Pediatric gastroesophageal varices: treatment strategy and long-term results.
OBJECTIVE
There are various treatment strategies for gastroesophageal varices in children. We studied the therapeutic value of endoscopic variceal clipping (EVC) and ligation (EVL).


METHODS
Four hundred ninety-nine endoscopic examinations performed between 1991 and 2005 were retrospectively analyzed. F2 and F3 varices with red color signs on follow-up endoscopy were treated with prophylactic EVC. In variceal rupture cases, EVC and EVL were used in combination.


RESULTS
Eighty-two prophylactic EVCs were done, and variceal progression was prevented in 89.9%. However, some patients had persistent red color signs and required frequent EVC. Ten emergent procedures were done for variceal rupture, and, in 4 cases, EVL was used to arrest massive variceal bleeding. Five patients developed bleeding during follow-up cause by rupture of gastric fundal varices, which probably had been aggravated by prior treatment for esophageal varices.


CONCLUSIONS
The control of gastroesophageal varices by routine EVC was satisfactory. However, ruptures during follow-up suggested the importance of controlling gastric fundal varices. Endoscopic variceal ligation is a simple, effective, and safe treatment tool, particularly for ruptured varices. However, it is difficult to treat gastric fundal varices with EVL; this disadvantage of EVL can be overcome by the concomitant use of EVC.
Mitsunaga
Tetsuya
T
Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. tetsuya@z.email.ne.jp
Yoshida
Hideo
H
Kouchi
Katsunori
K
Hishiki
Tomoro
T
Saito
Takeshi
T
Yamada
Shin-ichi
S
Sato
Yoshiharu
Y
Terui
Keita
K
Nakata
Mitsuyuki
M
Takenouchi
Ayako
A
Ohnuma
Naomi
N
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D005773:Gastroscopy; D006801:Humans; D007223:Infant; D008026:Ligation; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome