Endoscopic sclerotherapy in children with extrahepatic portal venous obstruction.
BACKGROUND
Extrahepatic portal vein obstruction (EHPVO) is a common cause of variceal bleeding in children in India. There is paucity of data regarding the results of treatment with endoscopic sclerotherapy.


METHODS
Fifty-nine children (mean age 11 +/- 3.8 years; range 7 months to 12 years; 36 males and 23 females) were studied from February 1990 to September 1999. EHPVO was diagnosed on the basis of portal cavernoma on ultrasonography in 55 patients and on splenoportovenogram in 4 patients. Endoscopic sclerotherapy was caried out at weekly intervals for the first three weeks and at 3 weekly intervals thereafter till complete or near complete thrombosis was achieved. All patients were followed up with check endoscopy every 3-6 months after thrombosis of oesophageal varices.


RESULTS
Over a mean follow up of 25.4 months (range 3 to 87 months) total thrombosis was achieved in 53 (89.8%) of 59 children. The mean number of sclerotherapy sessions required were 7.5 +/- 2.2. The mean number of blood transfusions required per bleeding episode was 3.8 +/- 3.2. Of the 59 children 21 (35.6%) rebled, of which 17 (28.8%) bled during and 4(6.8) after thrombosis of varices. Seven (11.9%) children had more than one episode of bleeding. Once thrombosis of the varices was achieved 15 (26%) of 59 children developed fresh varices on follow up. Gastric varices were detected in 47 (60%) children. In 39 (66%) children it was present at the onset and in 8 (13.5%) children it developed after thrombosis of oesophageal varices. Bleeding from gastric varix occurred in 7(9%) children. Ascites developed in 6(10.6%) children. One child developed oesophageal stricture. There were 3 (5%) deaths. Two died due to upper gastrointestinal bleed while on sclerotherapy schedule and one died due to cerebral abscess.


CONCLUSIONS
EHPVO is an important and common cause of upper gastrointestinal bleeding in children in Western India. EST is safe and useful in controlling oesophageal variceal bleeding in children.
Patraval
V
V
Department of Gastroenterology, L.T. Municipal Medical College & L. T. Municipal General Hospital, Sion, Mumbai-400 022.
Rathi
P
P
Sawant
P
P
Vyas
K
K
Das
H
H
D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D015911:Sclerotherapy; D014463:Ultrasonography