Endoscopic sclerotherapy in children

Dilawari, J. B.; Chawla, Yogesh; Ramesh, Ganesh; Mitra, Suvradeep; Walia, B. N. S.

doi:10.1111/j.1440-1746.1989.tb00820.x

Cited by 46 publications

(63 citation statements)

References 14 publications

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“…Our rate of rebleeding in sclerotherapy group is comparable with reported figures of 23% to 30% in children with EXPVO. 1,[9][10][11] The proportion of patients with large variceal size (grade 3 and 4) or active variceal bleeding at index endoscopy, which are predictors of variceal rebleeding, were similar in both groups. The most likely reason for lower rebleeding rate in the ligation group was its ability to accomplish variceal eradication with fewer sessions compared with the sclerotherapy group.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][29][30][31] In some cases, shunt surgery may not be technically possible because of thrombosis of splenic and superior mesenteric veins or small-sized splenic vein. 1,8,30,31 Recently, a Rex shunt that involves insertion of venous jugular autograft between the left portal vein and superior mesenteric vein has been performed successfully in a small number of patients with EXPVO. 32,33 Although a technically demanding procedure, it obviates technical problems associated with blocked splenic vein and restores the portal blood flow to the liver.…”

Section: Discussionmentioning

confidence: 99%

“…The analysis of studies with a mean period of long-term follow-up of 19 months to 8.7 years showed variceal recurrence of 0% to 33% 1,2,9-12 ; however, with the exception of 1 report, 2 others reported further bleeding episodes an uncommon occurrence. 1,[9][10][11][12] Furthermore, most of these cases were successfully managed by a further course of sclerotherapy. These rates of variceal recurrence and rebleeding after initial obliteration are as good or may be better than surgical reports.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Bleeding from the esophageal varices is the most common presenting feature of EXPVO and is associated with significant morbidity. 1,3,4 Although optimal treatment for these patients is a matter of controversy, current therapeutic options include a variety of surgical procedures [5][6][7][8] or endoscopic injection sclerotherapy (EIS).…”

Section: E Xtrahepatic Portal Venous Obstruction (Expvo) Ismentioning

confidence: 99%

“…1,3,4 Although optimal treatment for these patients is a matter of controversy, current therapeutic options include a variety of surgical procedures [5][6][7][8] or endoscopic injection sclerotherapy (EIS). 1,2,[9][10][11][12] Although EIS provides an effective treatment for esophageal varices, there is potential for improvement because sclerotherapy is associated with substantial complications, including rebleeding at a rate of 20% to 30% and sclerosant-induced esophageal injury that may cause ulceration, bleeding, perforation, or stricture formation. 1,2,9-11 Consequently, endoscopic variceal ligation (EVL) was developed by Stiegmann and Goff 13 as an alternative to EIS for the treatment of esophageal varices in adults.…”

Section: E Xtrahepatic Portal Venous Obstruction (Expvo) Ismentioning

confidence: 99%

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Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction

et al. 2002

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Endoscopic sclerotherapy is an effective treatment for bleeding esophageal varices, but it is associated with significant complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, has been shown to be superior to sclerotherapy in adult patients with cirrhosis. To determine the efficacy and safety of endoscopic sclerotherapy and ligation, the 2 methods were compared in a randomized control trial in 49 children with extrahepatic portal venous obstruction who had proven bleeding from esophageal varices. Twenty-four patients were treated with sclerotherapy and 25 with band ligation. No significant differences were found between the sclerotherapy and ligation groups in arresting active index bleeding (100% each) and achieving variceal eradication (91.7% vs. 96%, P ‫؍‬ .61). Band ligation eradicated varices in fewer endoscopic sessions than did sclerotherapy (3.9 ؎ 1.1 vs. 6.1 ؎ 1.7, respectively, P < .0001). The rebleeding rate was significantly higher in the sclerotherapy group (25% vs. 4%, P ‫؍‬ .049), as was the rate of major complications (25% vs. 4%, P ‫؍‬ .049). After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy (17.4% vs. 10%, P ‫؍‬ .67). In conclusion, variceal band ligation in children is a safe and effective technique that achieves variceal eradication more quickly, with a lower rebleeding rate and fewer complications compared with sclerotherapy. (HEPATOLOGY 2002;36:666-672.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: E Xtrahepatic Portal Venous Obstruction (Expvo) Ismentioning

confidence: 99%

Section: E Xtrahepatic Portal Venous Obstruction (Expvo) Ismentioning

confidence: 99%

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Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction

et al. 2002

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Extrahepatic Portal Vein Obstruction in Children: Anthropometry, Growth Hormone, and Insulin‐Like Growth Factor I

