INJECTION SCLEROTHERAPY OF BLEEDING GASTRIC VARICES USING ABSOLUTE ALCOHOL

Objectives: To evaluate the effectiveness of absolute alcohol injection in the management of bleeding gastric varices. Material and methods: This descriptive study was conducted in the department of Gastroenterology, Hayatabad Medical Complex Peshawar from September 2006 to September 2009. Twenty Seven patients with portal hypertension fulfilling the inclusion criteria and consenting were included in the study. Endoscopy was arranged within 12 hours of admission to the hospital. The gastric varices were injected with 5-10 ml of absolute alcohol depending upon the size of the varices. Both intravariceal and paravariceal techniques were used. Subsequent endoscopy sessions were arranged at 2 weeks intervals. The outcomes assessed were variceal eradication, rebleed and death.. Findings were noted and entered into a structuredproforma. Data was analyzed using SPSSv.10. Results: Fifteen (55.56%) patients were male and 12 (44.44%) were female with a mean age of 47.52+15.09 years. Twenty one (77.78%) patients had cirrhosis due to chronic hepatitis C, 4 (14.81%) were HBV related while 2 (7.40%) had alcoholic liver disease. Majority (70.73%) had childʹs class C followed by B and A (18.51% and 11.11% respectively). Variceal eradication was achieved in 19(70.37%o) patients. Three were lost to follow up while 5 died due to uncontrolled bleeding. Post sclerotheraphy ulceration was the most common complication (64%) followed by pyrexia (28%), Retrosternal/epigastric pain (16%) and dysphagia (8%). Conclusion: Sclerotherapy with absolute alcohol may be effective in achieving hemostasis in bleeding gastric varices but with exceptionally high rate of complications.