Sökücü Semra, Süoglu Ozlem Durmaz, Elkabes Berna, Saner Günay
Departmentof Pediatric Gastroenterology and Hepatology, Istanbul School of Medicine and Instituteof Child Health, Istanbul University, Istanbul, Turkey.
Pediatr Int. 2003 Aug;45(4):388-94. doi: 10.1046/j.1442-200x.2003.01743.x.
Esophageal variceal bleeding is a life-threatening complication of portal hypertension. Optimal treatment for the prophylaxis of variceal rebleeding in children has not yet been determined. In the present study, we aimed to compare the long-term efficacy of endoscopic sclerotherapy with or without oral beta-blocker therapy in the secondary prophylaxis of variceal bleeding.
Thirty-eight children who had undergone endoscopic sclerotherapy (EST) sessions for variceal bleeding in the Department of Pediatric Gastroenterology, Istanbul University Istanbul School of Medicine, were entered into this retrospective cohort study. Twenty patients (mean +/- SD age 7.0 +/- 2.7 years) had undergone only sclerotherapy sessions (SG), whereas 18 patients (mean age 6.8 +/- 3.4 years) had received oral propranolol (1-2 mg/kg per day) additionally for 2 years (SPG). The number of patients with successful obliteration, the time required for obliteration and variceal recurrence rate were analyzed as primary indicators of the effectiveness of therapy.
Variceal obliteration was achieved in 16 of 20 patients (80%) in the SG group and in 16 of 18 patients (88%) in the SPG group. Time required for variceal obliteration was significantly shorter in the SPG group compared with the SG group (4.1 +/- 1.4 vs 3.2 +/- 0.9 months; P < 0.05). The variceal recurrence rate was 65 and 38.8% in the SG and SPG groups, respectively. Compared with the SG group, less variceal rebleeding was observed during EST in the SPG group (25 vs 16.6%, respectively).However, these differences were not statistically significant.
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.
食管静脉曲张破裂出血是门静脉高压症的一种危及生命的并发症。儿童静脉曲张再出血的最佳预防治疗方法尚未确定。在本研究中，我们旨在比较内镜下硬化疗法联合或不联合口服β受体阻滞剂治疗在静脉曲张出血二级预防中的长期疗效。
本回顾性队列研究纳入了伊斯坦布尔大学伊斯坦布尔医学院儿科学胃肠病科因静脉曲张出血接受内镜下硬化疗法（EST）的38名儿童。20例患者（平均年龄±标准差7.0±2.7岁）仅接受了硬化疗法（SG组），而18例患者（平均年龄6.8±3.4岁）额外接受了2年的口服普萘洛尔（每天1 - 2mg/kg）治疗（SPG组）。将静脉曲张成功闭塞的患者数量、闭塞所需时间和静脉曲张复发率作为治疗效果的主要指标进行分析。
SG组20例患者中有16例（80%）实现了静脉曲张闭塞，SPG组18例患者中有16例（88%）实现了静脉曲张闭塞。与SG组相比，SPG组静脉曲张闭塞所需时间显著缩短（4.1±1.4个月对3.2±0.9个月；P < 0.05）。SG组和SPG组的静脉曲张复发率分别为65%和38.8%。与SG组相比，SPG组在EST期间观察到的静脉曲张再出血较少（分别为25%对16.6%）。然而，这些差异无统计学意义。
内镜下硬化疗法联合口服普萘洛尔治疗可缩短静脉曲张闭塞所需时间。然而，治疗方案中添加普萘洛尔对其他治疗效果指标无统计学影响。在将EST与口服普萘洛尔联合作为儿童食管静脉曲张出血二级治疗的最合理方法之前，需要在更大规模的儿科系列中进行随机前瞻性临床研究。
