title: Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous obstruction: benefit of injection tract embolisation.
abstract: BACKGROUND
  The outcome of sclerotherapy for bleeding oesophageal varices may be influenced by injection technique. In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection tract was introduced in an attempt to reduce injection-related complications.
  
  
  METHODS
  To determine the outcome and effectiveness of injection tract embolisation in reducing injection-related complications, we retrospectively reviewed a series of 59 children who underwent injection sclerotherapy for oesophageal varices (29 for extrahepatic portal vein obstruction (EHPVO) and 30 for intrahepatic disease) in our centre.
  
  
  RESULTS
  Sclerotherapy resulted in variceal eradication in only 11.8% of the children (mean follow-up duration: 38.4 months). Variceal eradication with sclerotherapy alone was achieved in 20.7% and 3.3% of EHPVO and intrahepatic disease patients, respectively. Injection tract embolisation was successful in reducing the number of complications and re-bleeding rates. Complications that arose included: transient pyrexia (16.7%); deep oesophageal ulcers (6.7%); stricture formation (3.3%); and re-bleeding before variceal sclerosis (23%).
  
  
  CONCLUSIONS
  Injection sclerotherapy did not eradicate oesophageal varices in most children. Injection tract embolisation by sclerosant was associated with fewer complications and reduced re-bleeding rates.
authors.affiliation: University of Cape Town, Cape Town, South Africa. bandikav@yahoo.com
authors.forename: Victor Lewa
authors.initials: VL
authors.lastname: Bandika
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Goddard
authors.forename: Ronalda D
authors.initials: RD
authors.lastname: De Lacey
authors.forename: Robin Alexander
authors.initials: RA
authors.lastname: Brown
mesh_terms: D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D015282:Octreotide / Q000008:administration & dosage; D009829:Oleic Acids / Q000008:administration & dosage; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy / Q000379:methods*
chemical_list: D005765:Gastrointestinal Agents; D009829:Oleic Acids; D012597:Sclerosing Solutions; D015282:Octreotide; C033343:ethanolamine oleate