Long‐term outcome after sclerotherapy withor without a beta‐blocker for variceal bleeding in children

Abstract

Endoscopic sclerotherapy combined with oral propranolol treatment shortens the time required for variceal obliteration. However, the other indicators of treatment effectiveness are not influenced statistically by the addition of propranolol to the treatment regimen. Randomized prospective clinical studies in larger pediatric series are needed before offering a combination of EST with oral propranolol as the most rational approach in the secondary treatment of esophageal variceal bleeding in children.

Endoscopic and Pharmacological Secondary Prophylaxis in Children and Adolescents With Esophageal Varices

“…Therefore, secondary prophylaxis should always be used. Although the current consensus on the best form of prophylaxis in childhood is in favor of banding ligation (26), there are few studies on secondary prophylaxis in this age group, most of which were conducted in a limited number of patients and they were nonrandomized studies (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). As reported by Ling et al (2), several factors make it difficult to conduct a randomized controlled study in pediatrics patients: poor understanding of natural history and consequences of variceal hemorrhage, multiple etiologies of underlying PH in children, large sample size requirement, inadequate understanding of hemodynamic pathophysiology in children with PH, inadequate understanding of appropriate dosing of b-blockers in children with PH, drug toxicity, and poor compliance with repeated endoscopies.…”

“…Literature regarding secondary prophylaxis in children and adolescents is scarce, although the current consensus on the best form of prophylaxis in childhood is in favor of banding ligation (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Nonrandomized and uncontrolled studies of endoscopic therapy in pediatric patients show that both band ligation and sclerotherapy have high rates of variceal eradication, approximately 80% to 100%, and rebleeding rates vary from 0% to 30% (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

“…The literature on pharmacological therapy with propranolol in pediatric patients is even more scarce. There are few reports of the use of pharmacological therapy in children and no controlled and randomized studies assessing its results (22)(23)(24)(25). Only 1 study, conducted by So ¨ku ¨cu ¨et al (25), has reported endoscopic treatment in association with propranolol.…”

“…There are few reports of the use of pharmacological therapy in children and no controlled and randomized studies assessing its results (22)(23)(24)(25). Only 1 study, conducted by So ¨ku ¨cu ¨et al (25), has reported endoscopic treatment in association with propranolol. That study showed no benefits of the combination of propranolol and sclerotherapy.…”

Profilaxis primaria de várices esofágicas en pediatría

“…Se han publicado seis trabajos en que reportan experiencia clínica con uso de β-bloquea-dores no selectivos en niños con hipertensión portal [43][44][45][46][47][48] , algunas incluyen terapia profi láctica primaria (tabla 1). En total conforman 131 pacientes con distintas etiologías de daño hepático crónico.…”