Band ligation plus sclerotherapy versus sclerotherapy alone in children with extrahepatic portal venous obstruction.

Although endoscopic band ligation (EVL) plus sclerotherapy (EST) has shown to be superior to any individual method, there is no study in children. We therefore analyzed our experience of EST and EVL + EST in children with extrahepatic portal venous obstruction (EHPVO). Over a period of 8 years, 136 children who presented with a history of recent variceal bleeding due to EHPVO were studied; 30 of them received EVL + EST and 106 received EST alone. In the EVL + EST group, after the first session of EVL, EST was done three times weekly until variceal eradication was achieved. The mean age of these children was 7 +/- 3.6 years with a male-to-female ratio of 2.6:1. The rate of eradication was comparable in both groups (100% in EVL + EST and 96% in EST). However, EVL + EST group required a significantly fewer sessions and lower volume of sclerosant (2 +/- 1 vs. 4.4 +/- 2 sessions, P < 0.001 and 3.1 +/- 2 mL versus 7.5 +/- 4 mL, P < 0.001 respectively). There were significantly less complications in EVL + EST group (10% vs. 36%, P < 0.01). Over a mean follow-up of 27 months, varices recurred in 6.6% and 10% cases, respectively. EVL + EST is a better method in the treatment of esophageal varices in children with EHPVO than EST alone, as it required fewer session and had fewer complication.