Band Ligation Plus Sclerotherapy Versus Sclerotherapy Alone in Children With Extrahepatic Portal Venous Obstruction

Abstract

Although endoscopic band ligation (EVL) plus sclerotherapy (EST) has shown to be superior to any individual method, there is no study in children. We therefore analyzed our experience of EST and EVL + EST in children with extrahepatic portal venous obstruction (EHPVO). Over a period of 8 years, 136 children who presented with a history of recent variceal bleeding due to EHPVO were studied; 30 of them received EVL + EST and 106 received EST alone. In the EVL + EST group, after the first session of EVL, EST was done three times weekly until variceal eradication was achieved. The mean age of these children was 7 +/- 3.6 years with a male-to-female ratio of 2.6:1. The rate of eradication was comparable in both groups (100% in EVL + EST and 96% in EST). However, EVL + EST group required a significantly fewer sessions and lower volume of sclerosant (2 +/- 1 vs. 4.4 +/- 2 sessions, P < 0.001 and 3.1 +/- 2 mL versus 7.5 +/- 4 mL, P < 0.001 respectively). There were significantly less complications in EVL + EST group (10% vs. 36%, P < 0.01). Over a mean follow-up of 27 months, varices recurred in 6.6% and 10% cases, respectively. EVL + EST is a better method in the treatment of esophageal varices in children with EHPVO than EST alone, as it required fewer session and had fewer complication.

Portal Vein Thrombosis

“…150,151 Band ligation plus sclerotherapy is considered to be better in treating children with chronic PVT than EST alone as it required fewer sessions and fewer complications. 152 Our study has shown that variceal obliteration following endoscopic sclerotherapy opens up spontaneous shunts due to a possible increase in portal pressure in 40% of patients, which in turn protects these patients from further bleeds and recurrence of varices. 153 Patients with chronic portosystemic venous thrombosis have an acceptable long term outcome with 1 and 5 year survival rates of 85.7% and 82.1% respectively.…”

Interventional upper endoscopy: The pediatric perspective

“…Despite the benefits of EVL, risk of variceal recurrence is higher, due to the difficulty of ligating smaller varices in children [8]. Adult studies have shown that EVL followed by low-dose EST is superior to EVL or EST alone, with few variceal recurrences likely due to obliteration of perforating veins and paraesophageal collaterals with EST [8][9][10]. Poddar et al [8] reported their study, the first such study in children, in which they compared combination therapy with sclerotherapy alone.…”

“…However, band ligation eradicated varices in a significantly shorter time, with fewer treatment sessions, a lower rebleeding rate, and fewer complications when compared with injection sclerotherapy. Despite the benefits of EVL, risk of variceal recurrence is higher, due to the difficulty of ligating smaller varices in children [8]. Adult studies have shown that EVL followed by low-dose EST is superior to EVL or EST alone, with few variceal recurrences likely due to obliteration of perforating veins and paraesophageal collaterals with EST [8][9][10].…”

Extra Hepatic Portal Venous Obstruction in Children

“…It reduces the sessions required, complications associated with large-dose EST for initial variceal eradication and the risk of variceal recurrence. Two studies from India supported this combination intervention (Poddar, 2005; Poddar, 2011).…”