Ujjal Poddar1, Babu R Thapa, Kartar Singh. 1. Division of Pediatric Gastroenterology, Department of Gastroenterology, PGIMER, Chandigarh, India.
Abstract
BACKGROUND: Endoscopic sclerotherapy often is used to treat variceal bleeding in children with extrahepatic portal hypertension, but published data are limited. The role of endoscopic sclerotherapy in a large number of children with extrahepatic portal hypertension was evaluated. METHODS: Consecutive children presenting with variceal bleeding because of extrahepatic portal hypertension were included in this study. All children underwent endoscopic sclerotherapy with absolute alcohol at presentation and at 2-week to 3-week intervals thereafter, until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months after eradication and then every 6 months thereafter. RESULTS: A total of 257 patients with extrahepatic portal hypertension were managed from January 1992 to December 2001. Of these, 50 were lost to follow-up before eradication was achieved, leaving 207 patients (144 boys, 63 girls; mean age at presentation, 7 [SD 3.5] years) for whom evaluation was complete. Of the 207 patients, 5 died of bleeding, 23 underwent surgery, and 6 are still undergoing endoscopic treatment. Varices were successfully eradicated in 165 of 173 cases (95%) after a mean of 4.5 (1.9) endoscopic sclerotherapy sessions (mean volume of sclerosant, 8 [4] mL). Complications encountered were ulcer (17%), stricture (18%), and perforation (1.4%). Interval bleeding before eradication was encountered in 10.6% of cases. At a mean follow-up of 36 (29) months, varices had recurred in 17% patients, but only 3 of them had recurrent bleeding. CONCLUSIONS: Endoscopic sclerotherapy effectively eradicates varices in children with extrahepatic portal hypertension, with an acceptable complication rate. On long-term follow-up, recurrent bleeding after eradication is rare.
BACKGROUND: Endoscopic sclerotherapy often is used to treat variceal bleeding in children with extrahepatic portal hypertension, but published data are limited. The role of endoscopic sclerotherapy in a large number of children with extrahepatic portal hypertension was evaluated. METHODS: Consecutive children presenting with variceal bleeding because of extrahepatic portal hypertension were included in this study. All children underwent endoscopic sclerotherapy with absolute alcohol at presentation and at 2-week to 3-week intervals thereafter, until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months after eradication and then every 6 months thereafter. RESULTS: A total of 257 patients with extrahepatic portal hypertension were managed from January 1992 to December 2001. Of these, 50 were lost to follow-up before eradication was achieved, leaving 207 patients (144 boys, 63 girls; mean age at presentation, 7 [SD 3.5] years) for whom evaluation was complete. Of the 207 patients, 5 died of bleeding, 23 underwent surgery, and 6 are still undergoing endoscopic treatment. Varices were successfully eradicated in 165 of 173 cases (95%) after a mean of 4.5 (1.9) endoscopic sclerotherapy sessions (mean volume of sclerosant, 8 [4] mL). Complications encountered were ulcer (17%), stricture (18%), and perforation (1.4%). Interval bleeding before eradication was encountered in 10.6% of cases. At a mean follow-up of 36 (29) months, varices had recurred in 17% patients, but only 3 of them had recurrent bleeding. CONCLUSIONS: Endoscopic sclerotherapy effectively eradicates varices in children with extrahepatic portal hypertension, with an acceptable complication rate. On long-term follow-up, recurrent bleeding after eradication is rare.
Authors: Shivaram P Singh; Manav Wadhawan; Subrat K Acharya; Sawan Bopanna; Kaushal Madan; Manoj K Sahoo; Naresh Bhat; Sri P Misra; Ajay Duseja; Amar Mukund; Anil C Anand; Ashish Goel; Bonthala S Satyaprakash; Joy Varghese; Manas K Panigrahi; Manu Tandan; Mihir K Mohapatra; Pankaj Puri; Pravin M Rathi; Rajkumar P Wadhwa; Sunil Taneja; Varghese Thomas; Vikram Bhatia Journal: Indian J Gastroenterol Date: 2021-12-10
Authors: Farina M Hanif; Ghous Bux Soomro; Sara Nazir Akhund; Nasir Hassan Luck; Syed Mudassir Laeeq; Zaigham Abbas; Syed Mujahid Hassan; Muhammed Mubarak Journal: J Transl Int Med Date: 2015-06-30