title: Prophylactic endoscopic sclerotherapy of large esophagogastric varices in infants with biliary atresia.
abstract: BACKGROUND
  Esophageal varices-related GI bleeding occurs frequently and early in life in children with biliary atresia and it may be life threatening.
  
  
  OBJECTIVE
  We report the results of prophylactic sclerotherapy in 13 infants with biliary atresia and large varices.
  
  
  METHODS
  Mean age was 13 months, mean weight was 8.2 kg, mean total serum bilirubin was 258 mumol/L, and mean prothrombin time was 78%. Esophageal varices were grade III (11 patients) or II (2 patients), with red signs in all infants and gastric varices in 12. None had GI bleeding.
  
  
  METHODS
  Sclerotherapy was performed with the patient under continuous intravenous octreotide therapy in 7 infants.
  
  
  RESULTS
  In 8 children a complete or almost complete eradication of varices was obtained; none of these children bled later, 4 underwent liver transplantation, 3 are alive without liver transplantation, and 1 died of sepsis after 9 months awaiting liver transplantation. In 4 children a partial eradication was obtained and liver transplantation was performed. None of these children bled. One other child bled to death after 2 sessions of sclerotherapy.
  
  
  CONCLUSIONS
  Four ulcers and 2 stenoses occurred in 6 children with no octreotide versus no ulcer and 1 stenosis in 7 children receiving octreotide.
  
  
  CONCLUSIONS
  These results (1) indicate that primary prevention of GI bleeding by sclerotherapy of esophageal varices is technically feasible and fairly effective in infants with biliary atresia and large varices, even in those with end-stage liver disease, (2) suggest that decreasing the risk of bleeding may allow liver transplantation under better conditions, and (3) further suggest that octreotide associated with sclerotherapy lowers the rate of complications.
authors.affiliation: Division of Radiologie, Hopital Bicetre, Le Kremlin Bicêtre, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Duché
authors.forename: Dalila
authors.initials: D
authors.lastname: Habès
authors.forename: Philippe
authors.initials: P
authors.lastname: Roulleau
authors.forename: Vincent
authors.initials: V
authors.lastname: Haas
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Jacquemin
authors.forename: Olivier
authors.initials: O
authors.lastname: Bernard
mesh_terms: D001656:Biliary Atresia / Q000150:complications* / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015552:Injections, Intralesional; D008297:Male; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods*; D012720:Severity of Illness Index; D014014:Tissue Adhesives; D016896:Treatment Outcome
chemical_list: D012597:Sclerosing Solutions; D014014:Tissue Adhesives; D000077423:Polidocanol; D011092:Polyethylene Glycols