title: Pediatric gastroesophageal varices: treatment strategy and long-term results.
abstract: 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.
authors.affiliation: 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
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsunaga
authors.forename: Hideo
authors.initials: H
authors.lastname: Yoshida
authors.forename: Katsunori
authors.initials: K
authors.lastname: Kouchi
authors.forename: Tomoro
authors.initials: T
authors.lastname: Hishiki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Yamada
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sato
authors.forename: Keita
authors.initials: K
authors.lastname: Terui
authors.forename: Mitsuyuki
authors.initials: M
authors.lastname: Nakata
authors.forename: Ayako
authors.initials: A
authors.lastname: Takenouchi
authors.forename: Naomi
authors.initials: N
authors.lastname: Ohnuma
mesh_terms: 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