Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Gastroenterol Hepatol. 2011 Feb;26(2):255-9. doi: 10.1111/j.1440-1746.2010.06397.x.
There is scarcity of data about children on a combination of endoscopic variceal ligation (EVL) and endoscopic sclerotherapy (EST). We assessed the efficacy of EVL followed by EST and EST alone in children with extrahepatic portal venous obstruction (EHPVO).
From January 2000 to March 2007, 186 consecutive children (mean age 6.3 ± 4.2 years, 82% boys) with EHPVO with variceal bleeding were included. EVL followed by EST (Group I, n = 101) or EST alone (Group II, n = 60) was carried out at 3-weekly intervals until eradication. Surveillance endoscopy was done at 3 to 6-monthly intervals. In all cases, the number of sessions required to eradicate the esophageal varices, the volume of sclerosant, the complications and the endoscopic outcome on follow up were recorded.
Eradication was achieved in 158 of 161 (98%) children and 25 were lost to follow up. Group I required significantly fewer sessions (5.2 ± 1.8 vs 6.8 ± 2.8, P < 0.005), less sclerosant (13 ± 8.2 mL vs 30 ± 20 mL, P < 0.001) and had fewer complications (7% vs 28%, P < 0.001) as compared with Group II. On follow up (33 ± 17.6 months in Group I and 43 ± 16.7 months in Group II), there was a significant increase in the prevalence of portal hypertensive gastropathy as well as isolated gastric varices in both the groups. However, the prevalence of gastroesophageal varices decreased.
EVL followed by EST is better than EST alone in children with EHPVO as it requires fewer sessions and has fewer complications. However, following eradication, evolution of gastric varices and portal hypertensive gastropathy was similar in the two groups.
关于联合内镜下套扎（EVL）和内镜下硬化治疗（EST）的儿童数据稀缺。我们评估了在肝外门静脉高压症（EHPVO）儿童中 EVL 后行 EST 与单独行 EST 的疗效。
2000 年 1 月至 2007 年 3 月，我们纳入了 186 例 EHPVO 伴静脉曲张出血的连续患儿（平均年龄 6.3 ± 4.2 岁，82%为男性）。EVL 后行 EST（I 组，n = 101）或单独行 EST（II 组，n = 60），每 3 周进行一次，直到根除。每 3 至 6 个月进行一次监测内镜检查。记录所有情况下根除食管静脉曲张所需的治疗次数、硬化剂用量、并发症和随访时的内镜结果。
161 例患儿中的 158 例（98%）和 25 例失访患儿达到了根除。I 组所需的治疗次数（5.2 ± 1.8 次 vs 6.8 ± 2.8 次，P < 0.005）、硬化剂用量（13 ± 8.2 mL 比 30 ± 20 mL，P < 0.001）和并发症发生率（7%比 28%，P < 0.001）均显著低于 II 组。随访（I 组 33 ± 17.6 个月，II 组 43 ± 16.7 个月）时，两组胃底静脉曲张和孤立性胃静脉曲张的患病率均显著增加。然而，食管胃静脉曲张的患病率下降。
EHPVO 患儿 EVL 后行 EST 优于单独行 EST，因为它需要的治疗次数更少，并发症更少。然而，根除后，两组胃静脉曲张和门静脉高压性胃病的演变相似。
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