Injection sclerotherapy is a minimally invasive procedure used to treat varices (abnormally enlarged veins) and certain other vascular or venous conditions by injecting a sclerosing agent (a chemical irritant) into the affected vein. This causes the vein to shrink, collapse, and eventually be reabsorbed by the body, leading to the cessation of blood flow through the abnormal vein.
Common Uses of Injection Sclerotherapy
Esophageal and Gastric Varices:
- Varices are abnormally enlarged veins, typically in the esophagus or stomach, that develop due to high pressure in the portal vein system, often caused by liver cirrhosis. If varices bleed, it can be life-threatening.
- Sclerotherapy is used to inject a sclerosing agent directly into the varix via endoscopy, causing the vein to close and preventing or controlling bleeding.
Hemorrhoids:
- Sclerotherapy is also used to treat hemorrhoids by injecting the sclerosing agent into the affected hemorrhoidal tissue, which causes the vein to shrink and eventually resolve.
Spider and Varicose Veins:
- In non-emergency contexts, sclerotherapy is commonly used to treat superficial varicose veins and spider veins, especially in the legs.
Procedure
- The patient is typically sedated if the sclerotherapy is performed endoscopically, such as for esophageal or gastric varices.
- During the procedure, an endoscope is passed into the digestive tract, allowing the physician to view the varices. A thin needle is then passed through the endoscope, and a sclerosing agent is injected directly into or around the varices.
- For hemorrhoids or superficial varicose veins, a sclerosing solution is injected directly into the veins using a fine needle.
Sclerosing Agents
The most common sclerosing agents used are:
- Sodium morrhuate
- Ethanolamine oleate
- Polidocanol
- Sodium tetradecyl sulfate These agents irritate the vein lining, triggering a localized inflammatory response, causing the vein walls to stick together and close off.
Advantages of Sclerotherapy
- Minimally Invasive: Requires no surgery, leading to faster recovery.
- Effective for Acute Bleeding: In cases of variceal bleeding, it can provide rapid control.
- Versatile: Can be used in multiple areas of the body, including the esophagus, stomach, rectum, and legs.
- Outpatient Procedure: For varicose veins and hemorrhoids, it is often performed in a clinic setting without the need for general anesthesia.
Disadvantages and Risks
- Recurrent Bleeding: Varices, particularly in the esophagus, may rebleed even after sclerotherapy.
- Ulceration: The sclerosing agent may cause ulcers or tissue damage at the injection site.
- Stricture Formation: Especially in the esophagus, scarring can lead to narrowing (stricture).
- Infection: Though rare, there is a risk of infection at the injection site.
- Pain: Some patients experience pain or discomfort after the procedure, especially in hemorrhoid or varicose vein treatments.
Alternatives to Injection Sclerotherapy
- Endoscopic Band Ligation (EBL): For esophageal varices, this is now more commonly used than sclerotherapy, as it has lower complication rates and is often more effective in preventing rebleeding.
- Laser Therapy or Radiofrequency Ablation: For spider and varicose veins.
- Hemorrhoidectomy: For severe hemorrhoids, surgery may be considered.