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Endoscopic sclerotherapy of esophageal varices in infants and children
1Division of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Endoscopic sclerotherapy (EST) effectively controlled bleeding in children with esophageal varices, achieving an avariceal state in 90% of cases. While complications occurred, EST proved a viable treatment for pediatric variceal bleeding.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Hepatology
Background:
- Esophageal varices are a serious complication in children, often linked to extrahepatic portal vein obstruction (EHPVO).
- Bleeding from esophageal varices necessitates urgent and effective management in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic sclerotherapy (EST) for managing bleeding esophageal varices in children.
- To assess complication rates and long-term outcomes following EST in this pediatric cohort.
Main Methods:
- Thirty children with bleeding esophageal varices underwent EST using fiberoptic pediatric endoscopes and sclerosing agents (ethoxysclerol 1%, absolute alcohol).
- Treatments included emergency sessions for active bleeding and planned sessions at 2-3 week intervals, averaging five injections per patient for obliteration.
Main Results:
- EST achieved an avariceal state in 90% of cases; 10% showed reduced varices. Emergency EST was successful in all bleeding episodes.
- Complications included retrosternal discomfort (60%), esophageal ulceration (20%), stricture (20%), and aspiration pneumonia (6.6%), all managed conservatively.
- Recurrence of varices or rebleeding occurred in 10-13.3% of cases, with 13.3% requiring shunt surgery for gastric varices.
Conclusions:
- Endoscopic sclerotherapy is an effective emergency treatment for controlling acute variceal bleeding in children.
- EST is a valuable therapeutic option for pediatric esophageal varices, though careful monitoring for complications and recurrence is essential.
Abstract:
Thirty children, aged 7 months to 13 years, with bleeding esophageal varices were managed by endoscopic sclerotherapy (EST). Of these children, 73.3% had extrahepatic portal vein obstruction (EHPVO), 16.6% had cirrhosis of the liver, and 10% had noncirrhotic portal fibrosis. EST was done with fiberoptic pediatric upper gastrointestinal endoscopes and a flexible sclerotherapy needle under sedation with intravenous diazepam and pentazocine. The sclerosants used were ethoxysclerol 1% and absolute alcohol. Ten injections were given to control active variceal bleeding, and 145 injections were given on planned basis at 2-3-week interval. An average of five injections was required to obliterate the esophageal varices. In 90% of cases, an avariceal state was achieved; 10% had decreased size and number of varices. Emergency EST was effective to control bleeding in all sessions. Complications, including retrosternal discomfort, esophageal ulceration, stricture formation, and aspiration pneumonia, occurred in 60, 20, 20, and 6.6% of cases, respectively; complications were managed conservatively. Strictures were dilated with Eder-Puestow's olive dilators. Recurrence of esophageal varices, gastric varices, and rebleeding was seen in 13.3, 13.3, and 10% of cases, respectively. Shunt surgery was performed in 13.3% cases, who had developed gastric varices and were having EHPVO.
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