A novel approach to stabilization of bleeding gastroesophageal varices in infants

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Critical Care Medicine

Background:

• Gastroesophageal variceal bleeding is a severe complication of portal hypertension.
• Available endoscopic interventions have limitations, particularly in young pediatric patients.
• Congenital infections like cytomegalovirus can lead to pediatric liver disease and portal hypertension.

Purpose of the Study:

• To describe a case of severe gastroesophageal variceal bleeding in a 4-month-old infant.
• To highlight the challenges of managing variceal bleeding in infants.
• To evaluate the utility of balloon tamponade as a temporizing measure.

Main Methods:

• Case report of a 4-month-old infant with congenital cytomegalovirus, cholestasis, and splenomegaly presenting with hematemesis.
• Diagnostic upper endoscopy to assess esophageal and gastric varices.
• Initial endoscopic treatment with sclerotherapy followed by balloon tamponade using a Foley catheter for re-bleeding.

Main Results:

• The infant presented with significant hematemesis and anemia, requiring transfusion.
• Endoscopy revealed grade 3 esophageal varices and a gastric varix.
• Initial sclerotherapy failed to prevent re-bleeding, necessitating balloon tamponade.
• Balloon tamponade served as a temporizing measure for transfer to a liver transplant center.

Conclusions:

• Managing gastroesophageal variceal bleeding in infants presents unique challenges due to anatomical limitations.
• Endoscopic interventions like sclerotherapy may have limited efficacy in this age group.
• Balloon tamponade can be a crucial temporizing method for stabilizing infants with variceal bleeding prior to definitive treatment, such as liver transplantation.