198
THE EFFICIENCY OF ENDOSCOPIC LIGATING OF ESOPHAGEAL VARICES IN
CHILDREN WITH EXTRAHEPATIC PORTAL HYPERTENSION
Turaev B. master's degree student of TashPMI
Supervisor: prof. M.M. Aliyev
TashPMI, Department of Pediatric Surgery
Background:
Bleeding from esophageal varices is considered as a devastating complication of the
portal hypertension, with a high rate of mortality. However, prophylaxis and management of bleeding from
esophageal varices currently is still a matter of debate for children with portal hypertension. According to
endoscopic criteria and recent reports, endoscopic reduction of esophageal varices (EST, EVL) has been
considered as a beneficial and important method in children population.
Aim of the study:
to learn and assess EVL on eradication of esophageal varices in children with
EXPH.
Materials and methods:
A retrospective and prospective cohort study was performed. 11 patients
with esophageal varices who were diagnosed with an Extra-Hepatic Portal Hypertension (EHPH) and
underwent endoscopy banding of esophageal varices between January 2015 and December 2019 in
Pediatric Surgery Department of RSSPMCP in Tashkent were included in the study. Patients underwent
this procedure two times with the period of 1 month to 12 months between procedures. Band ligation was
performed using the multiband ligator under general anesthesia. Esophagogastroduodenoscopy findings
examined three times: before 1
st
procedure, before 2
nd
procedure and after 2
nd
procedure. All statistical
analyses were carried out with SPSS Statistics 22.0 software.
Results:
all procedures were performed without any intraoperative complications, such as death,
severe hemorrhage and etc. During first examination only 3
rd
and 4
th
degrees of esophageal varices were
revealed, while during last examination only 1
st
degrees were found. Comparing these findings using
Wilcoxon-signed rank test showed statistically difference (z- score=-3.022, p=0.003). Re-bleeding
occasions have not followed during follow-up period after procedures. Besides that, red spots (indicators
of high risk of bleeding) was revealed in 5 patients, while no red spots were found during last examination
(p=0.006). On the other hand, gastric varices type GOV1 and gastropathy remained stable (in 5 patients in
both), while type GOV2 gastric varix increased (from 3 patients to 6 patients) (p=0.013).
Conclusion:
Gastroesophageal variceal hemorrhage is the most serious life threatening complication
of portal hypertension. Endoscopic ligation of esophageal varices is one of the most wide-spread procedure
to eradicate varices, especially, in patients with EXPVO. Our study showed EVL is a safe and highly
effective method for eradicate the esophageal varices and prophylaxis of varicealrebleeding in children
with portal hypertension. However, there is no influence of EVL procedure to gastric varices.
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