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Our experience and review of the literature suggests that perforation follows fiberoptic sclerotherapy at an incidence of 1-6% per patient. Perforation is delayed for 2-14 days after the procedure and is due to chemical necrosis of the esophageal wall. The risk of perforation is higher in Child's class C patients. The use of large volumes or high concentrations of sclerosant may increase the risk of perforation. To reduce this risk, we suggest a cautious approach to Child's class C patients, with no more than two sclerosis sessions during the first 2 weeks of treatment using less than or equal to 10 ml of 1.5% sodium tetradecyl sulfate per session.
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