MANAGEMENT OF ESOPHAGEAL-VARICES IN CHILDREN BY ENDOSCOPIC VARICEAL LIGATION

Endoscopic variceal sclerotherapy (EVS) has been considered the mainst ay of therapy for bleeding esophageal varices in adults. However, rece nt data have shown that endoscopic variceal ligation (EVL) is just as efficacious and has fewer complications than EVS. Although there are m any reports concerning EVL in adults, only a few studies have been don e in children. This report describes experience with EVL in 22 childre n with esophageal variceal hemorrhage. Eighty-seven EVL procedures wer e performed during a g-year period in 22 children. The causes of porta l hypertension were biliary atresia (10), portal vein thrombosis (8), chronic active hepatitis (1), cirrhosis secondary to cystic fibrosis ( 2), and primary sclerosing cholangitis (1). The age range at the onset of variceal bleeding was 8 months to 19 years. Twelve patients had EV S before EVL treatment was begun. Distal esophageal varices (one to fo ur per session) were mechanically ligated using an elastic band ligatu re device attached to a flexible endoscope. The aim of therapy was obl iteration of distal esophageal varices by EVL, every 2 to 4 weeks, unt il eradication. Subsequent EVL was dictated by the status of the varic es. Outcome was assessed with respect to survival, rebleeding, status of varices, and complications. The patients underwent a mean of four s essions of EVL (range, one to eight). Four patients subsequently under went liver transplantation. Of the 18 patients remaining (average foll ow-up period, 5.3 years), 12 had their varices eradicated (average of four EVL sessions), four are still in treatment, one has not been eval uated in the past 4 years, and one died of liver failure. Complication s included bleeding between sessions (6 patients), cervical esophageal perforation (1 patient), and transient fever (2 patients). No child h as experienced symp toms of esophageal stenosis or gastroesophageal re flux. Two patients died of liver disease, unrelated to bleeding from p ortal hypertension. EVL is effective in controlling variceal hemorrhag e in children with portal hypertension, regardless of etiology. The co mplication rate is low, and EVL is an acceptable and perhaps preferabl e alternative to EVS in children with esophageal varices. Copyright (C ) 1996 by W.B. Saunders Company