1- The patient history is a crucial issue and also clinical examination when the patient came with upper GI bleeding, and there was a history of a chronic liver disease, you should pay attention to variceaL bleeding.
2- A good wash of the fundus of the stomach during endoscopy to remove food remnants and blood to good delighted the fundus and not to miss varices
3- To confirm it is a fundal varices and not other lesions, e.g., tumor, you should guess (palpate) the varices with closed forceps or maybe with the shealth of the injector( it yields with palpation)
4- Check the needle (blade) of your injector before introducing it in the endoscopy channel
5- it is better to insert the injector into the endoscopy channel when the endoscopy is straight( in the antral region before you make a reflexion into the fundus.WHY, sometimes when you insert it when the endoscope in the fundus, it is difficult to appear from the endoscopy tip especially when the endoscope channel is narrow
6- Inject 1 to 1.5 cm of distilled water in varices, why
A- It gives you an idea that your injector is appropriately fixed into the varices.
B- It opens the variceal space giving an easy method for the glue injection.
7-After injection of the glue( amacryl and lipidol), you should check the fundal varices again with the injector shealth to confirm that it is properly secured( become firm to hard with palpation
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