Endoscopic ligation of esophageal varices for prophylaxis of first bleeding in children and adolescents with portal hypertension: Preliminary results of a prospective study
Endoscopic ligation of esophageal varices for prophylaxis of first bleeding in children and adolescents with portal hypertension: Preliminary results of a prospective study
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DOI：
10.1016/s0022-3468(03)00181-7
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发表时间：
2003-07-01
影响因子：
2.4
通讯作者：
Ryzko, J
中科院分区：
文献类型：
--
作者：
Celinska-Cedro, D;Teisseyre, M;Ryzko, J
背景/目的：内镜下静脉曲张结扎术（EVL）在控制儿童食管静脉曲张再出血方面是有效的，但尚无EVL用于预防初始出血的数据。本研究的目的是前瞻性地评估EVL在预防儿童食管静脉曲张首次出血的疗效。方法：37例门静脉高压症儿童（22例肝硬化，15例门静脉血栓形成），年龄4至17岁（M = 9.5 +/- 4.4岁），被纳入本研究。入选标准为：（1）既往无静脉曲张出血;（2）存在分级为11级或以上的食管静脉曲张;（3）观察6个月后，未进行内镜治疗或出现高出血风险的内镜体征，食管静脉曲张扩大至少为I级。使用多环结扎器，根据静脉曲张的数量和大小，在一次手术中在全身麻醉下固定2至6个环。每3个月进行一次随访检查，必要时重复该程序。结果：4例患者在静脉曲张根除前接受了肝移植。另外两名患者因未遵守方案而被排除在观察之外。在其余31例患者中，28例（90.3%）在间隔3个月进行2.0次EVL治疗后实现了静脉曲张根除。停止治疗后的平均随访时间为16个月。在治疗期间或治疗后，没有任何儿童发生静脉曲张出血。肝硬化和门静脉血栓形成患儿之间的结果无差异。在2名儿童中观察到高血压胃病的发展，其中一次出血。复发的静脉曲张无出血发生在3名儿童后12，13，28个月的根除.Conclusions：研究结果证实，内镜下静脉曲张结扎术是一种安全，高效的程序在儿童门静脉高压症，无论其病因。食管静脉曲张根除后16个月无出血。如果预防性EVL影响疾病的自然史并降低首次出血发作的风险，则必须进行长期观察以得出结论。(C)2003年爱思唯尔公司All rights reserved.
Background/Purpose: Endoscopic variceal ligation (EVL) is effective in controlling rebleeding from esophageal varices in children, but there is no data on the use of EVL to prevent initial bleeding. The objective of this study was to prospectively evaluate the efficacy of EVL in preventing the first hemorrhage from esophageal varices in children.Methods: Thirty-seven children with portal hypertension (22 liver cirrhosis, 15 portal vein thrombosis), aged 4 to 17 years (M = 9.5 +/- 4.4 years) were included in the study. The criteria for inclusion were (1) no previous variceal bleeding; (2) the presence of esophageal varices classified grade 11 or more, and (3) their enlargement by at least I grade after 6 months of observation without endoscopic treatment or appearance of endoscopic signs of high bleeding risk. A Multi-Band Ligator was used, and 2 to 6 bands were fixed under general anesthesia during one procedure depending on the number and size of varices. Follow-up examinations were performed every 3 months, repeating the procedure if necessary. In total, 75 procedures of EVL were performed, from one to 5 in each patientResults: Four patients underwent liver transplantation before eradication of varices. Two others were excluded from the observation because of lack of compliance to the protocol. Of the remaining 31 patients, eradication of varices was achieved in 28 children (90.3%) after 2.0 EVL sessions performed at 3-month intervals. The average time of follow-up after cessation of treatment is 16 months. No bleeding from varices occurred in any child during or after treatment. There were no differences in results between children with liver cirrhosis and portal vein thrombosis. Development of hypertensive gastropathy was observed in 2 children with one episode of bleeding. Recurrence of varices without bleeding occurred in 3 children after 12, 13, and 28 months from eradication.Conclusions: The study results confirmed that endoscopic variceal ligation is a safe and highly effective procedure in children with portal hypertension, regardless of its etiology. Eradication of esophageal varices was followed by 16 months free of bleeding. Prolonged observation is mandatory to conclude if preventive EVL influences the natural history of disease and diminishes the risk of first bleeding onset. (C) 2003 Elsevier Inc. All rights reserved.