Esophageal damage caused by sclerotherapy
Introduction
Introduction to esophageal damage caused by sclerotherapy It is currently believed that esophageal varicose sclerotherapy (EVS) is an effective method for esophageal variceal bleeding and esophageal varicosity (EV) treatment, but it is often accompanied by post-sternal pain or discomfort, difficulty swallowing. Symptoms such as fever. basic knowledge The proportion of illness: 0.0021% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal stricture esophageal perforation
Cause
Causes of esophageal damage caused by sclerotherapy
Esophageal ulcers:
The most common complication of esophageal sclerotherapy is esophageal ulcer, the incidence rate is about 10% to 90%, which is due to local chemical stimulation caused by inflammation, esophageal venous thrombosis and tissue necrosis caused by esophageal mucosal damage.
Esophageal stricture:
Esophageal stenosis is a late manifestation of EVS, which can occur in a few weeks or months. The tissue inflammation caused by sclerosing agent may be the main cause of esophageal stenosis. The more treatments, the larger the dose, the repeated injection site along the circumference of the tube. The more opportunities there are, the greater the chance of stenosis, and the longer and larger ulcers tend to heal in a fibrotic manner, prone to esophageal stricture.
Esophageal perforation:
Perforation occurs mostly in deep ulcers and wounds during examination, but since the application of EVS, traumatic immediate perforation has been rare, and delayed perforation is caused by full-thickness of the esophageal wall and microabscess caused by sclerosing agents. It often occurs several days to two weeks after EVS. The factors are often related to the excessive dose of sclerosing agent injected into the blood vessels and the deep injection, active bleeding and the use of three-chamber two-capsule tube compression.
Esophageal hematoma:
EVS can produce aseptic inflammation and tissue necrosis of the esophageal mucosa, and can form submucosal ulcers and even muscle ulcers. As a result of portal hypertension and clotting disorders in patients with cirrhosis, aseptic inflammation under the esophageal mucosa can lead to hematoma formation. .
Prevention
Prevention of esophageal damage caused by sclerotherapy
To prevent complications of EVS, first of all, the injection should be accurate and avoid repeated injections at the same site.
Complication
Complications of esophageal damage caused by sclerotherapy Complications esophageal stricture esophageal perforation
1. Esophageal ulcer:
The most common complication of esophageal sclerotherapy is esophageal ulcer, which occurs in an incidence of about 10% to 90%. This is an inflammatory reaction caused by local chemical stimulation, esophageal venous thrombosis and tissue necrosis caused by esophageal mucosal damage, Kozarek It is believed that the occurrence of small esophageal ulcer is a good result after sclerotherapy treatment, indicating fibrosis in the vein wall, which is conducive to varicose vein occlusion and prevention of rebleeding. It is worth noting that large and deep ulcers often bleed. Perforation and esophageal stricture should be avoided.
Excessive doses of extravascular injection of sclerosing agents or repeated injections at a point are often the main cause of deep ulceration. X-ray monitoring found intravascular puncture injection of sclerosing agent, and its true intravascular injection rate is about 50%. The injection of sclerosing agent is about 5-10 ml, but if it exceeds 5 ml per point outside the blood vessel, there is a danger of deep ulceration and perforation. The sclerosing agent has a great relationship with the formation of esophageal ulcer, in terms of the degree of damage to the esophagus. , anhydrous alcohol? 5% phond almond oil? 5% oxidized ethanolamine oleate? 1% ethoxylated alcohol.
2. Esophageal stricture:
Esophageal stenosis is a late manifestation of EVS, which can occur in a few weeks or months. The tissue inflammation caused by sclerosing agent may be the main cause of esophageal stenosis. The more treatments, the larger the dose, the repeated injection site along the circumference of the tube. The more opportunities there are, the greater the chance of stenosis. Long-lasting and large ulcers tend to heal in a fibrotic manner, which is prone to esophageal stricture. In addition, the decrease in acid clearance is also a factor in esophageal stricture. The motor function is dysfunctional. The pressure measurement shows that the esophageal peristalsis is reduced, the non-propelled contraction in the middle and lower segments is significantly increased, and the mean pressure of the lower esophageal segment is decreased during swallowing, which may be caused by damage of the esophageal smooth muscle and degeneration of the plexus.
3. Esophageal perforation:
Esophageal perforation is one of the most dangerous complications of EVS, with an incidence of 0% to 4%, an average of about 1%. Perforation occurs mostly in deep ulcers and trauma during examination, but since the application of EVS, traumatic Immediate perforation has been rare. Delayed perforation is caused by full-thickness of the esophageal wall and microabscess caused by sclerosing agent. It often occurs several days to 2 weeks after EVS. The factors often occur with the hardener injected into the extravascular. Overdose and injections, active bleeding and combined with three-chamber two-capsule compression, it is reported that patients with severe liver disease and patients with corticosteroids before and after EVS, the risk of esophageal perforation after EVS increased.
4. Esophageal hematoma:
Esophageal hematoma is rare in the complications of EVS. The formation of esophageal hematoma is often associated with Mallory-Weiss syndrome, severe vomiting, and surgical dissection of esophageal tumors. Sometimes it can form spontaneously, and aseptic inflammation of esophageal mucosa can be produced after EVS. And tissue necrosis, and can form submucosal ulcers and even muscle ulcers, due to portal hypertension and clotting mechanism disorders in patients with cirrhosis, aseptic inflammation under the esophageal mucosa can lead to hematoma formation, in addition, the amount of each sclerosant injection Whether the injection action is gentle or not is also related to the production of esophageal hematoma.
Symptom
Symptoms of esophageal damage caused by sclerotherapy treatment Common symptoms Difficulty dysphagia Dysphagia Chest pain Coughing Esophageal obstruction empyema
Esophageal damage caused by sclerotherapy is usually caused by esophageal erosion, ulcers, etc. The symptoms are post-sternal burning or pain, difficulty in swallowing, vomiting, hematemesis, etc. Esophageal perforation may have localized mediastinal inflammation or empyema, esophageal bronchospasm , around the pericardium, etc., manifested as chest pain, shortness of breath, fever, cough, dyspnea and other symptoms, esophageal stricture will have obvious post-sternal pain, difficulty in swallowing, vomiting, etc., if esophageal hematoma occurs, its clinical manifestations There may be fever, nausea, vomiting and difficulty swallowing. There may be bloody mucus in the vomit, and esophageal obstruction can be seen in the esophagus.
Examine
Examination of esophageal damage caused by sclerotherapy
Esophageal pressure measurement: pressure measurement showed that esophageal peristalsis decreased, middle and lower non-propelled contractions increased significantly, and the mean pressure of lower esophageal lowering was decreased during swallowing, which may be caused by damage of esophageal smooth muscle and degeneration of nerve plexus.
1. Endoscopy and CT examination: Endoscopy and CT examination showed that almost all patients had different degrees of esophageal erosion, ulcers and so on.
2. X-ray: X-ray monitoring found intravascular puncture injection of hardener.
3. Esophageal barium meal: After the sclerotherapy treatment, the esophageal motor dysfunction can be seen.
Diagnosis
Diagnosis and diagnosis of esophageal damage caused by sclerotherapy
According to the medical history and clinical manifestations, the diagnosis is not difficult.
Suppurative esophagitis: suppurative esophagitis is the most common mechanical damage caused by foreign bodies. The bacteria multiply in the esophageal wall, causing local inflammatory exudation, different degrees of tissue necrosis and pus formation, and can also be widely distributed in honeycomb. inflammation.
