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Sclerotherapy for extrahepatic portal hypertension in childhood
E Hassall1, W E Berquist, M E Ament
1Division of Pediatric Gastroenterology, University of British Columbia, Vancouver, Canada.
Insights
Sclerotherapy effectively treats esophageal varices in children with extrahepatic portal hypertension, significantly reducing recurrent bleeding. This endoscopic treatment offers a safe and effective option for managing gastrointestinal bleeding in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Endoscopic Interventions
Background:
- Extrahepatic portal hypertension (EHPHT) in children often leads to severe gastrointestinal bleeding from esophageal varices.
- Previous treatments for variceal bleeding include surgery and medications like propranolol, with varying success rates.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic esophageal variceal sclerotherapy in pediatric patients with EHPHT.
- To assess the long-term outcomes and complication rates associated with this treatment modality.
Main Methods:
- Ten children with EHPHT and major esophageal variceal bleeding underwent sclerotherapy using flexible fiberoptic endoscopy under intravenous sedation.
- Patients were monitored for 1.4 to 7.1 years (mean 4.7 years) post-treatment.
Main Results:
- Only two patients experienced re-bleeding from esophageal varices during the follow-up period.
- Complications were minimal and easily managed; no child bled from gastric varices.
- Sclerotherapy sessions and sclerosant quantity decreased over time, suggesting accelerated natural history of reduced bleeding.
Conclusions:
- Endoscopic esophageal variceal sclerotherapy is a safe and effective treatment for preventing chronic and recurrent gastrointestinal bleeding in children with EHPHT.
- Sclerotherapy may accelerate the natural tendency for decreased bleeding over time in EHPHT patients.
Abstract:
Ten children with extrahepatic portal hypertension who had major bleeding from esophageal varices were treated with sclerotherapy of esophageal varices by means of flexible fiberoptic endoscopy and intravenous sedation. Four had had no previous therapy, five had had previous surgery for variceal bleeding, and five had received propranolol orally. During therapy and follow-up monitoring of 1.4 to 7.1 years (mean 4.7 years), only two patients bled again from esophageal varices, one before complete obliteration of varices and one who temporarily defaulted on follow-up. The few complications were easily managed, and only three required any specific therapy. No child bled from gastric varices. Frequency of sclerotherapy sessions and quantity of sclerosant could be decreased with time, usually after 3 years of sclerotherapy, suggesting that the natural history of decreased bleeding with time in extrahepatic portal hypertension may be accelerated by sclerotherapy. Esophageal varices in children with extrahepatic portal hypertension may be treated safely with sclerotherapy, which is effective in preventing chronic and recurrent gastrointestinal bleeding.