The effectiveness of endoscopic sclerotherapy in the treatment of esophageal varices in children with prehepatic portal hypertension.

Abstract

Aim: This study aims to evaluate the outcomes of endoscopic sclerotherapy (EST) in the treatment of esophagogastric varices in cases of extrahepatic portal hypertension (EHPH) secondary to portal vein thrombosis.

Materials and methods: Records of cases that underwent endoscopic sclerotherapy for esophagogastric varices between 1990 and 2022 in our clinic were retrospectively reviewed. The age, gender, symptomatology, etiology, clinical, laboratory, and radiological data of the patients, as well as treatment outcomes, were evaluated. Results were compared based on age groups, time periods, and etiological factors. The classification of the Japanese Portal Hypertension Research Society was used for variceal assessment. The absence of bleeding or bleeding not requiring transfusion within one year was considered a positive outcome.

Results: Of the 126 cases that underwent endoscopy with a diagnosis of EHPH, 41 had varices at the F1-F2 level and were not subjected to sclerotherapy. In 21 cases, due to advanced varices, gastropathy findings, frequent bleeding episodes, and hypersplenism, surgical indication was established after the first endoscopy. The remaining 64 cases were included in the study. Positive outcomes were achieved in 44 cases with an average of 4.1 sessions. Desired outcomes were not achieved in 20 cases, and surgical procedures were performed. When the results were evaluated based on the periods 1990-2000, 2001-2010, and 2011-2022, the success rates were 60%, 44%, and 88.2%, respectively. Statistically significant more favorable results were obtained in the last decade.

Conclusion: EST is a safe and effective minimally invasive method for the elective treatment of esophagocardial varices in children with EHPH. More effective results have been achieved with increased experience and advancements in imaging technology.