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Updated: May 3, 2026
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
Experiences with endoscopic interventions for variceal bleeding in children with portal hypertension: a single center
Seung Jin Kim1, Seak Hee Oh1, Jin Min Jo1
1Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Band ligation and injection sclerotherapy show similar effectiveness in controlling acute variceal bleeding and preventing rebleeding in children. Both endoscopic treatments offer comparable success rates for esophageal varices management.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Interventions
- Hepatology
Background:
- Esophageal varices are a serious complication in children, often linked to biliary atresia.
- Variceal bleeding necessitates prompt and effective endoscopic management.
- Endoscopic band ligation and injection sclerotherapy are primary treatment options.
Purpose of the Study:
- To compare the efficacy and safety of band ligation versus injection sclerotherapy for pediatric variceal bleeding.
- To evaluate initial success rates and duration of hemostasis.
- To assess rebleeding rates and procedural complications.
Main Methods:
- Retrospective analysis of 55 children with esophageal varices and bleeding.
- Comparison of outcomes between band ligation (39 patients) and injection sclerotherapy (16 patients).
- Primary endpoints: initial hemostasis, duration of hemostasis, rebleeding, and complications.
Main Results:
- Initial hemostasis success rates were high for both: 89.7% for band ligation and 87.5% for injection sclerotherapy.
- One-year rebleeding rates were comparable: 48.7% for band ligation and 43.8% for injection sclerotherapy.
- Complication rates were 10.3% for band ligation and 18.8% for injection sclerotherapy.
Conclusions:
- Band ligation and injection sclerotherapy demonstrate equivalent efficacy in controlling acute variceal bleeding in children.
- Both methods are similarly effective in preventing rebleeding episodes.
- These endoscopic treatments represent safe and efficient options for managing pediatric esophageal varices.
Purpose:
The aim of this study was to compare the efficacy and safety of band ligation and injection sclerotherapy in the endoscopic treatment of children with variceal bleeding.
Methods:
The study population included 55 children, all of whom were treated at the time of endoscopic diagnosis of esophageal varices at Asan Medical Center, Seoul, Korea, between January 1994 and January 2011. The primary outcomes included initial success rates and duration of hemostasis after endoscopic management (band ligation vs. injectionsclerotherapy).
Results:
The mean age was 6.7±5.2 years and the mean follow-up time was 5.4±3.7 years. The most common cause of esophageal varices was biliary atresia. Of 55 children with acute variceal bleeding, 39 had band ligation and 16 had injection sclerotherapy. No differences between groups were observed in terms of the size, location, and presence of red color sign. The success rates of band ligation and sclerotherapy in the control of acute bleeding episodes were 89.7% and 87.5%. The mean duration of hemostasis after endoscopic intervention was 13.2±25.1 months. After one year, 19 of 39 patients (48.7%) treated with band ligation and 7 of 16 patients (43.8%) with injection sclerotherapy had experienced rebleeding episodes. Complications after the procedures were observed in 10.3% and 18.8% of children treated with band ligation and injection sclerotherapy.
Conclusion:
The results of our current study suggest that band ligation and injection sclerotherapy are equally efficient treatments for the control of acute variceal bleeding and prevention of rebleeding.
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