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Management of Variceal Hemorrhage in Children with Extrahepatic Portal Venous Obstruction-Shunt Surgery Versus Endoscopic Sclerotherapy

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Abstract

Extrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertention in children. Esophageal variceal hemorrhage is a major cause of morbidity and mortality in these patients. For many decades, portal systemic shunts were considered as the most effective treatment of variceal hemorrhage. Endoscopic injection sclerotherapy (EIS) was first introduced for emergency management of bleeding varices and subsequently as definitive treatment to prevent recurrent hemorrhage. The purpose of the study was to compare the safety and efficacy of shunt surgery and endoscopic sclerotherapy for patients with proven esophageal variceal bleeding due to EHPVO. The study was a prospective randomized study of 61 children with bleeding esophageal varices due to EHPVO carried out jointly by the department of General Surgery and Gastroenterology at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, between March 2001 and September 2003. Thirty patients received surgery and other 31 patients received EIS. Overall incidence of rebleeding was 22.6% in sclerotherapy group and 3.3% in shunt surgery group. Treatment failure occurred in 19.4% patients in sclerotherapy group and 6.7% in shunt surgery group. The rebleeding rate of sclerotherapy is significantly higher than that of shunt surgery. However, the therapy failure rate of sclerotherapy is not significantly different from that of shunt surgery.

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References

  1. Orozco H, Takahashi T, Mercado MA, Prado E, Chan C (1994) Surgical management of extrahepatic portal hypertension and variceal bleeding. World J Surg 18:246–250

    Article  PubMed  CAS  Google Scholar 

  2. Kagzi RS, Nadkarni KM, Jahangirdar RR, Pinto AC, Bhalerao RA (1982) Evaluation of the surgical treatment of extrahepatic portal hypertension. Indian J Surg 44:420–426

    Google Scholar 

  3. Pande GK, Reddy VM, Kar P, Sahni P, Berry M, Tandon BN (1987) Operation for portal hypertension due to extrahepatic obstruction: result and 10 year follow-up. Br Med J 295:1115–1117

    Article  CAS  Google Scholar 

  4. Garg PK, Joshi YK, Tandon RK (1999) Comparison of endoscopic variceal sclerotherapy with sequential endoscopic band ligation plus low-dose sclerotherapy for secondary prophylaxis of variceal hemorrhage: a prospective randomized study. Gastrointest Endosc 50:369–373

    Article  PubMed  CAS  Google Scholar 

  5. Hill TD, Bowle MD (1991) Endoscopic sclerotherapy for control of bleeding varices in children. Am J Gastroenterol 86:472–476

    PubMed  CAS  Google Scholar 

  6. Mitra SK, Rao KLN, Narasinham KL, Dilawari JB, Batra YK, Chawla Y et al (1993) Side-to-side lienorenal shunt without splenectomy in noncirrhotic portal hypertension in children. J Pediatr Surg 78:398–402

    Article  Google Scholar 

  7. Howard ER, Stringer MD, Mowat AP (1998) Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices. Br J Surg 75:404–408

    Article  Google Scholar 

  8. Stringer MD, Howard ER (1994) Long-term outcome after injection sclerotherapy for oesophageal varices in children with extrahepatic portal hypertension. Gut 35:257–259

    Article  PubMed  CAS  Google Scholar 

  9. Alvarez F, Bernard O, Brunnelle F, Hadchouel P, Odièvre M, Alagille D (1983) Portal obstruction in children. Clinical investigations and hemorrhage risk. J Pediatr 103:696–702

    Article  PubMed  CAS  Google Scholar 

  10. Jean-Bernard OHC, Reynaert M, De Hemptime B (1982) Arterialization of the portal vein in conjunction with a therapeutic portal shunt. Ann Surg 196:656–662

    Article  Google Scholar 

  11. Webb IJ, Sherlock S (1979) The etiology, presentation and natural history of extrahepatic portal venous obstruction. Q J Med 48:627–639

    PubMed  CAS  Google Scholar 

  12. Gimson AE, Ramage JK, Panos MZ, Hayllar K, Harrison PM, Williams R (1993) Randomized trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices. Lancet 342:391–394

    Article  PubMed  CAS  Google Scholar 

  13. Langer B, Taylor BR, Mackenzie DR, Gilas T, Stone RM, Blendis L (1985) Further report of a prospective randomized trial comparing distal splenorenal shunt with end-to-side portocaval shunt. Gastroenterol 88:424–429

    CAS  Google Scholar 

  14. Cello JP, Grendell JH, Crass RA, Weber TE, Trunkey DD (1987) Endoscopic sclerotherapy versus portocaval shunt in patients with severe cirrhosis and acute variceal hemorrhage. N Engl J Med 316:11–15

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, SD Hospital Kupwara, Kashmir, India, 193222

    Arshad Hussain Wani

  2. Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India

    Omar Javed Shah

  3. Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India

    S. A. Zargar

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  1. Arshad Hussain Wani
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  2. Omar Javed Shah
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  3. S. A. Zargar
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Correspondence to Arshad Hussain Wani.

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Wani, A.H., Shah, O.J. & Zargar, S.A. Management of Variceal Hemorrhage in Children with Extrahepatic Portal Venous Obstruction-Shunt Surgery Versus Endoscopic Sclerotherapy. Indian J Surg 73, 409–413 (2011). https://doi.org/10.1007/s12262-011-0345-z

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  • DOI: https://doi.org/10.1007/s12262-011-0345-z

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