Endoscopic Sclerotherapy for Varices in Children

Sarin, Shiv Kumar; Misra, Sri Prakash; Singal, Amit; Thorat, Vinay; Broor, S L

doi:10.1097/00005176-198809000-00007

Cited by 41 publications

(33 citation statements)

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“…Opinions on the use of sedation for EIS have long been divided between those who advocate conscious sedation 9,12 and those who prefer general anesthesia with intubation. 2,11 Our own policy is to use general anesthesia for EIS if a child has active bleeding, is uncooperative, or is 6 years or less of age.…”

Section: Discussionmentioning

confidence: 99%

“…The analysis of studies with a mean period of long-term follow-up of 19 months to 8.7 years showed variceal recurrence of 0% to 33% 1,2,9-12 ; however, with the exception of 1 report, 2 others reported further bleeding episodes an uncommon occurrence. 1,[9][10][11][12] Furthermore, most of these cases were successfully managed by a further course of sclerotherapy. These rates of variceal recurrence and rebleeding after initial obliteration are as good or may be better than surgical reports.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: E Xtrahepatic Portal Venous Obstruction (Expvo) Ismentioning

confidence: 99%

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

et al. 2002

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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.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: E Xtrahepatic Portal Venous Obstruction (Expvo) Ismentioning

confidence: 99%

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

et al. 2002

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“…[2][3][4]9,10] Conventional wisdom states that the children with EHPH stop bleeding as they grow up, but there are no long-term data to support this notion. Proponents of the EST state that the bleeding episodes are not life-threatening in children with EHPH; shunts are difficult and have an associated morbidity of a major surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…While in 1960's, surgery was the only option available, late 1980's saw the development of endoscopic sclerotherapy (EST), which totally replaced surgery, [3,4] in 1990's, a renewed interest has been ushered in the portosystemic shunts as a viable option for paediatric EHPH. [5][6][7][8] In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children with extra hepatic portal venous obstruction: Our experience

Kumar

Sharma

Bajpai

et al. 2014

Afr J Paediatr Surg

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Portal-vein obstruction in children leads to growth retardation

et al. 1992

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The portal vein is the main source of blood and hepatotrophic factors to the liver. Partial portal-vein ligation in rats results in reduced growth compared with that in control rats. To investigate whether extrahepatic portal vein obstruction occurring in early childhood influences growth in humans, anthropometric and nutritional assessments were prospectively carried out in 61 patients with extrahepatic portal vein obstruction. Comparisons were made with 183 matched healthy controls using National Center of Health Statistics reference. Fifty-one percent of children with extrahepatic portal vein obstruction had stunted growth (height for age less than 90% of normal), compared with 16% of controls (p less than 0.01). Growth retardation was severe in patients with longer (greater than 5 yr) than with shorter (less than 2.5 yr) duration of clinical portal hypertension (height for age, 88.0 +/- 3.2 vs. 95.1 +/- 3.0; p less than 0.01). Little difference was seen in the energy intake (1,302 +/- 463 kcal/day vs. 1,335 +/- 449 kcal/day; p = not significant) and weight for height index (83.6 +/- 9.3 vs. 88.0 +/- 7.9; p = not significant) between extrahepatic portal vein obstruction patients and controls. This suggested that despite comparable nutrition, marked growth retardation occurred in extrahepatic portal vein obstruction patients. Incremental growth velocity was studied in 31 patients; in 24 (73%) the baseline Z score (-2.1 +/- 0.2) had decreased further (-2.4 +/- 0.2) at the end of follow-up (15.5 +/- 1.6 mo). Although the incremental height velocity was only 56% of the expected height, incremental weight gain was 98% of the expected weight for the attained height.(ABSTRACT TRUNCATED AT 250 WORDS)

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Endoscopic Sclerotherapy for Varices in Children

Cited by 41 publications

References 0 publications

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

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

Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children with extra hepatic portal venous obstruction: Our experience

Portal-vein obstruction in children leads to growth retardation

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