Endoscopic sclerotherapy of esophageal varices in infants and children.
Thirty children, aged 7 months to 13 years, with bleeding esophageal varices were managed by endoscopic sclerotherapy (EST). Of these children, 73.3% had extrahepatic portal vein obstruction (EHPVO), 16.6% had cirrhosis of the liver, and 10% had noncirrhotic portal fibrosis. EST was done with fiberoptic pediatric upper gastrointestinal endoscopes and a flexible sclerotherapy needle under sedation with intravenous diazepam and pentazocine. The sclerosants used were ethoxysclerol 1% and absolute alcohol. Ten injections were given to control active variceal bleeding, and 145 injections were given on planned basis at 2-3-week interval. An average of five injections was required to obliterate the esophageal varices. In 90% of cases, an avariceal state was achieved; 10% had decreased size and number of varices. Emergency EST was effective to control bleeding in all sessions. Complications, including retrosternal discomfort, esophageal ulceration, stricture formation, and aspiration pneumonia, occurred in 60, 20, 20, and 6.6% of cases, respectively; complications were managed conservatively. Strictures were dilated with Eder-Puestow's olive dilators. Recurrence of esophageal varices, gastric varices, and rebleeding was seen in 13.3, 13.3, and 10% of cases, respectively. Shunt surgery was performed in 13.3% cases, who had developed gastric varices and were having EHPVO.
Thapa
B R
BR
Division of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Mehta
S
S
D000293:Adolescent; D000438:Alcohols / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods*
D000438:Alcohols; D000077423:Polidocanol; D011092:Polyethylene Glycols