Endoscopic Treatment of Esophageal Varices: Kitano Method

  • Masayuki OhtaEmail author
  • Masafumi Inomata
  • Seigo Kitano


A technique of endoscopic injection sclerotherapy (EIS) for esophageal varices, which Kitano et al. reported in 1987, consists of the use of an over-tube, a sclerosant of 5% ethanolamine oleate, and 1-week intervals between injections, with the EIS repeated until complete elimination of the lower esophageal mucosa. The technique was validated by several randomized controlled trials (RCTs) that were conducted by a portal hypertension group in the Department of Surgery II, Kyushu University. The results of 2105 cases showed that the cumulative nonbleeding rate was 90% at 15 years. This EIS technique was also compared with surgical procedures through another RCT and was equivalent to the surgical procedures in terms of nonbleeding and survival rates. In addition, the technique was also compared to endoscopic variceal ligation (EVL), and EVL significantly decreased the adverse effects associated with EIS. Although the EIS technique is now only performed in a limited number of institutions, it is safe, long-lasting, and established, and the achievement of favorable results remains excellent even now.


Esophageal varices Endoscopic injection sclerotherapy Eradication Ethanolamine oleate 


  1. 1.
    Crafoord C, Frenckner P. New surgical treatment of varicose veins of the oesophagus. Acta Otolaryngol. 1939;27:422–9.CrossRefGoogle Scholar
  2. 2.
    Johmston GW, Rodgers HW. A review of 15 years’ experience in the use of sclerotherapy in the controls of acute haemorrhage from oesophageal varices. Br J Surg. 1973;33:797–800.CrossRefGoogle Scholar
  3. 3.
    Terblanche J, Northover JM, Bornman P, Kahn D, Silber W, Barbezat GO, et al. A prospective controlled trial of sclerotherapy in the long term management of patients after esophageal variceal bleeding. Surg Gynecol Obstet. 1979;148:323–33.PubMedGoogle Scholar
  4. 4.
    Takase Y, Ozaki A, Oril K, Nagoshi K, Okamura T, Iwasaki Y. Injection sclerotherapy of esophageal varices for patients undergoing emergency and elective surgery. Surgery. 1982;92:474–9.PubMedGoogle Scholar
  5. 5.
    Kitano S, Hashizume M, Yamaga H, Wada H, Sugimachi K. Endoscopic injection sclerotherapy: variants of sclerotherapy technique. J Gastroenterol Hepatol. 1989;4(Suppl 1):171–2.PubMedGoogle Scholar
  6. 6.
    Kitano S, Sugimachi K. A rapid and relatively safer method of sclerosing esophageal varices utilizing a new transparent tube. Am J Surg. 1987;153:317–9.CrossRefGoogle Scholar
  7. 7.
    Kitano S, Koyanagi N, Iso Y, Higashi H, Sugimachi K. Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate. Hepatology. 1987;7:810–5.CrossRefGoogle Scholar
  8. 8.
    Kitano S, Koyanagi N, Iso Y, Iwanaga T, Higashi H, Sugimachi K. Prospective randomized trial comparing two injection techniques for sclerosing oesophageal varices: over-tube and free-hand. Br J Surg. 1987;74:603–6.CrossRefGoogle Scholar
  9. 9.
    Hashizume M, Kitano S, Koyanagi N, Tanoue K, Ohta M, Wada H, et al. Endoscopic injection sclerotherapy for 1,000 patients with esophageal varices: a nine-year prospective study. Hepatology. 1992;15:69–75.CrossRefGoogle Scholar
  10. 10.
    Tomikawa M, Hashizume M, Okita K, Kitano S, Ohta M, Higashi H, et al. Endoscopic injection sclerotherapy in the management of 2105 patients with esophageal varices. Surgery. 2002;131(Suppl 1):S171–5.CrossRefGoogle Scholar
  11. 11.
