Comparison of injection sclerotherapy only for bleeding esophageal varices and injection sclerotherapy with somatostatin analogue infusion: randomized prospective study with 2 years follow-up in children

ABSTRACT

Portal hypertension is a pathological rise of portal blood pressure above 10 mmHg with subsequent development of portosystemic collaterals including esophageal varices. Variceal hemorrhage may cause significant morbidity and mortality in children with cirrhosis and rational for upper Endoscopy. Besides the general hemodynamic resuscitation, Octerotide was used to control acute bleeding with success. Endoscopic sclerotherapy arrests hemorrhage in 80% to 90% of cases, however, with 0.5% to 2% mortality. To evaluate the difference between treating first time bleeding varices in children with Endoscopic sclerotherapy alone or combined with Somatostatrn analogue, Octerotide, we designated this random, prospective study and 2 year follow-up. Forty children were enrolled, 30 male and 10 females. Children were randomly divided into 2 groups Group I consists of 20 children with first time bleeding esophageal varices who were treated by injection sclerotherapy only and Group II consists of simlar 20 children whom bleeding was managed by sclerotherapy and Octerotide. The sample was homogenous as regard the clinical presentations and examination except for hepatomegaly which was seen in 7 [35%] in group I and in 13 [65%] in group II. Portal vein thrombosis, Bilharzial fibrosis and post-hepatitic cirrhosis represented the most frequent etiology with 13 [32.5%], 9 [22.5%] and 7 [17.5%] order of detection. Endoscopic appearance at the time of first bleeding revealed predominance of grade II varices. It was seen in 12 [60%] in group I and 10 [50%] in group II. Two years later majority of group I varices were grade I, while majority of group II varices were grade II [0 [55%] and 11 [70%] respectively]. Portal hypertensive gastropathy were absent in 12 [61%] in group I and in II [70%] in group II after 2 years follow-up. Endoscopy and Octerotide related complications were seldom in this study. We concluded that Injection sclerotherapy remains the standard of care, combining Octerotide can improve the control of acute bleeding and early rebleeding however, its high cost renders its use rather limited