Endoscopic sclerotherapy of esophageal varices in children with prehepatic portal hypertension

Abstract Endoscopic sclerotization of oesophageal varices in adult patients with prehepatic portal hypertension has become the method of choice in haemorrhage from these varicosities. The objective of the present work was to prove the effectiveness of this treatment in children. Between November 1987 and May 1993 in the authors' departments endoscopic sclerotization was used to treat 20 children (age 2.5-17 years) with bleeding oesophageal varices (o.v.) associated with prehepatic portal hypertension (PPH), caused by thrombosis of the portal vein. Half the children were treated unsuccessfully before sclerotherapy by surgery, some repeatedly. Complete eradication of o.v. was achieved in 19 children (95%). In the course of sclerotherapy before completed obliteration of all varices 5 children (25%) had another spell of haemorrhage. In three instances this early relapse of haemorrhage was controlled by another sclerotization. In one patient continuing haemorrhage from an oesophageal varix was treated by establishment of a splenorenal anastomosis. In another patient the source of haemorrhage were gastric varices which were ligatured and after the operation the authors proceeded with sclerotherapy. A relapse of o.v. during the average 3-year follow up period was recorded in 7 children (35%), while a relapse of haemorrhage from these neovarices occurred only in one child (5%). Successful eradication of oesophageal varices by sclerotherapy in 95%, and 95% successful prevention of relapsing haemorrhage from neovarices for a period of three years after surgery justify a change of tactics of treatment. The method of first choice should be always sclerotization of bleeding varices.