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Long-term outcome after sclerotherapy with or without a beta-blocker for variceal bleeding in children
Semra Sökücü1, Ozlem Durmaz Süoglu, Berna Elkabes
1Departmentof Pediatric Gastroenterology and Hepatology, Istanbul School of Medicine and Instituteof Child Health, Istanbul University, Istanbul, Turkey.
Insights
Endoscopic sclerotherapy with propranolol shortened esophageal variceal obliteration time in children. However, further studies are needed to confirm if this combination therapy offers superior long-term benefits for preventing variceal rebleeding.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Therapeutics
Background:
- Esophageal variceal bleeding is a critical complication of portal hypertension in children.
- The optimal strategy for preventing rebleeding after initial treatment remains undetermined.
- This study evaluates long-term efficacy of endoscopic sclerotherapy with or without beta-blockers for secondary prophylaxis.
Purpose of the Study:
- To compare the efficacy of endoscopic sclerotherapy (EST) alone versus EST combined with oral propranolol for secondary prophylaxis of esophageal variceal bleeding in children.
- To assess the impact of propranolol on variceal obliteration rates, time to obliteration, and recurrence rates.
Main Methods:
- Retrospective cohort study of 38 children treated with EST.
- Group 1 (SG): 20 children received only EST.
- Group 2 (SPG): 18 children received EST plus oral propranolol (1-2 mg/kg/day) for 2 years.
Main Results:
- Variceal obliteration was achieved in 80% of the SG group and 88% of the SPG group.
- The time to variceal obliteration was significantly shorter in the SPG group (3.2 months) compared to the SG group (4.1 months).
- Variceal recurrence rates were 65% in SG and 38.8% in SPG, with lower rebleeding rates in the SPG group, though not statistically significant.
Conclusions:
- Combination therapy of EST with oral propranolol significantly shortens the time to variceal obliteration in children.
- Propranolol did not statistically improve other key indicators of treatment effectiveness, such as recurrence or rebleeding rates.
- Larger, randomized prospective studies are necessary to establish the definitive role of combined EST and propranolol in managing pediatric esophageal variceal bleeding.
Background:
Esophageal variceal bleeding is a life-threatening complication of portal hypertension. Optimal treatment for the prophylaxis of variceal rebleeding in children has not yet been determined. In the present study, we aimed to compare the long-term efficacy of endoscopic sclerotherapy with or without oral beta-blocker therapy in the secondary prophylaxis of variceal bleeding.
Methods:
Thirty-eight children who had undergone endoscopic sclerotherapy (EST) sessions for variceal bleeding in the Department of Pediatric Gastroenterology, Istanbul University Istanbul School of Medicine, were entered into this retrospective cohort study. Twenty patients (mean +/- SD age 7.0 +/- 2.7 years) had undergone only sclerotherapy sessions (SG), whereas 18 patients (mean age 6.8 +/- 3.4 years) had received oral propranolol (1-2 mg/kg per day) additionally for 2 years (SPG). The number of patients with successful obliteration, the time required for obliteration and variceal recurrence rate were analyzed as primary indicators of the effectiveness of therapy.
Results:
Variceal obliteration was achieved in 16 of 20 patients (80%) in the SG group and in 16 of 18 patients (88%) in the SPG group. Time required for variceal obliteration was significantly shorter in the SPG group compared with the SG group (4.1 +/- 1.4 vs 3.2 +/- 0.9 months; P < 0.05). The variceal recurrence rate was 65 and 38.8% in the SG and SPG groups, respectively. Compared with the SG group, less variceal rebleeding was observed during EST in the SPG group (25 vs 16.6%, respectively).However, these differences were not statistically significant.
Conclusions:
Endoscopic sclerotherapy combined with oral propranolol treatment shortens the time required for variceal obliteration. However, the other indicators of treatment effectiveness are not influenced statistically by the addition of propranolol to the treatment regimen. Randomized prospective clinical studies in larger pediatric series are needed before offering a combination of EST with oral propranolol as the most rational approach in the secondary treatment of esophageal variceal bleeding in children.
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