Mehrotra,

Bhatia,

Dabadghao

et al. 1997

J. pediatr. gastroenterol. nutr.

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Background:Extrahepatic portal vein obstruction has been shown to cause growth retardation in children, though literature is scant. No information is available regarding the cause of growth retardation in these patients.Methods:To document the presence of growth retardation in this disease, we studied growth and nutrition in 33 consecutive prepubertal patients. Anthropometry, fasting growth hormone, and insulin‐like growth factor I levels were compared in 22 well‐nourished patients from this group with 35 age‐matched well‐nourished controls.Results:Mean ± SD height standard deviation score of well‐nourished patients (‐1.88 ± 1.33) was significantly below that of the controls (‐1.06 ± 0.64, p < 0.01). Patients also had significantly lower midarm muscle circumference z scores (‐2.65 ± 1.09) than controls (‐1.17 ± 1.09, p < 0.0001), though triceps skinfold thickness z scores were comparable in the two groups (‐1.60 ± 0.68 vs ‐1.24 ± 0.79, p = NS). Insulin‐like growth factor I z scores were significantly lower in patients (‐1.48 ± 0.88) than in controls (‐0.49 ± 1.09, p < 0.001), whereas basal growth hormone was significantly higher in patients (4.60 ± 3.70 mIU/L) compared with controls (2.66 ± 0.82, p < 0.01).Conclusion:Extrahepatic portal vein obstruction in children leads to growth retardation. Anthropometric and preliminary hormonal evaluation suggest resistance to the action of growth hormone as a possible mechanism.

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Endoscopic Sclerotherapy for Esophageal Varices in Children with Extrahepatic Portal Venous Obstruction: A Follow‐Up Study

Yachha,

Sharma,

Kumar

et al. 1997

J. pediatr. gastroenterol. nutr.

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Background:Results of treatment with endoscopic sclerotherapy for esophageal varices in children extrahepatic portal venous obstruction are limited.Methods:A prospective study was undertaken of fifty children (mean age, 7.4 ± 3.8 years; range, 4 months to 14 years) with esophageal variceal bleeding caused by extrahepatic portal venous obstruction (EHPVO) treated by repeated intravariceal endoscopic sclerotherapy (EST) at intervals of 2‐3 weeks until eradication (no varices on endoscopy).Results:Eradication of varices was achieved in 44 children (88%) with a mean of eight sessions per child. In six other cases, variceal grade decreased by 50% from the initial grades. Bleeding episodes at presentation were controlled in all of the children with first ET>. Over a mean follow‐up period of 19 months (range, 12‐36 months), a total of 15 episodes of rebleeding occurred in 13 children (26%) before the third session of EST and all were controlled with EST. Risk of rebleeding in children with eradicated varices (n = 44) significantly decreased from 0.2 episodes per month to nil after eradication. None of the children without eradicated varices had rebleeding. Thus, EST was successful in controlling rebleeding in all of the cases. Recurrence of varices was observed in five children (10%). None of our children either required surgery for EST failure or died.Conclusions:EST is a safe and effective nonsurgical mode of therapy in controlling esophageal variceal bleeding in children with EHPVO. Significant variceal bleeding did not occur during the relatively short follow‐up in this series.

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Endoscopic sclerotherapy in children

Cited by 46 publications

References 14 publications

Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction

Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction

Extrahepatic Portal Vein Obstruction in Children: Anthropometry, Growth Hormone, and Insulin‐Like Growth Factor I

Endoscopic Sclerotherapy for Esophageal Varices in Children with Extrahepatic Portal Venous Obstruction: A Follow‐Up Study

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