Abstract
The optimum method for the prevention of rebleeding from oesophageal varices remains controversial. Conservative treatment in children is associated with frequent rebleeding and a mortality rate of approximately 12%. Rebleeding occurs in 7 to 43% after oesophageal devascularisation or portosystemic shunting which may be complicated by enceaphalopathy, even in children with good hepatic function.
To assess the long-term efficiency of injection sclerotherapy, we have evaluated 68 children - 31 with portal vein obstruction (PVO)and 37 with intrahepatic disease(IHD) - treated by one operator (ERH) between 1979 & 1984. Although all cases had bled on at least two occasions before sclerotherapy rebleeding occurred in only six (one with PVO) from 2-6 years after variceal obliteration. Mild chest pain and fever were common for 48hrs after injection and 5 children developed oesophageal strictures which were relieved by simple dilatation. Abnormal oesophageal motility caused intermittent dysphagia in 2 cases. Five died from progression of their liver disease.
Sclerotherapy is a safe and effective means of preventing rebleeding from oesophageal varices, particularly in children with PVO. It is also useful in IHD where its use does not increase the difficulty of liver transplantation, should this become necessary later.
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Howard, E., Mowat, A. 66. BLEEDING OESOPHAGEAL VARICES IN CHILDREN: EVALUATION OF INJECTION SCLEROTHERAPY. Pediatr Res 22, 107 (1987). https://doi.org/10.1203/00006450-198707000-00087
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DOI: https://doi.org/10.1203/00006450-198707000-00087