Video 1Balloon-compression endoscopic injection
sclerotherapy for the treatment of
esophageal varices. A 50-year-old man with
schistosomiasis-induced
liver fibrosis presented with
melena and
hematemesis. The
bleeding stopped after
intravenous administration of
somatostatin and
ceftriaxone for 4 days. Balloon-compression endoscopic injection
sclerotherapy (bc-EIS) was performed with the patient under
general anesthesia to prevent rebleeding. The novel device for bc-EIS is composed of a syringe, a stopcock, a
catheter, and an inflatable balloon. In the majority of patients with
cirrhosis, the blood flow from the coronary vein drains into the azygos and hemiazygos venous system through esophageal and para-
esophageal varices, and eventually back to the inferior vena cava. With compression of proximal esophageal and para-
esophageal varices via an inflated balloon,
sclerosant can be retained at the injection site, rather than flowing back to the inferior vena cava. Endoscopy revealed the presence of moderately enlarged, beady
esophageal varices with red wale signs in the middle and lower esophagus. An inflatable balloon was fixed to an
endoscope at a distance of 3 cm from its distal end. When the end of the
endoscope was introduced to the target
varices, 20 mL of air was injected into the balloon through a thin
catheter, making its outer diameter expand to 3.5 cm. A disposable endoscopic injection needle then entered the base of the variceal columns near the cardia. When blood flowed back into the needle, a mixture of
Lauromacrogol and
methylene blue was intravariceally administered. Minor
bleeding at the injection site was stopped through brief compression with the needle sheath. The second injection was performed following the aforementioned procedure. Follow-up endoscopy at 1 month, 4 months, and 7 months revealed the progression from thrombosed blue
varices to complete eradication of
esophageal varices. Endoscopic ultrasonography also showed the absence of blood flow in the
varices after treatment. To date, bc-EIS has been performed successfully on 28 patients with
esophageal varices. Variceal eradication was obtained in 17 patients with 1 session, 10 patients with 2 sessions, and 1 patient with 3 sessions. Two patients showed recurrence of
esophageal varices on routine follow-up endoscopy and were re-treated with bc-EIS successfully. There were no severe complications during the follow-up period. With the
sclerosant retained at injection sites after balloon compression, bc-EIS enables complete eradication of
esophageal varices and lowers the risk of recurrence. The blockade of
sclerosant also decreases the incidence of complications related to large-volume injection of
sclerosant, such as embolization, ulceration, and perforation. In conclusion, bc-EIS appears to be an effective and safe approach for the treatment of esophaeal
varices. Further research is underway to determine its suitability for large-scale clinical application.