    Kitano S, Iso Y, Hashizume M, Yamaga H, Koyanagi N, Wada H, et al. Sclerotherapy vs. esophageal transection vs, distal splenorenal shunt for the clinical management of esophageal varices in patients with Child class A and B liver function: a prospective randomized trial. Hepatology. 1992;15:63–8.CrossRefGoogle Scholar
  12. 12.
    Tajiri T, Yoshida H, Obara K, Onji M, Kage M, Kitano S, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc. 2010;22:1–9. Scholar
  13. 13.
    Iso Y, Kitano S, Iwanaga T, Koyanagi N, Sugimachi K. A prospective randomized study comparing the effects of large and small volumes of the sclerosant 5% ethanolamine oleate injected into esophageal varices. Endoscopy. 1988;20:285–8.CrossRefGoogle Scholar
  14. 14.
    Kitano S, Iso Y, Koyanagi N, Higashi H, Sugimachi K. Ethanolamine oleate is superior to polidocanol (aethoxysklerol) for endoscopic injection sclerotherapy of esophageal varices: a prospective randomized trial. Hepatogastroenterology. 1987;34:19–23.PubMedGoogle Scholar
  15. 15.
    Kitano S, Iso Y, Yamaga H, Hashizume M, Higashi H, Sugimachi K. Trial of sclerosing agents in patients with oesophageal varices. Br J Surg. 1988;75:751–3.CrossRefGoogle Scholar
  16. 16.
    Kitano S, Wada H, Yamaga H, Hashizume M, Koyanagi N, Iwanaga T, et al. Comparative effects of 5% ethanolamine oleate versus 5% sodium morrhuate for sclerotherapy of oesophageal varices. J Gastroenterol Hepatol. 1991;6:476–80.CrossRefGoogle Scholar
  17. 17.
    Higashi H, Kitano S, Hashizume M, Yamaga H, Sugimachi K. A prospective randomized trial of schedules for sclerosing esophageal varices. 1- versus 2-week intervals. Hepatogastroenterology. 1989;36:337–40.PubMedGoogle Scholar
  18. 18.
    Hashizume M, Kitano S, Yamaga H, Sugimachi K. Haptoglobin protect against renal damage from ethanolamine oleate sclerosant. Lancet. 1988;2:340–1.CrossRefGoogle Scholar
  19. 19.
    Miyoshi H, Ohshiba S, Matsumoto A, Takada K, Umegaki E, Hirata I. Haptoglobin prevents renal dysfunction associated with intravariceal infusion of ethanolamine oleate. Am J Gastroenterol. 1991;86:1638–41.PubMedGoogle Scholar
  20. 20.
    Wada H, Hashizume M, Yamaga H, Kitano S, Sugimachi K. Hemodynamic and morphological changes in the dog kidney after injection of 5% ethanolamine oleate into the superior vena cava. Eur Surg Res. 1990;22:63–70.CrossRefGoogle Scholar
  21. 21.
    Ohta M, Hashizume M, Ueno K, Tanoue K, Sugimachi K. Albumin inhibits hemolysis of erythrocytes induced by ethanolamine oleate during endoscopic injection sclerotherapy. Hepatogastroenterology. 1993;40:65–8.PubMedGoogle Scholar
  22. 22.
    Kishihara F, Ohta M, Hashizume M, Tomikawa M, Kawanaka H, Tanoue K, et al. Systemic effects of ethanolamine oleate in analbuminemic rats. Hepatogastroenterology. 1999;46:376–80.PubMedGoogle Scholar
  23. 23.
    Stiegmann VG, Goff JS. Endoscopic esophageal varix ligation: preliminary clinical experience. Gastrointest Endosc. 1988;34:113–7.CrossRefGoogle Scholar
  24. 24.
    Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med. 1995;123:280–7.CrossRefGoogle Scholar
  25. 25.
    Hashizume M, Ohta M, Ueno K, Tanoue K, Kitano S, Sugimachi K. Endoscopic ligation of esophageal varices compared with injection sclerotherapy: a prospective randomized trial. Gastrointest Endosc. 1993;39:123–6.CrossRefGoogle Scholar
  26. 26.
    Hashizume M, Ohta M, Kawanaka H, Kishihara F, Sugimachi K. Recurrence rate of oesophageal varices with endoscopic banding ligation followed by injection sclerotherapy. Lancet. 1994;344:1643.CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
  2. 2.Oita UniversityOitaJapan

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