Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices

Abstract

A total of 152 consecutive children with oesophageal varices have been endoscopically reviewed since 1979. In all, 108 of these children presented with variceal bleeding which was managed by injection sclerotherapy. Variceal obliteration was achieved in 33 (92 per cent) children with extrahepatic portal hypertension and 54 (75 per cent) with intrahepatic portal hypertension. Prophylactic injection sclerotherapy was used to obliterate large varices in 11 children with no history of haemorrhage. Bleeding episodes occurred in 38 (39 per cent) children before variceal obliteration was complete. However, the mortality rate from variceal bleeding was only 1 per cent. Complications were oesophageal ulceration (29 per cent) and stricture (16 per cent) which both resolved with conservative management. During a mean follow-up period of 2.9 years after sclerotherapy, recurrent oesophageal or gastric varices developed in 12 (12 per cent) cases, with rebleeding in 9 (9 per cent), but all responded successfully to a second course of treatment. These results are superior to contemporary surgical management and injection sclerotherapy should therefore currently be the primary treatment of choice for bleeding oesophageal varices in children.

Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction

“…1,2,[9][10][11][12] The percentage of patients (4.2%) who developed esophageal stricture in our EIS group is lower than reported (6% to 16%) in other studies of EXPVO treated by EIS. 1,2,[9][10][11][12] The relatively lower incidence of stricture in our study may be related to the use of primarily intravariceal injec- tion, smaller volume of the sclerosant used, and routine use of sucralfate gel or pantoprazole after endoscopic treatment.…”

“…1,2 Bleeding from the esophageal varices is the most common presenting feature of EXPVO and is associated with significant morbidity. 1,3,4 Although optimal treatment for these patients is a matter of controversy, current therapeutic options include a variety of surgical procedures [5][6][7][8] or endoscopic injection sclerotherapy (EIS).…”

“…1,3,4 Although optimal treatment for these patients is a matter of controversy, current therapeutic options include a variety of surgical procedures [5][6][7][8] or endoscopic injection sclerotherapy (EIS). 1,2,[9][10][11][12] Although EIS provides an effective treatment for esophageal varices, there is potential for improvement because sclerotherapy is associated with substantial complications, including rebleeding at a rate of 20% to 30% and sclerosant-induced esophageal injury that may cause ulceration, bleeding, perforation, or stricture formation. 1,2,9-11 Consequently, endoscopic variceal ligation (EVL) was developed by Stiegmann and Goff 13 as an alternative to EIS for the treatment of esophageal varices in adults.…”

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

“…The spectrum also varies from country to country. In the West, intrahepatic causes of portal hypertension are common in children, whereas in the East, portal hypertension in children is mainly due to extrahepatic portal venous obstruction [96][97][98][99][100][101][102][103]. Endoscopic screening is still the best option in children for detecting varices.…”

“…No wellestablished approaches exist for preprimary and early primary prophylaxis in children. At present, only a few studies have been reported on primary prophylaxis of variceal bleeding in children [101][102][103][104][105][106]. In one retrospective study, propanolol was used in children with portal hypertension for prevention of variceal bleeding [106].…”