Paediatric Hepatobiliary

Endoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous obstruction: Benefit of injection tract embolisation

Victor Lewa Bandika, Elizabeth A Goddard, Ronalda D De Lacey, Robin Alexander Brown

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%).

Conclusion. 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' affiliations

Victor Lewa Bandika, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town

Elizabeth A Goddard, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town

Ronalda D De Lacey, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town

Robin Alexander Brown, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town

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Keywords

Endoscopic injection sclerotherapy; esophageal varices; portal hypertension, Extra hepatic portal vein obstruction

Cite this article

South African Medical Journal 2012;102(11):884-887. DOI:10.7196/SAMJ.6263

Article History

Date submitted: 2012-09-04
Date published: 2012-09-11

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