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Pediatric gastroesophageal varices: treatment strategy and long-term results

Tetsuya Mitsunaga1, Hideo Yoshida, Katsunori Kouchi

  • 1Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. tetsuya@z.email.ne.jp

Journal of Pediatric Surgery
|December 13, 2006
PubMed

Insights

Endoscopic variceal clipping (EVC) effectively prevented gastroesophageal varices progression in children. However, gastric varices require attention, and endoscopic variceal ligation (EVL) combined with EVC offers a comprehensive treatment approach.

Area of Science:

  • Pediatric Gastroenterology
  • Endoscopic Interventions
  • Hepatology

Background:

  • Gastroesophageal varices are a significant complication in children.
  • Various endoscopic treatment modalities exist, including EVC and EVL.

Purpose of the Study:

  • To evaluate the therapeutic efficacy of endoscopic variceal clipping (EVC) and endoscopic variceal ligation (EVL) for gastroesophageal varices in pediatric patients.
  • To compare the effectiveness of EVC and EVL in preventing variceal progression and managing bleeding.

Main Methods:

  • Retrospective analysis of 499 endoscopic examinations from 1991 to 2005.
  • Prophylactic EVC was administered for F2/F3 varices with red color signs.
  • Combined EVC and EVL were employed for variceal rupture cases.

Main Results:

  • Prophylactic EVC prevented variceal progression in 89.9% of cases.
  • EVL was effective in arresting massive bleeding in 4 emergent procedures.
  • Five patients experienced bleeding from gastric fundal varices post-treatment, indicating a need for gastric varix management.

Conclusions:

  • Routine EVC provides satisfactory control of gastroesophageal varices in children.
  • Gastric fundal varices pose a challenge and require specific management strategies.
  • EVL is effective for ruptured varices, and its limitations in treating gastric varices can be addressed by combining it with EVC.
Abstract

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