Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices

[Presenter] In this video, we reported the underwater endoscopic injection sclerotherapy for patients with gastroesophageal varices. The procedure was ethically approved by the Second Affiliated Hospital of Soochow University, and written informed consent was obtained from this patient. This case involved a 57-year-old male patient with a history of Hepatitis B virus cirrhosis for 10 years without active bleeding. His Child-Pugh score was 6 and MELD score was 12. Four gastroesophageal Type 1 one varices with red wale signs and no active bleeding were observed by the endoscope. Before injecting the lauromacrogol into the varices' vein, infuse the room temperature water to fill up the esophageal lumen through the endoscope. The needle must be ensured to be injected into the varices' vein on the anal side, inflow vein of the varices, the lower esophagus. Them inject a mixture of lauromacrogol and methylene blue into the varices in an underwater environment with obviously decreased esophagus peristalsis. After the injection of lauromacrogol, inject the cyanoacrylate through the same needle to occlude the puncture site. After the procedure is completed, check the esophagus again to ensure that all the varices' vein have turned blue and filled with the mixture of lauromacrogol and methylene, which means that the procedure has been completed successfully. Finally, draw out the water from the esophageal lumen. After the procedure, no signs of re-bleeding and no complications were observed during the follow-up period. Gastroscopy was repeated three months after discharge and showed that varicocele elimination rate reached nearly 100%. In this video, we proposed underwater endoscopic injection sclerotherapy as a new choice for patients with gastroesophageal varices. The decreased peristalsis of esophagus underwater can increase the success rate of intravascular injection and make the vision stable.