Esophageal endosclerosis in children with portal vein thrombosis.

During the past 3 2/3 yr, 6 children with portal vein thrombosis were treated for esophageal hemorrhage by direct injection of esophageal varices with sodium morrhuate (endosclerosis). Four children were actively hemorrhaging at the time of initial endosclerosis; 2 patients were treated electively. Endosclerosis was performed by (1) employment of an especially slotted rigid esophagoscope, (2) direct intravariceal injection, (3) injection of varices at the gastroesophageal junction only. In patients actively hemorrhaging, endosclerosis was repeated every 3 to 4 days until the bleeding ceased. Once bleeding was controlled the procedure was done at 6-wk intervals until esophageal varices were obliterated. In the four patients actively hemorrhaging, bleeding was controlled by 2 to 3 separate injection sessions. Four patients have completed treatment and varices are absent radiographically and endoscopically. No patient has rebled during or after treatment in follow-up from 1/6 to 3 2/3 yr. Esophageal endosclerosis is advocated as a legitimate alternative to portosystemic shunt operations and nonoperative management of esophageal variceal hemorrhage in children with portal vein thrombosis.