertension, etc. v. Patients with cervical vertebrae trauma, intestinal perforation, esophageal fistula, peritonitis. The patient has concomitant varicose veins in the gastric aneurysm or body.

To perform the esophageal scleroderma injection procedure, you need to prepare:
Implementation team: Includes 1 doctor and 2 nurses, 1 doctor and 3 nurses, 1 doctor and 2 anesthesia technicians. passionate about. Equipment used: A gastrointestinal endoscopy system with endoscopic scleroderma needle, 20ml syringe, 50ml syringe, a ventilator and means of anesthesia resuscitation, pre-anesthetic drugs (Midazolam, Fentanyl) used in the procedure. In case of irritation in patients, substances that cause varicose veins: Polidocanol 1% (common), Leat d'ethanolamine 5%, Morrhuate de sodium, Chlorhydrate de quinine-urea, Tetradecyl sulfate 1.5%, absolute alcohol. Patients need to prepare: Clinical examination before the procedure. Fast for at least 6 hours. Insert gastric lavage catheter (if necessary). Sign the certificate of performing the procedure. In case of an emergency, the patient must be actively resuscitated, put on an intravenous line for blood transfusion, give fluids to help compensate for the volume of the circulatory system, breathe oxygen, install a monitor to monitor before the endoscopy. People with respiratory failure, impaired consciousness must be intubated, control breathing before the procedure.

Time to conduct: About 60-90 minutes. Steps to administer oesophageal scleroderma include:
Step 1: Determine the injection site
Use endoscopic tools to assess the degree of esophageal varices, look for signs of portal vein rupture, damage to the coordination case of bleeding. Determine the injection site is the tuft of veins a few mm from the center of the cardia, around the circumference of the esophagus. Then, the injection is estimated to be higher up the esophagus. Injecting is usually preferred in venous bunions that are bleeding or at risk of bleeding. Step 2: Determine the injection technique
After determining the injection site, push the scleroderma needle sheath out of the machine's operating channel and fix it in that position. Push the scleroderma needle out of the sheath and inject the sclerosus. The bronchoscope assistant retracts the needle into the sheath of the needle and pulls the sheath about 2cm toward the endoscope, while the bronchoscope observes and looks for other injection sites and then moves the fixed scleroderma needle into the this position.
There are 3 injection methods:
Intravenous injection: Each injection is from 2-10ml, average 5ml. Each injection is from 20 to 60ml. Submucosal injection next to varicose veins: Each injection is from 0.5-3ml, each injection is 15-30ml. Mixed injection: Combine 2 injection methods above. Inject into the submucosa on either side of the vein wall first and then into the vein. Step 3: Post-procedure monitoring
Note that patients performing the procedure in an emergency situation are often at risk of respiratory and circulatory dysfunction. Always monitor the patient's condition during the procedure. art.
After the procedure of sclerotherapy, the patient needs to lie down and monitor for 24 hours and evaluate the following signs:
Assess the overall status: Cardiovascular, respiratory, consciousness, gastrointestinal bleeding (abdominal pain, walking) in addition to blood, vomiting blood, abdominal distension...), difficulty swallowing, chest pain. Monitor common complications of gastrointestinal endoscopy, especially gastrointestinal perforation.

Complications after the oesophageal scleroderma injection procedure include:
Bleeding at the injection site: Signs are normal, bleeding is small and will clear up when the esophagus is compressed with the bronchoscope. Gastrointestinal bleeding: Insert endoscope and deflate stomach. Remove the endoscope after 15 minutes, consult with surgery and emergency resuscitation if the condition worsens. Pain behind the breastbone, difficulty swallowing, painful swallowing: Usually resolves spontaneously after 72 hours, patients are encouraged to follow a liquid diet combined with pain relievers. Esophageal perforation: due to transmural necrosis, causing esophageal abscess and fistula, directed to surgical treatment, using antibiotics, intravenous nutrition. Pleural effusion i: Usually the amount of effusion is small, it will clear up on its own over time. Esophageal ulcers: Indications for anti-acid secretion and sucralfate. Esophageal stricture: In case of severe narrowing, dilation of the esophagus is required. Fever due to sepsis : Indicates the patient to take antibiotics. Death: Rare (probability 0 - 10%). Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment.
To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.