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Endoscopic variceal ligation using a clipping apparatus in children with portal hypertension
N Ohnuma1, H Takahashi, M Tanabe
1Dept. of Pediatric Surgery, Chiba University School of Medicine, Japan.
Insights
Endoscopic variceal ligation with clipping (EVLC) is a safe and effective treatment for esophageal varices in children. This new method successfully eradicated varices in most patients, offering an alternative to traditional endoscopic variceal sclerotherapy (EVS).
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Interventions
- Hepatology
Background:
- Endoscopic variceal sclerotherapy (EVS) is standard for adult esophageal varices but carries risks for children.
- A novel endoscopic variceal ligation with clipping (EVLC) apparatus offers a potential alternative for pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of a new EVLC apparatus in pediatric patients.
- To assess the effectiveness of EVLC in treating esophageal and gastric fundic varices in children.
Main Methods:
- EVLC was performed on 12 children (ages 2-14) with portal hypertension.
- A total of 417 variceal clipping procedures were conducted on 118 esophageal and 65 gastric fundic varices.
- Follow-up ranged from 9 to 48 months.
Main Results:
- Successful variceal ligation was achieved in 99.3% of procedures.
- Initial eradication of esophageal varices was observed in all patients.
- Complete eradication or significant reduction of varices was achieved in 11 of 12 patients during follow-up.
Conclusions:
- EVLC demonstrates significant advantages for treating pediatric patients with esophageal varices.
- This technique is effective for managing both esophageal and gastric fundic varices in children.
- EVLC presents a promising, safer alternative to EVS in pediatric populations.
Background And Study Aims:
Endoscopic variceal sclerotherapy (EVS) is a procedure frequently used to control bleeding from esophageal varices in adults. The use of EVS has been restricted in children due to the associated risks. The present paper describes the safety and efficacy of a new apparatus for endoscopic variceal ligation with clipping (EVLC).
Patients And Methods:
Endoscopic variceal ligation using a clipping apparatus (HX-3 L, Olympus, Tokyo, Japan), was carried out in 12 children with portal hypertension (four with extrahepatic portal vein obstruction and eight with congenital biliary atresia; four boys and eight girls, age range 2-14 years). A total of 417 variceal clipping procedures were carried out in 56 separate EVLC sessions; 118 esophageal varices and 65 gastric fundic varices were ligated using 417 clips. Initially, the EVLC sessions were repeated at approximately monthly intervals until the varices were eradicated, but the interval was gradually extended to twice a year or once a year.
Results:
Varices were successfully ligated at the first attempt in 414 (99.3%) of the 417 clipping procedures. The esophageal varices were initially eradicated in all patients. The follow-up period ranged from nine to 48 months, and complete variceal eradication or reduction of the grade of the varices was obtained in 11 of the 12 patients after initial eradication during this period.
Conclusions:
These data indicate that EVLC offers advantages in the treatment of patients with esophageal varices combined with gastric fundic varices.