JP Lu, Y Huang, SY Chen, J Wu

Abstract

Purpose: Our purpose was to evaluate the efficacy and safety of endoscopic variceal band ligation (EVL) and Histoacryl injection for the treatment of gastroesophageal varices in children. Risk factors of rebleeding were analysed preliminarily. Methods: 15 children with esophageal varices and/or gastric varices who received EVL and/or Histoacryl injection were enrolled at our endoscopy center between October 2009 and March 2012. Demographic data, clinical characteristics and endoscopic data were registered and analysed as a Single-center prospective study. Results: The mean age was 9.5±3.3 years (2.5-14.3 years). The mean of clinical follow-up was 13.0±10.8 months (range 1-30 months). EVL and/or Histoacryl injection was successfully performed in all children. Immediate control of bleeding was achieved in all cases. The number of rubber bands placed in all patients ranged from 2 to 6. Early slippage of the rubber bands were not been found in the post-EVL rebleeding. Varices relapse with rebleeding was observed in 4 of 15 (26.7%) patients after a mean time of 14.8±6.5 weeks (5-24 weeks) follow-up. Patients with variceal rebleeding were retreated. Aggravated coagulation state, decreased platelets and ascites may be meaningful in predicting rebleeding. During follow-up, no fatal complication was observed in the patients. Conclusion: In children, the use of EVL and Histoacryl injection is safe and effective for the treatment of gastroesophageal varices. Effective measures for prevention and treatment of rebleeding should be adopted before and after operation.

目的：評估在兒童中應用內鏡下靜脈曲張套紮術（EVL）和組織黏合劑注射治療胃食管靜脈曲張的療效和安全性。初步分析了再出血的危險因素。方法：2009年10月-2012年3月期間，我們內鏡中心納入了15名食管靜脈曲張和/或胃靜脈曲張的兒童，他們接受了EVL和/或組織黏合劑注射治療。作為一項單中心前瞻性研究，記錄了患兒人口統計學資訊、臨床資料和內鏡資料，並加以分析。結果：患兒平均年齡是9.5±3.3 歲（2.5-14.3 歲）。臨床平均隨訪時間為13.0±10.8月（範圍：1-30月）。所有患兒成功接受了EVL和/或組織黏合劑注射治療，並且都能立即控制出血。所有患兒使用橡膠圈2-6個。EVL術後再出血中未見橡膠圈早期滑脫。經過平均14.8±6.5週（5-24週）隨訪，26.7%（4/15）的患兒出現靜脈曲張復發再出血。再出血患兒接受了治療。血凝增強、血小板降低和腹水對預測再出血有意義。隨訪期間患兒無致命性併發症。結論：在兒童中，使用EVL和組織黏合劑注射治療胃食管靜脈曲張安全有效。術前術後應採取有效措施防治再出血。