Endoscopic variceal sclerotherapy (EVS) is a procedure used to treat esophageal bleeding. The procedure involves introducing a flexible endoscope into the esophagus to inject sclerosing agents into the varices. Varices are enlarged veins on the esophagus that bleed and have fatal effects in up to 50 percent of patients. The sclerosing agent destroys varices and slows thrombosis, which stops esophageal bleeding.
Effusion
One of the most common complications associated with EVS is effusion, which is the leaking of fluids--specifically sclerosing agents--into the surrounding esophageal tissue. This causes necrosis, or cell and tissue death, and may be accompanied by fever and chest pain. Effusion occurs in about 50 percent of EVS treatments, however the severity of the complication varies. If pain and fever persist for more than a few days, serious measures are taken to stop further complication from effusion.
Perforation
Because the EVS procedure involves the insertion of a needle into the esophageal varice in order to inject sclerosing agents, a possibility of esophageal perforation exists. This means that the needle has punctured the esophagus and, in more serious cases, the lung. Perforation occurs in 10 to 15 percent of patients, and can result in bleeding and lung problems or, in more serious cases, it can lead to deep ulcers. When perforation occurs, a patient may feel chest pain or difficulty swallowing.
Ulceration
In some cases, too much sclerosing agent is used or it is strong enough to damage or kill the surrounding esophageal tissue, in turn creating deep ulcers. This also can occur in procedures if a patient has an allergic reaction to the sclerosing agent used. This only occurs in about 1 to 2 percent of patients but can have fatal results or produce fistulas, which are abnormal passages between organ surfaces. Superficial ulcers occur more frequently, but these are less damaging and tend to heal on their own.
Pneumonia
Pneumonia is another complication of EVS and is generally associated with deep ulceration or the development of fistulas in the esophagus. In this case, the fluid in the lungs can generally be treated with antibiotics and chest therapy. However, if a fistula is present, surgical repair of the tissue may be necessary.
Other Complications
Common minor complications of EVS procedures include chest pain, difficulty swallowing, fever and sometimes infection, which occur in about 50 percent of patients. Adult respiratory distress syndrome (ARDS) is another complication, however it is much more rare. In this situation, the sclerosing agent may enter the lung.
