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Endoscopic sclerotherapy in children with extrahepatic portal venous obstruction
V Patraval1, P Rathi, P Sawant
1Department of Gastroenterology, L.T. Municipal Medical College & L. T. Municipal General Hospital, Sion, Mumbai-400 022.
Insights
Extrahepatic portal vein obstruction (EHPVO) is a common cause of gastrointestinal bleeding in Indian children. Endoscopic sclerotherapy (EST) effectively controls bleeding and is safe for treating children with EHPVO.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Endoscopic Interventions
Background:
- Extrahepatic portal vein obstruction (EHPVO) is a prevalent cause of variceal bleeding in pediatric populations in India.
- Limited data exists on the efficacy of endoscopic sclerotherapy (EST) for managing EHPVO in children.
Purpose of the Study:
- To evaluate the safety and effectiveness of endoscopic sclerotherapy (EST) in treating children diagnosed with Extrahepatic portal vein obstruction (EHPVO).
- To assess the outcomes of EST in controlling esophageal variceal bleeding in pediatric patients with EHPVO.
Main Methods:
- A cohort of 59 children (mean age 11 years) diagnosed with EHPVO underwent endoscopic sclerotherapy (EST).
- Treatment involved weekly sessions for three weeks, followed by three-weekly intervals until variceal thrombosis was achieved.
- Patients were monitored with follow-up endoscopies every 3-6 months post-treatment.
Main Results:
- Complete or near-complete thrombosis of esophageal varices was achieved in 89.8% of children after a mean of 7.5 EST sessions.
- Rebleeding occurred in 35.6% of patients, with 28.8% bleeding during and 6.8% after thrombosis.
- Gastric varices were common (60%), and bleeding from gastric varices occurred in 9% of cases. Ascites developed in 10.6%.
Conclusions:
- Extrahepatic portal vein obstruction (EHPVO) is a significant cause of upper gastrointestinal bleeding in children in Western India.
- Endoscopic sclerotherapy (EST) is a safe and effective treatment modality for controlling esophageal variceal bleeding in pediatric EHPVO patients.
Background:
Extrahepatic portal vein obstruction (EHPVO) is a common cause of variceal bleeding in children in India. There is paucity of data regarding the results of treatment with endoscopic sclerotherapy.
Methods:
Fifty-nine children (mean age 11 +/- 3.8 years; range 7 months to 12 years; 36 males and 23 females) were studied from February 1990 to September 1999. EHPVO was diagnosed on the basis of portal cavernoma on ultrasonography in 55 patients and on splenoportovenogram in 4 patients. Endoscopic sclerotherapy was caried out at weekly intervals for the first three weeks and at 3 weekly intervals thereafter till complete or near complete thrombosis was achieved. All patients were followed up with check endoscopy every 3-6 months after thrombosis of oesophageal varices.
Results:
Over a mean follow up of 25.4 months (range 3 to 87 months) total thrombosis was achieved in 53 (89.8%) of 59 children. The mean number of sclerotherapy sessions required were 7.5 +/- 2.2. The mean number of blood transfusions required per bleeding episode was 3.8 +/- 3.2. Of the 59 children 21 (35.6%) rebled, of which 17 (28.8%) bled during and 4(6.8) after thrombosis of varices. Seven (11.9%) children had more than one episode of bleeding. Once thrombosis of the varices was achieved 15 (26%) of 59 children developed fresh varices on follow up. Gastric varices were detected in 47 (60%) children. In 39 (66%) children it was present at the onset and in 8 (13.5%) children it developed after thrombosis of oesophageal varices. Bleeding from gastric varix occurred in 7(9%) children. Ascites developed in 6(10.6%) children. One child developed oesophageal stricture. There were 3 (5%) deaths. Two died due to upper gastrointestinal bleed while on sclerotherapy schedule and one died due to cerebral abscess.
Conclusion:
EHPVO is an important and common cause of upper gastrointestinal bleeding in children in Western India. EST is safe and useful in controlling oesophageal variceal bleeding in children.