All issues > Volume 36(12); 1993

Original Article

J Korean Pediatr Soc. 1993;36(12):1691-1700. Published online December 15, 1993.

Esophageal Varix in Children - Endoscopic Evaluation and Clinical characteristics-

Soon Young SY Kim¹, Jeong Kee JK Seo¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Abstract

Fifty five children with encoscopically proven esophageal varices form Jul. 1987 to Dec. 1992 were analyzed for endoscopic and clinical characteristics. The results were as follows : 1) According to etiological classification of portal hypertension in 55 cases, 35 cases showed intrahepatic causes (64%) and cases had extrahepatic causes (36%). The most common clinical manifestation on admission was hematemesis (42%) and abdominal mass (36%). 2) Portal vein thrombosis was the most common cause of portal hypertension. Patients with portal vein thrombosis showed more frequent bleeding than with intrahepatic portal hypertension. Most of them had the first bleeding episode before 7 years old of age. Progression of portal hypertension in portal vein thrombosis was more rapid and bleeding episode was earlier than that in most of intrahepatic causes of the portal hypertension. 3) Twenty patients showed gastritis (10 cases), duodenitis (4 cases), gastric ulcer (4 cases) and esophagitis (2 cases) besides varix on the endoscopic examination. In 4 cases, the causes of upper GI bleeding was found as duodenal ulcer (3 cases) or hemorrhagic errosive gastritis (1 cases) with no variceal bleeding. 4) Among 36 cases with variceal bleeding, 20 cases had predisposing factors for bleeding such as medication for URI including Aspirin. 5) More than one episode of bleeding were noted in 36 cases (65%) of the patients with varix. Thirty-one cases were treated conservatively with success. The remaining 5 cases with severe bleeding were managed with IV pitressin, SB-tube insertion and emergency shunt operation. High mortality rate (40%) was found in these patients group. In conclusion, in patients with clinically suspected portal hypertension. Regular endoscopic examination might be recommended for the earlier recognition and effective prevention of variceal bleeding. For bleeding varices, in addition to conservative management, active treatment such as pitressin, SB-tube, sclerotherapy, endoscopic variceal ligation and emergency shunt operation should be considered with the emergency endoscopy with can identify bleeding focus and predict the chance or rebleeding.

Keywords :Esophageal varix, Protal hypertension, Children, Gastroduodenoscopy