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New method of endoscopic injection sclerosis for esophageal varices using by modified endoscopic hood

ENDOSCOPIC INJECTION SCLEROSIS (EIS) is a therapy for esophageal varices in patients with portal hypertension. However, there are technical difficulties in administering this therapy owing to the moving of target varices and instability of the tip of the endoscope during puncture. A 60-year-old man with esophageal varices was referred to our hospital. He had been treated for cirrhosis caused by hepatitis C infection. Esophagogastroduodenoscopy revealed moderately enlarged varices with red color sign. EIS was performed, and we used our new modified endoscopic hood; we made a 5-mm slit cut with scissors on the soft endoscopic hood (Elastic Touch, F-030; TOP, Tokyo, Japan; Fig. 1A). This endoscopic hood was softened with polyvinyl chloride, therefore, it did not damage the varices and the mucosa of the esophagus or the oral cavity (Video S1). First, we caught the target varix in the slit, and the variceswere certainly holed by a little suction (Fig. 1B andVideo S1). Themovement of the tip of endoscope was stabilized by the hood, therefore, we could maintain a stable condition and easily puncture the target varix by using the 23G puncture needle (TOP; Fig. 1C and Video S1). Five percent ethanolamine oleate (EO) with iopamidol was injected in the varix. We could observe the EO with iopamidol in the intra esophageal varix with radiography (Fig. 1D and Video S1). This procedure was approved by the Hakodate Municipal Hospital Institutional Review Board (#2020-7). Endoscopic ultrasonography-guided injection sclerotherapy has been reported for the esophageal varices, however, this technique is not yet a common method. This new modified endoscopic hood made esophageal EIS easier and safer. In addition, the use of an endoscopic hood with a slit is cost-efficient. We conclude that this new method using an endoscopic hood with slit is a suitable for esophageal EIS. Authors declare no Conflict of interests for this article.