Related Experiment Videos
Patient and procedure variables associated with complications following variceal sclerotherapy in children
R Proujansky1, S R Orenstein, S A Kocoshis
1Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pennsylvania.
Insights
Pediatric variceal sclerotherapy is safe when specific patient and procedure variables are monitored. Careful attention to weight, platelet count, and sclerosant dosage minimizes early and late complications in children.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Sclerotherapy
Background:
- Variceal sclerotherapy is used in pediatric patients, but optimal techniques and sclerosant dosages lack standardization.
- Empirical recommendations exist, necessitating a review of clinical experience to identify complication predictors.
Purpose of the Study:
- To identify patient and procedural variables associated with early and late complications of variceal sclerotherapy in children.
- To establish safer sclerotherapy guidelines for pediatric patients.
Main Methods:
- Retrospective review of 150 sclerotherapy sessions in 37 pediatric patients (ages 1-18).
- Analysis of patient demographics, sclerosant dosages, and procedural details to correlate with complication occurrence.
Main Results:
- 12 early complications (bleeding, respiratory issues, false channel, hematuria) occurred in 11 patients.
- Four patients developed strictures; increased sessions (>6) correlated with stricture formation.
- Complication predictors identified: low platelet count (<100,000/mm3) for bleeding; weight (<12 kg) for respiratory issues/false channels; high sclerosant dose (>1.75 ml/kg or >20 ml total) for false channels/hematuria.
Conclusions:
- Variceal sclerotherapy can be performed safely in children with careful monitoring.
- Patients <12 kg, with low platelets, or receiving high sclerosant doses require vigilant observation for potential complications.
Abstract:
Variceal sclerotherapy has been performed in the pediatric population, but techniques and dosages of sclerosant recommended in the literature are largely empirical. Having accumulated much data through experience with sclerotherapy in children, we have identified patient and procedure variables associated with early and late complications. We reviewed our experience with 37 pediatric patients, ages 1-18, who underwent 150 sclerotherapy sessions. Sclerotherapy was associated with 12 early complications in 11 patients. Early complications were bleeding (five), respiratory problems (three), false channel formation (two), and gross hematuria (two). Four patients developed strictures. We identified the following variables associated with complications: for bleeding, platelet count less than 100,000/mm3; for respiratory complications and false channel formation, weight less than 12 kg; for false channel formation, dosage of sclerosant/kg/session greater than 1.75 ml/kg; for gross hematuria, total sclerosant/session greater than 20 ml. A need for more than six sclerotherapy sessions for obliteration of varices was associated with a greater frequency of stricture formation. Sclerotherapy can be performed safely in children. Patients less than 12 kg or with platelet counts less than 100,000/mm3 should be monitored carefully for respiratory complications and postprocedure bleeding. Sclerosant dosages greater than 1.75 ml/kg, or 20 ml total sclerosant, should be given with caution.