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Updated: Mar 16, 2026
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
A proposal for a scoring system for hemoglobinuria following ethanolamine oleate sclerotherapy in children with
Hitomi Matsutani1, Yuki Iwashina1, Naoya Oshima1
1Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, 181-8611 Tokyo, Japan.
Background:
Ethanolamine oleate (EO) is a sclerosing agent commonly used to treat slow-flow vascular malformations (SFVMs). Macroscopic hemoglobinuria is the most frequent complication of EO sclerotherapy and may occasionally progress to acute renal failure. Because EO was originally developed for adult esophageal and gastric varices, data on its pediatric use remain limited. This study aimed to identify risk factors for macroscopic hemoglobinuria and to develop a practical scoring system to support the safe use of EO in children.
Methods:
This retrospective study included patients aged ≤15 years who underwent EO sclerotherapy for venous or lymphatic-venous malformations between January 2019 and March 2025. Associations between macroscopic hemoglobinuria and patient characteristics, magnetic resonance imaging findings, and intraoperative factors, including the weight-adjusted EO dose, were analyzed. Based on significant factors, a risk-scoring system was developed and its diagnostic performance evaluated.
Results:
A total of 100 procedures with 51 patients were analyzed, and macroscopic hemoglobinuria occurred in 34.6% of cases. Hemoglobinuria was not observed in patients with lesions confined to subcutaneous tissue, or those without drainage outflow on contrast imaging. Four factors were identified: lesion size, morphology, drainage outflow, and weight-adjusted EO dose (>0.158 mL/kg). A 8-point scoring system demonstrated good discriminative performance (area under the curve, 0.828), with a cutoff score ≥4 providing optimal diagnostic balance (Youden index, 0.44). All cases resolved with hydration and haptoglobin administration, and no patient developed acute renal impairment.
Conclusion:
This study presents the first pediatric-focused risk scoring framework for hemoglobinuria after EO sclerotherapy. The proposed scoring system enables objective clinical risk stratification and may contribute to safer and more individualized treatment strategies for children with SFVMs.
