Yorulmaz Poyraz, Hakalmaz Ali Ekber, Kalyoncu Ucar Ayse, Kendigelen Pinar, Senyuz Osman Faruk, Emre Senol
Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Cerrahpasa Faculty of Medicine, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Pediatr Surg Int. 2024 Dec 20;41(1):36. doi: 10.1007/s00383-024-05938-z.
This study aims to evaluate the outcomes of endoscopic sclerotherapy (EST) in the treatment of esophagogastric varices in cases of extrahepatic portal hypertension (EHPH) secondary to portal vein thrombosis.
Records of cases that underwent endoscopic sclerotherapy for esophagogastric varices between 1990 and 2022 in our clinic were retrospectively reviewed. The age, gender, symptomatology, etiology, clinical, laboratory, and radiological data of the patients, as well as treatment outcomes, were evaluated. Results were compared based on age groups, time periods, and etiological factors. The classification of the Japanese Portal Hypertension Research Society was used for variceal assessment. The absence of bleeding or bleeding not requiring transfusion within one year was considered a positive outcome.
Of the 126 cases that underwent endoscopy with a diagnosis of EHPH, 41 had varices at the F1-F2 level and were not subjected to sclerotherapy. In 21 cases, due to advanced varices, gastropathy findings, frequent bleeding episodes, and hypersplenism, surgical indication was established after the first endoscopy. The remaining 64 cases were included in the study. Positive outcomes were achieved in 44 cases with an average of 4.1 sessions. Desired outcomes were not achieved in 20 cases, and surgical procedures were performed. When the results were evaluated based on the periods 1990-2000, 2001-2010, and 2011-2022, the success rates were 60%, 44%, and 88.2%, respectively. Statistically significant more favorable results were obtained in the last decade.
EST is a safe and effective minimally invasive method for the elective treatment of esophagocardial varices in children with EHPH. More effective results have been achieved with increased experience and advancements in imaging technology.
本研究旨在评估内镜硬化治疗（EST）对门静脉血栓形成继发肝外门静脉高压（EHPH）患者食管胃静脉曲张的治疗效果。
回顾性分析1990年至2022年在我院接受内镜硬化治疗食管胃静脉曲张的病例记录。评估患者的年龄、性别、症状、病因、临床、实验室及影像学资料，以及治疗效果。根据年龄组、时间段和病因因素对结果进行比较。采用日本门静脉高压研究学会的分类方法评估静脉曲张。一年内无出血或无需输血的出血被视为阳性结果。
126例诊断为EHPH并接受内镜检查的病例中，41例静脉曲张处于F1 - F2级，未接受硬化治疗。21例因静脉曲张进展、胃病表现、频繁出血发作和脾功能亢进，在首次内镜检查后确立手术指征。其余64例纳入研究。44例平均接受4.1次治疗取得阳性结果。20例未达到预期结果，接受了手术。按1990 - 2000年、2001 - 2010年和2011 - 2022年时间段评估结果，成功率分别为60%、44%和88.2%。过去十年取得了统计学上更显著的良好结果。
EST是一种安全有效的微创方法，用于选择性治疗EHPH患儿的食管心静脉曲张。随着经验增加和成像技术进步，已取得更有效的结果。
