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Endoscopic sclerotherapy in children
J B Dilawari1, Y K Chawla, G N Ramesh
1Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Endoscopic sclerotherapy effectively treated esophageal varices in children with portal hypertension, significantly reducing rebleeding rates. While complications occurred, the procedure proved successful in achieving variceal obliteration.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Endoscopic Procedures
Background:
- Portal hypertension in children often leads to variceal bleeding, a serious complication.
- Extrahepatic portal venous obstruction is a common cause of portal hypertension in pediatric patients.
- Endoscopic sclerotherapy is a potential treatment to manage variceal bleeding.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic sclerotherapy for treating esophageal varices in children.
- To assess the rate of variceal obliteration and rebleeding after sclerotherapy.
- To document major complications associated with the procedure.
Main Methods:
- Thirty-eight children (aged 1-15 years) with portal hypertension and recent variceal bleeding underwent repeated endoscopic sclerotherapy.
- Thirty-six patients had extrahepatic portal venous obstruction.
- The study tracked variceal obliteration, rebleeding rates, and complications.
Main Results:
- Variceal obliteration was achieved in 35 (92%) of the 38 patients.
- An average of 5.3 sclerotherapy sessions were required per patient.
- Major complications, including esophageal perforations and strictures, occurred in seven patients.
- Sclerotherapy significantly reduced rebleeding rates, especially after variceal obliteration.
Conclusions:
- Repeated endoscopic sclerotherapy is an effective treatment for esophageal varices in children with portal hypertension.
- The procedure achieves high rates of variceal obliteration and reduces rebleeding.
- Careful monitoring for complications such as esophageal perforation and stricture is essential.
Abstract:
Thirty-eight children, aged 1-15 years, with portal hypertension and recent variceal bleeding, were treated with repeated endoscopic sclerotherapy. Thirty-six of them had extrahepatic portal venous obstruction. Obliteration of varices was achieved in 35 (92%) patients requiring an average of 5.3 sessions per patient. Major complications occurred in seven patients, three of whom had oesophageal perforations and four had oesophageal stricture. Sclerotherapy significantly reduced the rate of rebleeding after the start of sclerotherapy and more so after variceal obliteration.