الفهرس 
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Abstract
Esophageal varices are the major complication of portal hypertension,they are present in nearly 30% to 40% of patients with compensated cirrhosis and in 60% of those with decompensated cirrhosis .Variceal hemorrhage is perhaps the most devastating portal hypertension-related complication in patients with cirrhosis, occurring in up to 30% of such individuals during the course of their illness. Endoscopic variceal sclerotherapy is an efficient treatment of acute variceal haemorrage,although it has some disadvantages .chest pain is one of the most common reported symptom post variceal sclerotherapy
Lidocaine is used commonly in vascular surgery for relief of post sclerotherapy pain by mixing with the sclerosant. Hundred cihrrotic patients (Child B class) suffering from bleeding esophageal varices have been included in our study and diagnosed and treated in El-Minia endoscopy unit. All of them had been subjected to full history,clinical examination, CBC, liver function tests, ECG, chest X ray and abdominal ultrasonography.
After taking a written consent,the patients were classified into two groups; group I included 50 patients were treated by injection sclerotherapy using lidocaine-ethanolamine oleate mixture while group II included 50 patients were treated by injection sclerotherapy using ethanolamine oleate only. Before sclerotherapy, there was no significant difference between both groups as regard age, sex, pulse, blood pressure, liver function tests and ultrasonographic finding. After sclerotherapy, patients of both groups were assessed for presence and degree of chest pain using NRS and clinical monitoring was done ,and CBC, liver function tests, ECG, chest X ray and abdominal ultrasonography were repeated.
After sclerotherapy, there was significant difference between both groups as regard presence of pain as 8(16%)patients reported pain in group I while 44(88%) patients in group II .Also there was significant reduction of pain score in group I rather than group II.
There was no significant difference between both groups as regard clinical monitoring and no patient developed seizures or confusion.
As regard rebleeding within 5 days it occurred in 2 patients of goup I and 3 patients of group II with no significant difference.
There was no significant difference between post sclerotherapy LFTs in both groups ,also no significant difference between pre and post sclerotherapy LFTs in patients of group I.
As regard abdominal sonographic findings, no significant changes between both groups post sclerotherapy.
Conclusion
Addition of lidocaine to ethanolamine oleate (1:5 dilution) is effective in alleviation of post sclerotherapy chest pain and dilution of ethanolamine by lidocaine dose not affect its efficacy as a sclerosant. Lidocaine dose used in this mixture is safe and dose not produce any adverse effect or manifestation of lidocaine toxicity,also it dose not lead to any deterioration of liver function tests.
Recommendation
More studies needed to be done with larger number of patients and long term follow up for evaluation of repeated use of lidocaine-ethanolamine mixture and its effect on efficacy of variceal eradication ,also to assess effects of repeated use on liver function tests.