Skip to main content
NCBI home page
Gut logoLink to Gut
. 1994 Feb;35(2):257–259. doi: 10.1136/gut.35.2.257

Longterm outcome after injection sclerotherapy for oesophageal varices in children with extrahepatic portal hypertension.

M D Stringer 1, E R Howard 1
PMCID: PMC1374504  PMID: 8307479

Abstract

A consecutive series of 36 children with bleeding from oesophageal varices secondary to extrahepatic portal hypertension was successfully treated by endoscopic injection sclerotherapy and followed up over a mean period of 8.7 years after variceal obliteration. There were no deaths from portal hypertension or its treatment and morbidity related to oesophageal sclerotherapy was minimal. Endoscopic injection sclerotherapy alone proved safe and effective in controlling variceal bleeding from portal hypertension in over 80% of the children. Recurrent variceal bleeding developed in 10 (31%) patients but half of these were effectively treated by further sclerotherapy. Gastric variceal bleeding unresponsive to sclerotherapy necessitated successful portosystemic shunt surgery in four (13%) patients. Two children required splenectomy for painful splenomegaly. In most children injection sclerotherapy is the best treatment for the primary management of bleeding oesophageal varices, reserving portosystemic shunting or other surgical procedures for those with bleeding from gastrointestinal varices.

Full text

PDF
257

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alvarez F., Bernard O., Brunelle F., Hadchouel P., Odièvre M., Alagille D. Portal obstruction in children. I. Clinical investigation and hemorrhage risk. J Pediatr. 1983 Nov;103(5):696–702. doi: 10.1016/s0022-3476(83)80460-0. [DOI] [PubMed] [Google Scholar]
  2. Alvarez F., Bernard O., Brunelle F., Hadchouel P., Odièvre M., Alagille D. Portal obstruction in children. II. Results of surgical portosystemic shunts. J Pediatr. 1983 Nov;103(5):703–707. doi: 10.1016/s0022-3476(83)80461-2. [DOI] [PubMed] [Google Scholar]
  3. Bismuth H., Franco D., Alagille D. Portal diversion for portal hypertension in children. The first ninety patients. Ann Surg. 1980 Jul;192(1):18–24. doi: 10.1097/00000658-198007000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dilawari J. B., Chawla Y. K., Ramesh G. N., Mitra S. K., Walia B. N. Endoscopic sclerotherapy in children. J Gastroenterol Hepatol. 1989 Mar-Apr;4(2):155–160. doi: 10.1111/j.1440-1746.1989.tb00820.x. [DOI] [PubMed] [Google Scholar]
  5. Dilawari J. B., Chawla Y. K. Spontaneous (natural) splenoadrenorenal shunts in extrahepatic portal venous obstruction: a series of 20 cases. Gut. 1987 Oct;28(10):1198–1200. doi: 10.1136/gut.28.10.1198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dina R., Cassisa A., Baroncini D., D'Imperio N. Role of esophageal brushing cytology in monitoring patients treated with sclerotherapy for esophageal varices. Acta Cytol. 1992 Jul-Aug;36(4):477–479. [PubMed] [Google Scholar]
  7. Hassall E., Berquist W. E., Ament M. E., Vargas J., Dorney S. Sclerotherapy for extrahepatic portal hypertension in childhood. J Pediatr. 1989 Jul;115(1):69–74. doi: 10.1016/s0022-3476(89)80331-2. [DOI] [PubMed] [Google Scholar]
  8. Heaton N. D., Davenport M., Howard E. R. Symptomatic hemorrhoids and anorectal varices in children with portal hypertension. J Pediatr Surg. 1992 Jul;27(7):833–835. doi: 10.1016/0022-3468(92)90377-j. [DOI] [PubMed] [Google Scholar]
  9. Heaton N. D., Howard E. R. Complications and limitations of injection sclerotherapy in portal hypertension. Gut. 1993 Jan;34(1):7–10. doi: 10.1136/gut.34.1.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Heloury Y., Valayer J., Hay J. M., Gauthier F., Alagille D. Hypertension portale chez l'enfant. Attitude thérapeutique en cas d'échec d'une dérivation portosystémique. Chir Pediatr. 1986;27(3):143–147. [PubMed] [Google Scholar]
  11. Hill I. D., Bowie M. D. Endoscopic sclerotherapy for control of bleeding varices in children. Am J Gastroenterol. 1991 Apr;86(4):472–476. [PubMed] [Google Scholar]
  12. Howard E. R., Stringer M. D., Mowat A. P. Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices. Br J Surg. 1988 May;75(5):404–408. doi: 10.1002/bjs.1800750504. [DOI] [PubMed] [Google Scholar]
  13. Kokudo N., Sanjo K., Umekita N., Harihara Y., Tada Y., Idezuki Y. Squamous cell carcinoma after endoscopic injection sclerotherapy for esophageal varices. Am J Gastroenterol. 1990 Jul;85(7):861–864. [PubMed] [Google Scholar]
  14. Maksoud J. G., Gonçalves M. E., Porta G., Miura I., Velhote M. C. The endoscopic and surgical management of portal hypertension in children: analysis of 123 cases. J Pediatr Surg. 1991 Feb;26(2):178–181. doi: 10.1016/0022-3468(91)90904-8. [DOI] [PubMed] [Google Scholar]
  15. Mitra S. K., Rao K. L., Narasimhan K. L., Dilawari J. B., Batra Y. K., Chawla Y., Thapa B. R., Nagi B., Walia B. N. Side-to-side lienorenal shunt without splenectomy in noncirrhotic portal hypertension in children. J Pediatr Surg. 1993 Mar;28(3):398–402. doi: 10.1016/0022-3468(93)90239-h. [DOI] [PubMed] [Google Scholar]
  16. Mowat A. P. Prevention of variceal bleeding. J Pediatr Gastroenterol Nutr. 1986 Sep-Oct;5(5):679–681. [PubMed] [Google Scholar]
  17. Pande G. K., Reddy V. M., Kar P., Sahni P., Berry M., Tandon B. N., Nundy S. Operations for portal hypertension due to extrahepatic obstruction: results and 10 year follow up. Br Med J (Clin Res Ed) 1987 Oct 31;295(6606):1115–1117. doi: 10.1136/bmj.295.6606.1115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Paquet K. J. Ten years experience with paravariceal injection sclerotherapy of esophageal varices in children. J Pediatr Surg. 1985 Apr;20(2):109–112. doi: 10.1016/s0022-3468(85)80280-3. [DOI] [PubMed] [Google Scholar]
  19. Rice S., Lee K. P., Johnson M. B., Korula J., Ralls P. W. Portal venous system after portosystemic shunts or endoscopic sclerotherapy: evaluation with Doppler sonography. AJR Am J Roentgenol. 1991 Jan;156(1):85–89. doi: 10.2214/ajr.156.1.1898575. [DOI] [PubMed] [Google Scholar]
  20. Stamatakis J. D., Howard E. R., Psacharopoulos H. T., Mowat A. P. Injection sclerotherapy for oesophageal varices in children. Br J Surg. 1982 Feb;69(2):74–75. doi: 10.1002/bjs.1800690205. [DOI] [PubMed] [Google Scholar]
  21. Warren W. D., Henderson J. M. Endoscopic sclerotherapy for oesophageal varices in children. Br J Surg. 1988 Oct;75(10):1045–1045. doi: 10.1002/bjs.1800751037. [DOI] [PubMed] [Google Scholar]
  22. Webb L. J., Sherlock S. The aetiology, presentation and natural history of extra-hepatic portal venous obstruction. Q J Med. 1979 Oct;48(192):627–639. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES