Endoscopic sclerotherapy: treatment of choice in patients less than 3 years old with extrahepatic portal vein obstruction.
Thirty-two children under 3 yr of age with extrahepatic portal vein obstruction were treated with endoscopic sclerotherapy. The group consisted of 22 males and 10 females, with a mean age of 1.96 yr (range 7 months to 3 yr). The procedure was well tolerated by all after premedication with intravenous diazepam. Esophageal varices were eradicated in all children after 4.45 sessions (+/- 1.12). Follow-up clinical and endoscopic evaluations have been carried out over a period of 9 months to 4 yr (mean 3.5 yr) after the patients were put on a sclerotherapy program. There was a significant reduction in number of bleeding episodes (60 vs. 8), mean blood transfusion requirement (2.19 vs. 0.31), and bleeding risk factor (0.09 vs. 0.008). There were a few minor conditions, such as transient dysphagia and esophageal ulcerations, in 14 patients (43.75%), which later responded to medical treatment. Perisclerotherapy bleeding, seen in six patients (18.7%), responded to repeat sclerotherapy. Recurrence of varices was encountered in two patients (6.25%); these were eradicated after reinstitution of sclerotherapy. Endoscopic sclerotherapy is the treatment of choice in patients of extrahepatic portal vein obstruction who are below 3 yr of age.
Rai
R R
RR
Department of Gastroenterology, Sawai Man Singh Medical College, Jaipur, India.
Nijhwawan
S
S
Bhargava
N
N
Nepalia
S
S
Pokharna
D S
DS
D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D003975:Diazepam / Q000627:therapeutic use; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D011169:Portal Vein; D011292:Premedication; D012008:Recurrence; D015911:Sclerotherapy / Q000009:adverse effects
D003975:Diazepam