Esophageal variceal bleeding secondary to portal hypertension: endoscopic sclerotherapy as the first-step treatment.

BACKGROUND

Variceal bleeding from the esophagus is an important cause of mortality and morbidity in children with portal hypertension (PHT).

PATIENTS AND

METHODS

A series of 69 PHT cases (41 intrahepatic, 28 extrahepatic) have been evaluated in our department since 1990. According to the Child-Pugh classification, 49 cases were in class A, 16 cases were in class B, and 4 cases were in class C at admission. In our protocol, endoscopic sclerotherapy is performed in all patients, and the diagnosis is achieved directly by diagnostic laparoscopy and fine-needle liver biopsy. The procedure is applied under general anesthesia, and 1% aethoxysclerol (polidocanol) is injected paravariceally and intravariceally with the use of a flexible endoscope.

RESULTS

The Sugiura procedure was performed in nine patients who presented with recurrent bleeding episodes despite the strict sclerotherapy protocol. Liver transplantation was performed in two patients who were in Child class C. The total mortality rate in this series was 7% (5/69).

CONCLUSION

Endoscopic sclerotherapy, as presented herein, decreases the need for additional surgical interventions in children with PHT.