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Updated: Aug 16, 2025
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
The presence of high-risk varices after sclerotherapy in biliary atresia
Shinya Yokoyama1, Yoji Ishizu1, Takashi Honda1
1Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
Insights
Increased liver stiffness (LS) is a key risk factor for high-risk esophagogastric varices (EGVs) after ethanolamine oleate endoscopic injection sclerotherapy (EO-EIS) in children with biliary atresia (BA). This finding helps predict post-treatment outcomes.
Area of Science:
- Pediatric gastroenterology
- Hepatology
- Endoscopic interventions
Background:
- Esophagogastric varices (EGVs) are a complication of portal hypertension in children with biliary atresia (BA).
- Endoscopic injection sclerotherapy (EIS) using ethanolamine oleate (EO) is a treatment for EGVs, but risk factors for persistent high-risk EGVs are unknown.
Purpose of the Study:
- To identify risk factors for the presence of high-risk EGVs after EO-EIS in pediatric BA patients.
Main Methods:
- Retrospective review of 28 EO-EIS treatment sessions in BA patients under 15 years.
- Focus on EGVs with red signs or larger than F2 (high bleeding risk).
- Survival analysis to assess the presence of high-risk EGVs post-treatment.
Main Results:
- Increased liver stiffness (LS) and Mac-2 binding protein glycan isomer (M2BPGi) were associated with higher risk of high-risk EGVs post-EO-EIS.
- Multivariate analysis confirmed high LS as a significant independent risk factor (HR 2.76).
- Median time to presence of high-risk EGVs was shorter in patients with LS ≥ 2.8 m/s and M2BPGi ≥ 4.0.
Conclusions:
- Elevated liver stiffness is a significant predictor of persistent high-risk EGVs following EO-EIS in pediatric BA.
- This finding aids in risk stratification and management of EGVs in this population.
Background:
Esophagogastric varices (EGVs) may develop as a result of portal hypertension in children with biliary atresia (BA). Although endoscopic injection sclerotherapy (EIS) with ethanolamine oleate (EO) is reported useful for children, risk factors associated with the presence of high-risk EGVs after treatment remain unknown.
Methods:
The subjects were BA patients under 15 years of age who underwent EO-EIS. We retrospectively reviewed a total of 28 treatment sessions of EGVs with red signs and those larger than F2, which were considered to be at high risk of bleeding. Survival analysis was performed for the presence of high-risk EGVs at the time of follow-up endoscopy as the occurrence of an event.
Results:
Univariate analysis showed a significantly increased risk of the presence of high-risk EGVs post-EO-EIS in patients with increased liver stiffness (LS) and Mac-2 binding protein glycan isomer (M2BPGi), with hazard ratios of 1.48 and 1.15, respectively. The median presence-free period was significantly shorter in the LS ≥ 2.8 m/s patients than in those with LS <2.8 m/s (189 vs. 266 days). Similarly, the median presence-free period was significantly shorter in patients with M2BPGi ≥ 4.0 than in those with M2BPGi < 4.0 (182 vs. 203 days). The results of multivariate analysis revealed that the risk of the presence of high-risk EGVs was significantly higher only in the high-LS group, with a hazard ratio of 2.76.
Conclusions:
Increased LS is associated with risk of the presence of high-risk EGVs following EO-EIS in children with BA.
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