Outcomes of Endoscopic Variceal Band Ligation for Esophageal Varices in Children
DOI:
https://doi.org/10.51985/Keywords:
Children, esophageal varices, endoscopic variceal band ligation, hematemesis, melenaAbstract
Objective: To determine outcomes of endoscopic variceal band ligation (EVBL) for esophageal varices (EV) in children presenting to a tertiary childcare hospital of Pakistan.
Study Design and Setting: A prospective observational cohort study was conducted at the Department of Pediatric Gastroenterology, The Children’s Hospital and Institute of Child Health, Faisalabad (June 2023–March 2025). Methodology: Children aged 2–16 years with endoscopically confirmed EV scheduled for EVBL were analyzed. Baseline demographics, EV grade, and etiology were recorded. Follow-up endoscopies were performed at 4-week intervals. Outcomes included number of sessions, grade reduction, obliteration, and rebleeding. Data were analyzed using SPSS v26 with p=0.05 considered significant.
Results: In a total of 97 children, the median age was 11 years (interquartile range: 8-13 years), while 51.5% children were female. Endoscopic grading showed Grade III, and IV varices in 67% cases. The mean follow-up was 8.8±2.6 months. Variceal grade reduction was achieved in 93.8%, and complete obliteration in 87.6%. One or two EVBL sessions were sufficient in 82.4%; 17.5% required =3. Rebleeding occurred in 8.2%, with no mortality. Higher-grade varices significantly required more sessions (p=0.0332), though other outcomes showed no significant grade-wise association.
Conclusion: EVBL is a safe, well-tolerated, and effective modality for the management of EV in children
References
1. Perisetti A, Kopel J, Shredi A, Raghavapuram S, Tharian B,
Nugent K. Prophylactic pre-esophagogastroduodenoscopy
tracheal intubation in patients with upper gastrointestinal
bleeding. Proc (Bayl Univ Med Cent). 2019;32(1):22-25. doi:
10.1080/08998280.2018.1530007
2. Abou-Taleb A, Ahmed ARH, El-Hennawy A. Pediatric Chronic
Liver Diseases: A clinicopathological study from a tertiary
care center. Int J Pediatr. 2019;7(4):9305-9315. doi:
10.22038/ijp.2019.37294.3246
3. Nasher O, Devadason D, Stewart RJ. Upper Gastrointestinal
Bleeding in Children: A Tertiary United Kingdom Children's
Hospital Experience. Children (Basel). 2017;4(11):95:1-6.
4. Jafari SA, Kiani MA, Kianifar HR, Mansooripour M, Heidari
E, Khalesi M. Etiology of gastrointestinal bleeding in children
referred to pediatric wards of Mashhad hospitals, Iran. Electron
Physician. 2018;10(2):6341-5.
5. Bai Y, Li ZS. Standardize the diagnosis and treatment of acute
non-variceal upper gastrointestinal bleeding based on the
update guidelines. Zhonghua Nei Ke Za Zhi. 2019;58(3):161-
3.
6. Jung K, Moon W. Role of endoscopy in acute gastrointestinal
bleeding in real clinical practice: An evidence-based review.
World J Gastrointest Endosc. 2019;11(2):68-83.
7. Mahmud S, Ahmed SS, Gulshan J, Tasneem F, Baidya M.
Outcome of band ligation in esophageal varices of Bangladeshi
children: A tertiary centre experience. Bangladesh J Child
Health. 2017;41(1):28-33.
8. Kim SJ, Oh SH, Jo JM, Kim KM. Experiences with endoscopic
interventions for variceal bleeding in children with portal
hypertension: a single center study. Pediatr Gastroenterol
Hepatol Nutr. 2013;16(4):248-53.
9. Voroniak DI, Godik OS, Fedoniuk LY, Shapoval OÌ, Piliponova
VV. Role of stage endoscopic variceal band ligation in
treatment of children with portal hypertension. Wiad Lek.
2020;73(10):2133-7.
