KẾT QUẢ ĐIỀU TRỊ GIÃN TĨNH MẠCH THỰC QUẢN – DẠ DÀY BẰNG THẮT VÒNG CAO SU QUA NỘI SOI Ở TRẺ EM

Abstract

Background: Variceal bleeding is a common complication of portal hypertension with high mortality rate in children. Endoscopic variceal band ligation is the main method to treat and prevent complications. Aims: To assess the efficacy and safety of endoscopic variceal band ligation in children with esophageal–gastric varices.  Materials and methods: Case series descriptive study was performed at the National Children's Hospital from July 2022 to June 2023. A total of 40 pediatric patients were treated for esophageal–gastric varices due to portal hypertension with endoscopic variceal band and evaluated for effectiveness and safety after 1 month. Results: The mean age of the study population was 8.3 ± 4.9 years and the mean weight was 23.1 ± 11.9 kg (from 8.0 kg to 54.0 kg). Most of the study subjects had hepatomegaly (77.5%) and splenomegaly (82.5%). Indications for ligation to prevent primary bleeding were performed on 21 pediatric patients (52.5%) and secondary bleeding prevention in 19 pediatric patients (47.5%). First endoscopy, the proportion of patients with esophageal varices grade 4: 32.5%; grade 3: 62.5%; grade 2: 5.0%; and there are no grade 1 patients; and gastric varices 57.5%. Second endoscopy1 month after ligation, the proportion of patients with esophageal varices grade 4: 8.6%; grade 3: 28.6%; grade 2: 57.1%; and grade 1: 5.7%; and gastric varices 28.6%. Undesirable manifestations after endoscopy include, painful swallowing (2.9%) and pain behind the sternum (37.1%), there were no patients with bleeding, esophageal perforation. The failure rate after the second endoscopy was 2.9% (1 child 15 months, 8 kg, the probe cannot be inserted through the upper esophageal sphincter). Conclusion: Treatment of esophageal-stomach varices with endoscopic rubber band ligation in children is effective and safe