Sclerotherapy Endoscopy Treatment

Sclerotherapy endoscopy—a form of minimally invasive sclerotherapy treatment—is a cornerstone of gastrointestinal (GI) bleeding management. For decades, physicians have injected liquid sclerosants to thrombose oesophageal and gastric varices, Dieulafoy lesions, and radiation-induced telangiectasia.

Adding a low-power endoscopic laser has refined that technique, giving endoscopists an immediate way to seal needle tracks, stabilize clots, and treat residual feeders through endoscopic injection sclerotherapy without changing scopes.

In this post, we’ll examine how laser-assisted sclerotherapy endoscopy works, which clinical problems benefit most, the step-by-step technique, and the laser platforms now making dual-modality therapy practical in everyday GI practice.

Doctor preparing for endoscopy.

The Evolution of Sclerotherapy

Sclerotherapy first slipped into the endoscopy suite in the late 1960s, laying the groundwork for modern sclerotherapy endoscopy treatment. Surgeons used the same sclerosants they had been injecting into varicose veins and portal collaterals during open procedures.

Back then, quinine and sodium morrhuate were blunt instruments—they provoked fibrosis, but the price was deep ulceration and post-treatment strictures.

By the early 1980s, safer detergents such as ethanolamine oleate and sodium tetradecyl sulfate had replaced the harsher agents. Their surfactant action damaged the endothelium without scorching the surrounding mucosa, so bleeding control improved and complications fell.

The 1990s saw the development of endoscopic band ligation, a mechanical solution that quickly became first-line for oesophageal varices. Yet operators soon realised no single modality could tame every bleed—large gastric varices, tortuous Dieulafoy lesions, and diffuse radiation proctitis still demanded something more adaptable.

Enter hybrid laser-assisted sclerotherapy.

By pairing a familiar chemical thrombogen with a pinpoint beam of light, today’s endoscopist can inject, seal, and spot-treat residual feeders through the same scope channel. It is the latest step in a half-century movement toward faster haemostasis, fewer sessions, and gentler tissue handling.

How Modern Sclerotherapy Works

An engorged varix is like an over-inflated bicycle tube—thin-walled, high-pressure, and ready to burst.

When a sclerosant is injected, it strips the inner lining (endothelium), exposes collagen, and sparks immediate clotting. Within seconds, platelets aggregate and a fibrin web begins to form.

The adjunct laser then plays two crucial roles:

Chemical injury starts the process; optical energy helps it forge a durable seal—all without switching devices or losing sight of the bleeding point.

Doctors looking at the monitor in the operation room.

What is Laser-Assisted Sclerotherapy Endoscopy?

The procedure combines two energy sources delivered through the same working channel:

Sclerosant initiates thrombosis, while laser pulses (usually 8-15 W for one second) photocoagulate the puncture site. Thermal energy denatures residual endothelium and shrinks surrounding tissue, reinforcing the chemical reaction.

Because both steps occur through a familiar accessory channel, teams already comfortable with standard injection adopt the technique quickly.

Together, chemical and optical energy shorten bleed-stop time, limit sclerosant back-bleed, and reduce the number of reinjection sessions.

Why Combine Laser and Sclerosant?

Traditional sclerotherapy endoscopy relies on chemistry alone. Most bleeds stop quickly, but a minority persist because injected columns leak or puncture holes reopen under portal pressure. The laser acts as a biological top-stitch, welding the entry site and coagulating surface vessels that escape the sclerosant halo.

Bench studies show that a one-second, 10-watt pulse seals a 21-gauge needle tract in porcine oesophagus in under three seconds. Clinical trials mirror those findings.

Benefits of Sclerotherapy Endoscopy

Randomised studies report acute control rates of 90-95% in oesophageal varices, with rebleed rates comparable to ligation when beta-blockade accompanies therapy. Practitioners cite several day-to-day benefits:

Close up of male doctor looking at the tablet, thinking.

Choosing the Right Sclerosant

Matching agent, concentration, and volume to vessel size improves efficacy. It also minimizes complications. Below is a list of sclerosants and their characteristics.

Agent Typical concentration Preferred lesions Key strengths Important caveats
Ethanolamine oleate 5 %
1-2 mL blebs
Oesophageal varices
  • Inexpensive
  • Well-studied
Mild chest pain; transient fever
Sodium tetradecyl sulfate 1-3 %
0.5-1 mL blebs
Small varices
Haemorrhoids
  • Foams easily
  • Low viscosity
Tissue necrosis if extravasated
Polidocanol 1-2 %
1-2 mL lines
Radiation proctitis
AVMs
  • Low pain profile
Multiple sessions often required
N-butyl-2-cyanoacrylate (0.5 mL) + lipiodol
Varices ≥10 mm
Gastric varices
  • Rapid polymerisation
  • Radiopaque
Embolism risk
Inject ≤1 mL per shot

Laser Platforms Suited to the Practice

Most units already house soft-tissue lasers for Barrett’s ablation or airway surgery. The same consoles adapt easily to GI haemostasis when paired with sterilizable 600 µm fibres that pass through 2.8 mm channels.

