Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices

The underwater technique is an important innovation in gastrointestinal endoscopy, which has been used for the treatment of colonic lesions, esophageal, and gastric neoplasms. Endoscopic injection sclerotherapy (EIS) is a safe and effective way to treat and prevent gastroesophageal variceal bleeding (GEVB). However, paravascular submucosal injection may result in the failure of the procedure, bleeding esophageal ulcers, or esophageal stenosis. Esophageal peristalsis is an important problem when the endoscopist injects the sclerosant into the varices. This may cause the needle inside the vein to become unstable and be removed, and the endoscopic vision may become unclear during injection. In our clinical experience, decreased peristalsis of the esophagus can be observed in an underwater environment. To decrease peristalsis of the esophagus and improve the success rate of intravascular injection, we propose a method called underwater endoscopic injection sclerotherapy that requires filling up the esophageal lumen with water before sclerotherapy. A case involving a 57-year-old male patient with gastroesophageal Type 1 varices is described to illustrate the underwater endoscopic injection sclerotherapy.