ENDOSCOPIC LIGATION OF ESOPHAGEAL-VARICES IN CHILDREN

Seven consecutive patients presenting acutely with suspected variceal hemorrhage underwent endoscopic variceal Ligation (EVL) of esophageal varices. Active bleeding had ceased by the time of the initial EVL ses sion in all patients, although active variceal hemorrhage was controll ed by EVL in one patient during a subsequent-episode of bleeding. Trea tment sessions were repeated at approximately monthly intervals until varices were reduced in size to grade 1 (<4 mm diameter) or eradicated . All patients had portal hypertension secondary to intrahepatic disea se. Patient age ranged from 2.4 to 14.5 years (mean, 8.5 years). One p atient underwent successful liver transplantation 1 week after the ini tial treatment session. The remaining six patients required a mean (+/ -SD) of 4.0 +/- 1.3 treatment sessions for elimination of varices. One episode of recurrent variceal hemorrhage and one episode of treatment -related hemorrhage occurred in two separate patients. Transient, mild dysphagia or odynophagia occurred in all patients. No other complicat ions were reported during a mean (+/-SD) follow-up period of 13.8 +/- 4.6 months (range, 8-20 months). Recurrent varices were seen in three of four (75%) patients returning for follow-up endoscopy between 5 and 8 months from initial eradication. All underwent repeat EVL without c omplication. Endoscopic variceal ligation may be a suitable substitute for sclerotherapy in children with bleeding esophageal varices.