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Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction
Author(s) -
Zargar Showkat Ali,
Javid Gul,
Khan Bashir Ahmad,
Yattoo Ghulam Nabi,
Shah Altaf Hussain,
Gulzar Ghulam Mohammad,
Singh Jaswinder,
Rehman Bilalul,
Din Ziaud
Publication year - 2002
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2002.35278
Subject(s) - sclerotherapy , medicine , ligation , esophageal varices , varices , surgery , varix , portal hypertension , cirrhosis , gastroenterology
Endoscopic sclerotherapy is an effective treatment for bleeding esophageal varices, but it is associated with significant complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, has been shown to be superior to sclerotherapy in adult patients with cirrhosis. To determine the efficacy and safety of endoscopic sclerotherapy and ligation, the 2 methods were compared in a randomized control trial in 49 children with extrahepatic portal venous obstruction who had proven bleeding from esophageal varices. Twenty‐four patients were treated with sclerotherapy and 25 with band ligation. No significant differences were found between the sclerotherapy and ligation groups in arresting active index bleeding (100% each) and achieving variceal eradication (91.7% vs. 96%, P = .61). Band ligation eradicated varices in fewer endoscopic sessions than did sclerotherapy (3.9 ± 1.1 vs. 6.1 ± 1.7, respectively, P < .0001). The rebleeding rate was significantly higher in the sclerotherapy group (25% vs. 4%, P = .049), as was the rate of major complications (25% vs. 4%, P = .049). After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy (17.4% vs. 10%, P = .67). In conclusion, variceal band ligation in children is a safe and effective technique that achieves variceal eradication more quickly, with a lower rebleeding rate and fewer complications compared with sclerotherapy.