Endoscopic variceal ligation as primary prophylaxis for upper GI bleeding in children

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Interventional Endoscopy

Background:

• Variceal hemorrhage is a critical complication of chronic liver disease.
• Optimal primary prophylaxis for variceal bleeding in children with portal hypertension (PH) lacks robust evidence.
• Existing guidelines primarily focus on adult management of PH.

Purpose of the Study:

• To evaluate the efficacy of endoscopic variceal ligation (EVL) as a primary prophylactic strategy.
• To prevent upper gastrointestinal bleeding in pediatric patients diagnosed with portal hypertension.
• To compare EVL with propranolol for primary prophylaxis in this population.

Main Methods:

• Prospective enrollment of pediatric patients with PH and esophageal varices undergoing EVL.
• Retrospective review of pediatric patients with PH treated with propranolol.
• Inclusion criteria: medium to large esophageal varices or reddish spots, irrespective of varix grade.

Main Results:

• EVL achieved varices eradication in 75% of pediatric patients (median 2 procedures).
• No adverse events were associated with EVL.
• The 3-year bleeding rate was significantly lower in the EVL group (3.2%) compared to the propranolol group (21.9%), P < .02.

Conclusions:

• Endoscopic variceal ligation (EVL) is a safe and effective method for preventing upper GI bleeding in children with portal hypertension.
• EVL demonstrates superior efficacy over propranolol in reducing bleeding rates.
• This study supports EVL as a primary prophylactic treatment in pediatric PH.