Doxycycline sclerotherapy in children with lymphatic malformations: outcomes, complications and clinical efficacy

Shergill, Arvind K; John, Philip; Amaral, João

doi:10.1007/s00247-012-2406-2

Cited by 77 publications

(61 citation statements)

References 28 publications

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“…6 Sclerotherapy has emerged as a promising alternative to surgery for the treatment of LMs in children during the past 30 years. Agents used include bleomycin, 7,8 alcoholic solution of zein (Ethibloc), 9,10 interferon α2a, 11 hypertonic saline solution, 12 fibrin sealant, 13 1% polidocanol, 14 acetic acid, 15 ethanol, 16 doxycycline, [17][18][19][20][21] and OK432. 2,3,[22][23][24][25][26][27][28] Although bleo mycin may be useful for treating microcystic lesions, 29 it has fallen out of favor for treating macrocystic LMs because of its risk of pulmonary fibrosis, since alternative agents are available.…”

Section: Introductionmentioning

confidence: 99%

“…This difference is likely attributable to inherent differences in the agents themselves, and not to our practice of leaving OK432 in the cyst, as most institutions that do not aspirate doxycycline still do not report marked postoperative swelling. 18,20,21,36 Despite parental counseling about this early and short-lived side effect, 2 patients in the OK432 group required readmission for analgesia and hydration. Serious adverse events that required hospitalization have been reported for both OK432 22,25,26,28 and doxycycline sclerotherapy, 20,21 but in our series only patients in the OK432 group required readmission.…”

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confidence: 99%

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OK432 Versus Doxycycline for Treatment of Macrocystic Lymphatic Malformations

Motz

Nickley

Bedwell

et al. 2014

Ann Otol Rhinol Laryngol

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Objectives: A variety of sclerotherapy agents are used to treat macrocystic lymphatic malformations (LMs). This retrospective study at a single institution was performed to compare the outcomes of pediatric macrocystic LMs of the head and neck that were treated with doxycycline or with OK432. Methods:The outcomes measured included early response to therapy, number of treatments required, operating room time, and adverse events. Results:The rates of clinical success for OK432 and doxycycline were similar (83% and 82%, respectively; p > 0.05), although OK432-treated patients required more treatments than did doxycycline-treated patients (1.9 versus 1.0 injections; p = 0.01; 95% confidence interval, 1.57 to 0.27). The average operating room time for a single OK432 injection was significantly shorter than that for doxycycline (53.2 versus 98.1 minutes; p < 0.001); however, when the total number of treatments administered was considered, the overall times in the operating room were similar. Adverse events in the early postoperative period were more common in OK432-treated patients, who experienced marked postoperative swelling compared to doxycycline-treated patients.Conclusions: OK432 and doxycycline are both effective sclerosants for the treatment of predominantly macrocystic LMs. The administration time for OK432 is shorter than that for doxycycline, but OK432 required more treatments overall to achieve clinical success. Early adverse events were more common in OK432-treated patients, but longer follow-up is necessary to determine whether rates of recurrence and adverse events are similar, particularly in light of the risk of tooth discoloration in doxycycline-treated patients.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

OK432 Versus Doxycycline for Treatment of Macrocystic Lymphatic Malformations

Motz

Nickley

Bedwell

et al. 2014

Ann Otol Rhinol Laryngol

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“…They occur most commonly within the head and neck but are rare in the orbit 4. Histologically, LMs consist of cystic dilatation of lymphatic channels lined by vascular endothelium; they contain proteinaceous fluid 6. They are thought to be a result of erroneous embryogenesis 5.…”

Section: Discussionmentioning

confidence: 99%

Sclerotherapy treatment of orbital lymphatic malformations: a large single-centre experience

et al. 2015

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“…Percutaneous injection of lyophilized group A Streptococcus pyogenes OK432 and doxycycline has been successful in the treatment of large, nonresectable lymphangiomas in children. 1,11 MLMs have been reported to regress prenatally. 12 The same study also suggested that neonatal patients with symptoms require surgery, whereas those without symptoms can be observed.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric Lymphatic Malformations in Children: Report of 7 Cases

Shironomae

Kohno

Yasui

et al. 2017

International Surgery

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Abstract:Introduction Mesenteric lymphatic malformations (MLMs) are rare, the most common etiology being benign proliferation of ectopic lymphatics in the mesentery, with these lymphatics lacking communication with the remainder of the lymphatic system. Case presentation The medical records of seven patients treated for MLMs at our center between 2001 and 2015 were reviewed. The seven patients included four boys and three girls of median age 96 months (range 4-161 months). The main symptoms were abdominal pain in five patients, fever in two, and vomiting in two. Four of the five patients with abdominal pain had elevated inflammatory reactions. Five patients had abdominal masses, and two had asymptomatic abdominal masses incidentally diagnosed during infant health checkups. Of the four patients with elevated inflammatory reactions, two required emergency surgery and the other two underwent surgery after antibiotic treatment. MLMs were located in the jejunal mesentery of three patients, in the ileal mesentery in three, and in the transverse mesocolon in one. Surgical procedures included excision of the MLMs and adjacent segment of the intestine in four patients and cystectomy in three. No patient experienced recurrence of MLM.Conclusions Clinical features of MLMs can vary from asymptomatic to acute abdominal pain and may affect adjacent organs. MLM should be treated surgically before it can cause serious complications.

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Doxycycline sclerotherapy in children with lymphatic malformations: outcomes, complications and clinical efficacy

Abstract: Doxycycline is a safe and effective sclerosant agent for treating LMs in children, with a low complication rate.

Cited by 77 publications

References 28 publications

OK432 Versus Doxycycline for Treatment of Macrocystic Lymphatic Malformations

OK432 Versus Doxycycline for Treatment of Macrocystic Lymphatic Malformations

Sclerotherapy treatment of orbital lymphatic malformations: a large single-centre experience

Mesenteric Lymphatic Malformations in Children: Report of 7 Cases

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