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

Abstract

Endoscopic sclerotherapy is an effective treatment for bleeding esophageal varices, but it is associated with significant complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, has been shown to be superior to sclerotherapy in adult patients with cirrhosis. To determine the efficacy and safety of endoscopic sclerotherapy and ligation, the 2 methods were compared in a randomized control trial in 49 children with extrahepatic portal venous obstruction who had proven bleeding from esophageal varices. Twenty-four patients were treated with sclerotherapy and 25 with band ligation. No significant differences were found between the sclerotherapy and ligation groups in arresting active index bleeding (100% each) and achieving variceal eradication (91.7% vs. 96%, P ‫؍‬ .61). Band ligation eradicated varices in fewer endoscopic sessions than did sclerotherapy (3.9 ؎ 1.1 vs. 6.1 ؎ 1.7, respectively, P < .0001). The rebleeding rate was significantly higher in the sclerotherapy group (25% vs. 4%, P ‫؍‬ .049), as was the rate of major complications (25% vs. 4%, P ‫؍‬ .049). After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy (17.4% vs. 10%, P ‫؍‬ .67). In conclusion, variceal band ligation in children is a safe and effective technique that achieves variceal eradication more quickly, with a lower rebleeding rate and fewer complications compared with sclerotherapy. (HEPATOLOGY 2002;36:666-672.)

Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous obstruction: Benefit of injection tract embolisation

“…The largest contributor to intrahepatic portal hypertension was biliary atresia, which ultimately necessitated LT. Sclerotherapy was used to 'buy time' while awaiting LT, enabling 11/30 children to undergo LT. Endoscopic variceal band ligation has been shown to be superior due to fewer complications, 13,14 but its use in children aged <3 years remains technically difficult due to the diameter of the smallest band applicator. As in our scenario, where 53.3% of intrahepatic disease patients and 41.4% with EHPVO presented with variceal bleeding were aged <3 years, sclerotherapy and octreotide have to be used as a first treatment option and subsequently sclerotherapy alone in controlling variceal bleeding while awaiting LT or an appropriate shunt procedure in EHPVO.…”

“…Endoscopic variceal band ligation is safer than sclerotherapy, but the diameter of the band applicator makes it impossible to insert the applicator into the small oesophagus of children aged <3 years. 7 Coupled with the success and increased availability of liver transplantation (LT), the successful management of bleeding oesophageal varices in these children is required in preparation for LT or other appropriate surgery.…”

Modern Methods of Endoscopic Diagnostics and Treatment for Upper Gastrointestinal Tract Diseases in Pediatrics

“…4). Перевязка-лигация варикозного расширения вен у паци-ентов с массой тела более 10 кг заменила проведение склеротерапии взрослым эндоскопом [23,24].…”

Extra Hepatic Portal Venous Obstruction in Children

“…However, the additional cost of banding is a constraint, especially in developing countries. The limited experience of EVL in children suggests its superiority over EST (Zargar, 2002).…”