Over the past 20 years, an endoscopy has become an integral part of the treatment for variceal-related bleeding disorders of the GI tract. There are essentially 2 effective endoscopic therapies: mechanical therapy via banding ligation and injection therapy. Of the injection therapies, sclerosants and tissue adhesives are the most studied. The appeal of injection therapy is its simplicity, portability, and affordability. The basic mechanisms of action of these solutions include sclerosis, thrombosis (via endogenous clotting mechanisms or the formation of a plastic cast), and vascular tamponade. This review will summarize the indications, technique, and the most current data that support the use of endoscopic injection therapies on variceal-related-bleeding GI disorders.
REVIEW METHODOLOGY
Key words, including ''endoscopic injection,'' ''gastrointestinal bleeding,'' and ''varices,'' and with limits to human clinical studies in English, were used to search the PUBMED database through May 2006. A manual search of citations from relevant articles was also performed. The strength of reported evidence based on reviewed studies were ranked according to ''Evidence based gastroenterology and hepatology'' (Appendix 1). 1
ESOPHAGEAL VARICES
Variceal hemorrhage is responsible for up to 10% of upper-GI bleeding. 2 Among patients with cirrhosis, mortality attributed to bleeding from varices is as high as 50%. 3 Rebleeding is common without intervention and is highest during the first 6 weeks, necessitating a reliable secondary prophylaxis strategy. 4 Injection therapy has been studied in primary prophylaxis, acute hemostasis, and secondary prophylaxis.