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Endoscopic and pharmacological secondary prophylaxis in children and adolescents with esophageal varices
Juliana Magalhães Reis dos Santos1, Alexandre Rodrigues Ferreira, Eleonora Druve Tavares Fagundes
1Minas Gerais State Hospital Foundation, João Paulo II Pediatric Hospital, Belo Horizonte, MG, Brazil. julianamreis@hotmail.com
Insights
Endoscopic secondary prophylaxis effectively eradicated esophageal varices in children. Combining it with propranolol showed no significant difference compared to endoscopic treatment alone for preventing upper gastrointestinal bleeding.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Endoscopic Interventions
Background:
- Esophageal varices pose a risk of upper gastrointestinal bleeding (UGIB) in children and adolescents.
- Secondary prophylaxis is crucial for managing this condition and preventing rebleeding.
Purpose of the Study:
- To evaluate the efficacy of endoscopic secondary prophylaxis, with or without propranolol, in preventing UGIB in pediatric patients with esophageal varices.
- To compare outcomes between endoscopic prophylaxis alone and in combination with propranolol.
Main Methods:
- An observational study of 43 pediatric patients (<18 years) receiving secondary prophylaxis between 2001-2009.
- Interventions included endoscopic sclerotherapy and/or band ligation, with propranolol use based on contraindications.
- Evaluated rebleeding rates, variceal eradication, recurrence, fundal varices, and portal hypertensive gastropathy.
Main Results:
- Esophageal varices were eradicated in all patients after a median of 3 endoscopic sessions.
- Varices recurred in 51.2% and rebleeding occurred in 30.2% of patients.
- No significant differences were found between endoscopic prophylaxis with and without propranolol.
Conclusions:
- Secondary prophylaxis via endoscopy is effective for eradicating esophageal varices in children.
- Propranolol did not significantly alter the outcomes of endoscopic prophylaxis.
- Further randomized trials are needed to determine optimal prevention strategies in childhood.
Objective:
The aim of this study was to describe the results of endoscopic secondary prophylaxis, alone or in combination with propranolol, used to prevent upper gastrointestinal bleeding (UGIB) in children and adolescents with esophageal varices.
Methods:
This observational study followed 43 patients younger than 18 years who received secondary prophylaxis between August 2001 and December 2009. Sclerotherapy and/or band ligation were performed, and propranolol was used when no contraindications were present. The rebleeding rate, number of endoscopic sessions required for variceal eradication, rate of varix recurrence, the occurrence of varices at the gastric fundus, and the occurrence of portal hypertensive gastropathy were evaluated.
Results:
Endoscopic prophylaxis in combination with propranolol was performed in 25 patients (58.1%) and endoscopic prophylaxis alone was performed in 18 patients (41.9%). Esophageal varices were eradicated in all of the patients after a median of 3 sessions. Varices recurred in 22 patients (51.2%). Rebleeding occurred in 13 patients (30.2%). Fundal varices and portal hypertensive gastropathy developed in 31% and 61.9% of patients, respectively. No deaths related to the endoscopic procedure or UGIB occurred. No statistically significant differences in any of the studied variables were observed when comparing endoscopic prophylaxis with propranolol and endoscopic prophylaxis alone.
Conclusions:
No significant differences were observed between sclerotherapy and band ligation. Secondary prophylaxis was effective in eradicating esophageal varices. The use of propranolol did not affect the results of the endoscopic prophylaxis. Furthermore, randomized studies will be necessary to assess the best form of prevention during childhood.
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