Use of a transparent cap with a slit facilitates endoscopic injection sclerotherapy of esophageal varices.

Prophylactic treatment for bleeding is indicated for esophageal varices if the varices are F2 or greater, or if the red-color sign is positive [1] [2]. In Japan, endoscopic treatment is the first choice of treatment for bleeding esophageal varices. Endoscopic injection sclerotherapy (EIS) includes the “EO method,” where 5 % ethanolamine oleate (EO) is injected intravascularly, and the “AS method,” where 1 % aethoxysklerol is injected extravascularly. The EO method involves endoscopic varicealography during injection sclerotherapy, with the esophageal varices and their supply tracts being occluded under fluoroscopic guidance; however, endoscopic puncture of esophageal varices and the holding of the needle tip in the blood vessel require advanced techniques. Thin varices are difficult to puncture and, even after they are punctured successfully, respiratory fluctuations, esophageal peristalsis, and the patient’s body movements can dislodge the needle. Therefore, we developed a transparent cap with a slit to facilitate puncture and needle fixation in this situation ([Fig. 1]).