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Esophageal endoscopic sclerotherapy in children using 3% aqueous phenol
A N Supe1, S K Mathur, S S Borwankar
1Department of Surgery, Seth G S Medical College, Bombay.
Insights
Endoscopic variceal sclerotherapy (EST) effectively controls acute bleeding and prevents recurrence of esophageal varices in children. This minimally invasive procedure shows high success rates with manageable complications.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Interventions
- Hepatology
Background:
- Esophageal varices are a serious complication of portal hypertension in children.
- Acute variceal bleeding poses a significant risk of morbidity and mortality.
- Effective management strategies are crucial for long-term outcomes.
Purpose of the Study:
- To evaluate the efficacy of endoscopic variceal sclerotherapy (EST) in managing acute variceal bleeding in pediatric patients.
- To assess the effectiveness of EST in preventing the recurrence of bleeding from esophageal varices.
- To determine the safety and complication profile of EST in children.
Main Methods:
- Ninety children with portal hypertension underwent EST using 3% phenol in water.
- The study included patients with extra-hepatic portal venous obstruction (EHPVO) and cirrhosis.
- Efficacy was measured by control of active bleeding, variceal obliteration, and recurrence rates.
Main Results:
- Active bleeding was controlled in 91% of cases.
- Variceal obliteration was achieved in 87% of patients over a mean of 5.4 sessions.
- Complications included ulceration (32%), stricture (4.5%), and perforation (1%); recurrence was seen in 22%.
Conclusions:
- Endoscopic variceal sclerotherapy using 3% phenol in water is effective for controlling acute variceal bleeding in children.
- EST demonstrates efficacy in preventing recurrent bleeding from esophageal varices.
- The procedure is a valuable therapeutic option for pediatric patients with portal hypertension and varices.
Objective:
To study the efficacy of endoscopic variceal sclerotherapy (EST) in controlling acute variceal bleeding and preventing recurrence of bleeding from esophageal varices in children.
Methods:
Ninety children (mean age 7.3 +/- 3.0 years) with portal hypertension [extra-hepatic portal venous obstruction (EHPVO) 83, cirrhosis 7] presenting with hematemesis and/or melena were subjected to EST using 3% phenol in water as sclerosant.
Results:
Active variceal bleeding could be controlled in 31 of 34 (91%) cases. Varices could be obliterated in 87% of patients with a mean of 5.4 +/- 2.5 injection sessions. Pre-obliteration variceal rebleeding was observed in 15% of patients. Complications such as esophageal ulceration, stricture and perforation were observed in 32%, 4.5% and 1% of patients respectively. Strictures responded to dilatation whereas perforation responded to conservative treatment. Recurrence of varices was seen in 22% of patients at a mean interval of 5.8 +/- 1.9 months. The mortality in the emergency group was 9.5% and nil in the elective group. Ten percent of patients required surgical intervention.
Conclusion:
EST with 3% phenol in water is effective in controlling active bleeding as well as preventing recurrent bleeding from esophageal varices in children.