Endoscopic sclerotherapy for bleeding esophageal varices secondary to extrahepatic portal vein obstruction.
Portal hypertension and variceal bleeding secondary to extrahepatic portal vein obstruction continue to present a therapeutic challenge. We performed endoscopic injection sclerotherapy in eight patients with extrahepatic portal vein obstruction and bleeding esophageal varices. In contrast to other reported series, all but one of our patients were adults at the time sclerotherapy was initiated. Six had episodes of continued bleeding after a variety of surgical procedures. After sclerotherapy, five had no further bleeding with a mean follow-up of 26 months. Three patients had episodes of bleeding prior to variceal obliteration; two of these patients underwent surgical intervention after emergency sclerosis to stabilize their condition. Transfusion requirements were less after sclerosis (p = 0.035), although the follow-up has been relatively short (mean, 24 months) compared to the duration of bleeding. Our results suggest that endoscopic sclerotherapy is an effective therapeutic alternative, and perhaps the initial treatment of choice, in patients with extrahepatic portal vein obstruction and bleeding esophageal varices.
D000293:Adolescent; D000328:Adult; D002648:Child; D003251:Constriction, Pathologic / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D004945:Esophagoscopy; D005233:Fatty Alcohols / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D011169:Portal Vein / Q000002:abnormalities; D012981:Sodium Tetradecyl Sulfate / Q000627:therapeutic use*
D005233:Fatty Alcohols; D012981:Sodium Tetradecyl Sulfate