Endoscopic Injection Sclerotherapy with Pre-deflation Ligation for Prolonged Sclerosant Retention in Esophageal Varices: A Case Report.

Esophageal varices are a common complication of portal hypertension, and prophylactic endoscopic injection sclerotherapy with ligation (EISL) is an established treatment option. Effective variceal thrombosis requires sufficient intravariceal retention of the sclerosant, because ethanolamine oleate exerts its thrombogenic effect through prolonged contact with the venous endothelium. In conventional EISL, endoscopic variceal ligation (EVL) is performed after balloon deflation, leaving a transient interval during which restored blood flow and an open puncture site may permit washout of the sclerosant and bleeding. We describe EIS with pre-deflation ligation (EISpdL), in which EVL of the puncture site is completed while the endoscope balloon remains inflated, and balloon compression is maintained throughout the retention period. A 59-year-old man with medium-sized esophageal varices with a positive red color sign (F2, RC1) secondary to metabolic dysfunction-associated steatohepatitis underwent EISpdL combined with gel-immersion EIS. The procedure was technically feasible, required no additional skills beyond conventional EISL, and no immediate procedure-related adverse events were observed. Follow-up endoscopy on post-procedure day 7 showed bronze-colored variceal changes indicating thrombosis, and contrast-enhanced computed tomography two months later confirmed obliteration. EISpdL may enable more stable and prolonged sclerosant retention.