Long-term endoscopic injection sclerotherapy of bleeding esophageal varices. A prospective analysis of results by endoscopy, manometry and 24-h pH-monitoring.

From 1 January 1986 to 1 January 1988, 91 consecutive patients who had undergone repeated paravariceal endoscopic injection sclerotherapy (PEIS) for bleeding esophageal varices over a period of up to 10 years were followed up prospectively by endoscopy, manometry and 24-h pH monitoring. In 39% nonfatal complications occurred after two phases of PEIS. The number of complications tended to decrease with increasing phases and was only 12% after five or more phases of PEIS. Endoscopy is undoubtedly the most important method in the follow-up of these patients. Early and long-term complications are mostly diagnosed by direct view and thus can be managed or sometimes even prevented in the follow-up. No significant motility disorders were found. Only 12 patients showed significant gastroesophageal reflux. No correlation was found between the severity of reflux and the number of phases of PEIS. No correlation between clinical symptoms and changes in the manometric and pH metric results could be found. The effects and side effects of PEIS can be closely monitored by manometry and pH monitoring and therapy can be tailored accordingly. Our results suggest that PEIS is a superb method with a low complication rate, both short- and long-term. It has proven to be an effective long-term treatment of bleeding esophageal varices.