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Esophageal endosclerosis in children with portal vein thrombosis
Insights
Esophageal endosclerosis effectively treated bleeding varices in children with portal vein thrombosis. This endoscopic injection therapy offers a safe and successful alternative to surgery for managing esophageal variceal hemorrhage.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Hepatology
Background:
- Portal vein thrombosis is a significant cause of esophageal variceal hemorrhage in children.
- Esophageal varices pose a risk of life-threatening bleeding.
- Current treatment options include surgery and nonoperative management, each with limitations.
Purpose of the Study:
- To evaluate the efficacy and safety of direct esophageal variceal injection using sodium morrhuate (endosclerosis) in children with portal vein thrombosis.
- To assess endosclerosis as an alternative to surgical shunts for managing esophageal variceal bleeding.
Main Methods:
- Six children with portal vein thrombosis and esophageal hemorrhage underwent direct intravariceal injection of sodium morrhuate.
- Treatment involved a rigid esophagoscope with a slotted tip for precise injection at the gastroesophageal junction.
- Active bleeding was treated with repeated sessions every 3-4 days; elective treatment and maintenance followed specific protocols.
Main Results:
- Bleeding was controlled in 2-3 sessions for actively hemorrhaging patients.
- Four patients completed treatment, showing complete absence of varices radiographically and endoscopically.
- No patient experienced rebleeding during follow-up periods ranging from 6 months to 3 2/3 years.
Conclusions:
- Esophageal endosclerosis is a safe and effective treatment for esophageal variceal hemorrhage in pediatric portal vein thrombosis.
- This endoscopic approach provides a viable alternative to portosystemic shunt operations.
- Endosclerosis offers a minimally invasive option for controlling and eradicating esophageal varices in this patient population.
Abstract:
During the past 3 2/3 yr, 6 children with portal vein thrombosis were treated for esophageal hemorrhage by direct injection of esophageal varices with sodium morrhuate (endosclerosis). Four children were actively hemorrhaging at the time of initial endosclerosis; 2 patients were treated electively. Endosclerosis was performed by (1) employment of an especially slotted rigid esophagoscope, (2) direct intravariceal injection, (3) injection of varices at the gastroesophageal junction only. In patients actively hemorrhaging, endosclerosis was repeated every 3 to 4 days until the bleeding ceased. Once bleeding was controlled the procedure was done at 6-wk intervals until esophageal varices were obliterated. In the four patients actively hemorrhaging, bleeding was controlled by 2 to 3 separate injection sessions. Four patients have completed treatment and varices are absent radiographically and endoscopically. No patient has rebled during or after treatment in follow-up from 1/6 to 3 2/3 yr. Esophageal endosclerosis is advocated as a legitimate alternative to portosystemic shunt operations and nonoperative management of esophageal variceal hemorrhage in children with portal vein thrombosis.