Thirty-three children with
esophageal varices due to
portal hypertension underwent injection
sclerotherapy over a period of 6 yr. Thirty-one completed the
sclerotherapy course, and the
varices were eradicated in all. In nine, the procedure was performed as an emergency because of continued
bleeding and, in each case, a gastric fundal
varix was the source of the blood loss.
Sclerotherapy successfully controlled the
bleeding in four of these, whereas five required surgical underrunning of the fundal
varix. After surgery, these five continued
sclerotherapy until the
esophageal varices were eradicated. Complications included transient
pyrexia (39%), retrosternal discomfort (30%), esophageal ulceration (18%), and
esophageal stricture (12%). Rebleeding before initial eradication of the
varices occurred in 12 patients but, thereafter, was very uncommon and always small in amount.
Esophageal varices recurred after initial eradication in 33% of cases but were easily sclerosed with further
injections. This study demonstrates that
sclerotherapy is effective in reducing
bleeding frequency in children with
portal hypertension, but emphasizes the need for regular follow-up endoscopy after initial eradication of
esophageal varices.