ENDOSCOPIC VARICEAL LIGATION IN THE MANAGEMENT OF GASTROESOPHAGEAL VARICES IN POSTOPERATIVE BILIARY ATRESIA

Background/Purpose: Gastroesophageal variceal bleeding is a serious an d difficult problem in the long-term management of biliary atresia (BA ). Recently, endoscopic approaches have been attempted to manage this problem. The authors have attempted endoscopic variceal ligation (EVL) , a less invasive procedure than endoscopic sclerotherapy. Methods: In the past 5 years, 66 EVL procedures using standard flexible endoscope with a diameter of 9 mm (type p-30, XQ200, or XQ240; Olympus, Tokyo, Japan) were performed in 30 separate sessions on 11 postoperative BA p atients. The mean age of the children was 7.8 (range, 3 to 15) years. The EVL device was a small elastic O-ring or a loop ligator. Results: EVL was performed for emergency hemostasis in two patients and prophyl axis for impending rupture in nine with Targe, blue varices, or with r ed spots on the variceal surface. During the initial procedure, all va rices were ligated successfully, and reduction in size was noted. Of e ight patients who were examined 7 to 14 days after treatment, seven (8 7.5%) had improved. Eight of 11 patients (72.7%) were finally cured or at least had improved after one to seven sessions of EVL. However, th ree patients did not show improvement after four to seven sessions bec ause of the reappearance of the varices, development of distal lesions such as gastric varices, and acute gastric mucosal lesions. A technic al complication encountered was a slippage of the O-ring in one patien t. A technical difficulty was seen in ligating the giant gastric varix in one patient. There was no deterioration of liver function induced by EVL in this entire series. Conclusions: EVL is an effective and fea sible treatment of gastroesophageal varices in postoperative BA patien ts. However, reappearance or reactivation of the varices or emergence of the more distal lesions is likely to occur even after repeated EVL. Copyright (C) 1998 by W.B. Saunders Company.