Esophageal endoscopic sclerotherapy in children using 3% aqueous phenol.

OBJECTIVE: To study the efficacy of endoscopic variceal sclerotherapy (EST) in controlling acute variceal bleeding and preventing recurrence of bleeding from esophageal varices in children. METHODS: Ninety children (mean age 7.3 +/- 3.0 years) with portal hypertension [extra-hepatic portal venous obstruction (EHPVO) 83, cirrhosis 7] presenting with hematemesis and/or melena were subjected to EST using 3% phenol in water as sclerosant. RESULTS: Active variceal bleeding could be controlled in 31 of 34 (91%) cases. Varices could be obliterated in 87% of patients with a mean of 5.4 +/- 2.5 injection sessions. Pre-obliteration variceal rebleeding was observed in 15% of patients. Complications such as esophageal ulceration, stricture and perforation were observed in 32%, 4.5% and 1% of patients respectively. Strictures responded to dilatation whereas perforation responded to conservative treatment. Recurrence of varices was seen in 22% of patients at a mean interval of 5.8 +/- 1.9 months. The mortality in the emergency group was 9.5% and nil in the elective group. Ten percent of patients required surgical intervention. CONCLUSION: EST with 3% phenol in water is effective in controlling active bleeding as well as preventing recurrent bleeding from esophageal varices in children.