10. Farooqi JI, Shah HA, Khan AA, Salamat A, Alam A, Khattak
AK, et al. Clinical Practice Guidelines on the Management
of Variceal Bleeding. J Coll Physicians Surg Pak. 2016
Jan;26(1):63-5. Available from: https://pubmed.ncbi.nlm.
nih.gov/26787034/
11. Alvi H, Zuberi BF, Rasheed T, Ibrahim MA. Evaluation of
endoscopic variceal band ligation sessions in obliteration of
esophageal varices. Pakistan Journal of Medical Sciences
2020;36(2):37.
12. Abbasi A, Bhutto AR, Bhatti KI, Mahmood K, Lal K. Outcome
of band ligation in esophageal varices. J Pak Med Assoc.
2013;63(8):983-987.
13. Butt N, Haleem F, Khan MA, Abbasi A. Efficacy and safety
of N-butyl 2 cyanoacrylate injection for treatment of gastric
varices: a five-year experience from a tertiary care hospital
in Karachi, Pakistan. Pak J Med Sci. 2022;38(5):1360.
14. Celiñska-Cedro D, Teisseyre M, Woynarowski M, Socha P,
Socha J, Ryzko J. Endoscopic ligation of esophageal varices
for prophylaxis of first bleeding in children and adolescents
with portal hypertension: preliminary results of a prospective
study. J Pediatr Surg. 2003;38(7):1008-11. doi: 10.1016/s0022-
3468(03)00181-7
15. Guo H, Zhang M, Zhang N, Yin X, Cheng Y, Gu L, et al.
Number of endoscopic sessions to eradicate varices identifies
high risk of rebleeding in cirrhotic patients. BMC Gastroenterol.
2022;22(1):213. doi: 10.1186/s12876-022-02283-0
16. Farhana T, Mahmud S, Tasneem F, haque E, Rashid R, Baidya
M, et al. Management of childhood esophageal varices:
learnings from an advanced medical centre. Gastroenterol
Hepatol. 2025;16(2):61-65. Available from: https://medcrave
online.com/GHOA/GHOA-16-00609.pdf
17. Kang KS, Yang HR, Ko JS, Seo JK. Long-term outcomes of
endoscopic variceal ligation to prevent rebleeding in children
with esophageal varices. J Korean Med Sci. 2013;28(11):1657-
60. doi: 10.3346/jkms.2013.28.11.1657
18. Li MM, Sun F, Huai MX, Qu CY, Shen F, Zhang Y, et al.
Endoscopic variceal ligation combined with sclerotherapy
for management of gastroesophageal variceal bleeding in
pediatric patients: a single-center retrospective study. Front
Pediatr. 2024;12:1325419. doi: 10.3389/fped.2024.1325419
19. Pallio S, Melita G, Shahini E, Vitello A, Sinagra E, Lattanzi
B, et a. Diagnosis and Management of Esophagogastric
Varices. Diagnostics (Basel). 2023;13(6):1031. doi: 10.3390/
diagnostics13061031
20. Alatas FS, Monica E, Ongko L, Kadim M. Endoscopic Primary
Prophylaxis to Prevent Bleeding in Children with Esophageal
Varices: A Systematic Review and Meta-Analysis. Pediatr
Gastroenterol Hepatol Nutr. 2023;26(5):231-238. doi: 10.5223
/pghn.2023.26.5.231
21. Shrestha B, Sudhamshu KC, Chaudhary S, Basnet BK, Mandal
AK, Poudyal NS. Outcome of Endoscopic Variceal Band
Ligation. J Nepal Med Assoc 2017;56(206):198-202. Available
from: https://pdfs.semanticscho lar.org/adb3/b3120dfe31
62baf87b59285e074d42520f40.pdf
22. Gana JC, Cifuentes LI, Gattini D, Torres-Robles R. Band
ligation versus sclerotherapy for primary prophylaxis of
oesophageal variceal bleeding in children with chronic liver
disease or portal vein thrombosis. Cochrane Database Syst
Rev. 2020;11(11):CD011803. doi: 10.1002/14651858
.CD011803.pub2
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0
