Li Ming-Ming, Sun Fang, Huai Man-Xiu, Qu Chun-Ying, Shen Feng, Zhang Yi, Xu Lei-Ming
Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Pediatr. 2024 Jul 1;12:1325419. doi: 10.3389/fped.2024.1325419. eCollection 2024.
Portal hypertension (PH) frequently gives rise to severe and life-threatening complications, including hemorrhage accompanied by the rupture of esophageal and gastric varices. In contrast to the guidelines for the management of PH in adults, the optimal endoscopic management of variceal bleeding for secondary prophylaxis in children remains unclear. The present study evaluated the efficacy and safety of endoscopic variceal ligation (EVL) and endoscopic sclerotherapy (EST) to control gastroesophageal variceal bleeding in children.
This retrospective study included children with gastroesophageal variceal bleeding who underwent EST or EVL at Xinhua Hospital, Shanghai Jiaotong University School of Medicine, between February 2013 and March 2020. Short-term hemostasis rate and long-term rebleeding rate were evaluated. Adverse events related to the procedures, such as esophageal ulcer, esophageal stricture, abnormal embolization, pneumonia and perforation, were also recorded.
EVL ( = 8) and EST ( = 13) were performed successfully in all pediatric patients diagnosed with moderate to severe esophageal varices concurrent with gastric varices. Hemostasis was achieved during episodes of upper gastrointestinal bleeding. The mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 ml (range: 0.1-0.5 ml). Varices were eradicated in six (75%) of the eight patients who underwent EVL after a median 2 (range: 1-4) procedures and a median time of 3.40 months (range: 1.10-13.33 months). Eleven (52.4%) of the 21 patients developed rebleeding events, with the mean duration of hemostasis being 11.1 ± 11.6 months (range 1.0-39.2 months). No treatment-related complications, for example, distal embolism, occurred except for abdominal pain in one patient (4.8%).
EST, alone or in combination with EVL, is an effective and safe method of managing gastroesophageal variceal hemorrhage in children undergoing secondary prophylaxis.
门静脉高压（PH）常引发严重且危及生命的并发症，包括食管和胃静脉曲张破裂伴出血。与成人PH管理指南不同，儿童静脉曲张出血二级预防的最佳内镜治疗方法仍不明确。本研究评估了内镜下静脉曲张套扎术（EVL）和内镜下硬化剂注射治疗（EST）控制儿童胃食管静脉曲张出血的疗效和安全性。
本回顾性研究纳入了2013年2月至2020年3月期间在上海交通大学医学院附属新华医院接受EST或EVL治疗的胃食管静脉曲张出血儿童。评估短期止血率和长期再出血率。还记录了与手术相关的不良事件，如食管溃疡、食管狭窄、异常栓塞、肺炎和穿孔。
所有诊断为中度至重度食管静脉曲张合并胃静脉曲张的儿科患者均成功进行了EVL（n = 8）和EST（n = 13）。上消化道出血发作期间实现了止血。每次注射的氰基丙烯酸酯单剂量平均体积为0.3±0.1 ml（范围：0.1 - 0.5 ml）。8例接受EVL的患者中有6例（75%）在中位2次（范围：1 - 4次）手术和中位3.40个月（范围：1.10 - 13.33个月）后静脉曲张得以根除。21例患者中有11例（52.4%）发生再出血事件，平均止血持续时间为11.1±11.6个月（范围1.0 - 39.2个月）。除1例患者（4.8%）出现腹痛外，未发生与治疗相关的并发症，如远端栓塞。
EST单独或联合EVL是儿童静脉曲张出血二级预防中管理胃食管静脉曲张出血的有效且安全的方法。
