Endoscopic sclerotherapy in children: experience with 257 cases of extrahepatic portal venous obstruction.

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.