Platform Wavelength Power range Notable GI features
1064 nm
5-20 W
  • Programmable pulse width
  • Smoke-evac port
1940 nm
2-6 W
  • Very shallow penetration
  • Gentle on thin mucosa

All accept autoclavable 600 µm GI fibres that pass through standard 2.8 mm channels, so no specialty scope is required. Each platform offers foot-pedal control, standby safety interlocks, and integration with existing smoke evacuation.

When to Consider Laser Assistance in Sclerotherapy Endoscopy Treatments

Hybrid therapy is most useful when anatomy or clinical urgency limits band ligation, over-the-scope clipping, or pure chemical injection.

Before detailing indications, clinicians should remember that laser fibres deliver energy forward, so clear visual fields remain essential.

Typical scenarios include:

Patient Selection and Safety

Most candidates mirror those for conventional endoscopic injection sclerotherapy, but the hybrid approach is advantageous when small, tortuous vessels make band capture unreliable.

Absolute contraindications remain uncorrected coagulopathy, allergy to the planned sclerosant, and airway instability that prevents safe endoscopy during active haemorrhage.

Relative cautions include prior extensive banding scars that narrow the lumen, recent oesophageal dilation, and known strictures that could impair fibre manoeuvrability.

Male doctor talking with a patient in the office.

Pre-Procedure Preparation

Endoscopy nurses confirm NPO status, check blood counts, and start proton-pump inhibitors or vasoactive agents when cirrhosis is present. Massive bleeds may need intubation before the procedure begins.

A 21 G injection needle, sclerosant vial, sterile 600 µm fibre, and laser console foot-switch are placed on the procedural cart.

Step-by-Step Laser-Assisted Sclerotherapy Endoscopy

The hybrid sclerotherapy endoscopy procedure sequence adds less than a minute to standard injection times. Most cases proceed under moderate sedation, using midazolam and fentanyl titrated to patient comfort. A typical workflow includes:

Recovery and Aftercare

Successful hemostasis is only the first step. Structured follow-up keeps patients comfortable and catches early recurrences. The post-procedure plan is simple but disciplined, moving from diet advancement to pharmacologic protection and scheduled surveillan

Diet Progression

Pharmacologic Protection

Doctor calming his patient before the endoscopy.

Early Surveillance

Long-Term Monitoring

Complications and Risk Mitigation

Complication patterns resemble those of traditional sclerotherapy but occur less often when laser settings remain conservative.

Event Mitigation strategy
Superficial ulceration
  • Limit laser dwell to ≤30 s per lesion
  • Maintain PPI therapy
Oesophageal stricture
  • Space sessions ≥4 weeks
  • Use power ≤15 W
Deep wall necrosis
  • Keep fibre mobile
  • Cool with 10 mL saline after every three pulses
Cyanoacrylate embolism
  • Mix 1:1 with lipiodol
  • Inject ≤1 mL aliquots
Post-procedure pain
  • Oral analgesia and sucralfate slurry

Training Requirements and Learning Curve

Endoscopists comfortable with standard injection adapt rapidly, but a few new competencies ensure safety and efficacy. Consider the following training components.

Laser-Safety Protocols

Fibre Handling and Preparation

Doctor holding endoscope.

Foot-Pedal Coordination

Integration with Injection Technique

Mentored Proctoring

Ongoing Skill Refinement

Implementing these training steps—eye protection, fibre prep, foot-pedal drills, proctored cases, and log reviews—shortens the learning curve. Within 3-5 hybrid procedures, an experienced injector can deliver laser-assisted sclerotherapy as efficiently as pure injection alone.

Key Takeaway for Surgical Teams and Device Buyers

Laser-assisted sclerotherapy endoscopy blends the deep thrombogenic effect of chemical injection with the immediate surface seal of photocoagulation.

Units already equipped with soft-tissue lasers can adopt this hybrid method quickly, improving hemostasis, lowering re-bleed rates, and reducing total sclerosant exposure without major capital investment.

For GI services seeking a nimble, cost-effective upgrade that complements band ligation and TIPS, hybrid sclerotherapy is an evidence-based option ready for immediate deployment.

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