| Objective:To retrospectively analyze the clinical characteristics of children with esophageal and gastric variceal,related risk factors for bleeding and the efficacy of endoscopic treatment in the first affiliated hospital of Nanchang University in the past10 years.It aims to provide a reference for the early formation of a unified treatment standard for children with esophageal and gastric varices in the future.Methods:From 2010.03.01 to 2020.03.01,a total of 21 patients diagnosed with esophageal and gastric variceal with younger than 18 years old underwent endoscopy in the Digestive Endoscopy Center of the First Affiliated Hospital of Nanchang University were collected.The clinical features,endoscopic manifestations and curative effects of 21 patients were summarized,and the risk factors of variceal bleeding were analyzed.Results:A total of 21 children were included in the study,including 13 males and 8females.The male: female ratio was 1.63:1,the youngest was 6 years old,the oldest was 17 years old,and the average age was 12.19±3.40.The number of hospitalizations was 47.A total of 42 times electronic endoscopy was performed.The causes were cavernous transformation of portal vein in 6 cases(28.57%),cryptogenic cirrhosis in 5 cases(23.81%),hepatolenticular degeneration in 4 cases(19.05%),schistosomiasis cirrhosis in 2 cases(9.52%),hepatitis B cirrhosis in 2 cases(9.52%),idiopathic portal hypertension in 1 case(4.76%)and primary biliary cirrhosis in 1case(4.76%).Hematemesis and / or melena(13 cases)were the most common symptoms.Other symptoms included abdominal pain / bloating(5 cases),jaundice(2 cases)and edema of both lower limbs(1 case).The onset age was 3-17 years old,with an average age of 10.10 ± 4.08 years old.A total of 19 cases had upper gastrointestinal bleeding during the course of disease,with an average age of 11.0±3.96 years old for the first time.Esophageal and gastric variceal bleeding is the second leading cause of upper gastrointestinal bleeding in children in our hospital in 10 years.57.14% of the children were diagnosed as GOV1,19.05% were diagnosed as GOV2,66.67% had erythema,and portal hypertensive gastropathy accounted for80.95%.There was no consistency between abdominal color Doppler ultrasound and abdominal CT / CTA in displaying esophagogastric varices,collateral circulation /shunt and portal vein thickening;there was strong consistency in displaying splenomegaly between them.There was no significant difference in the distribution of INR among children of different ages.Platelet count decreased linearly with age.53.19% of the children were over the 25 th percentile of their age when they were admitted to hospital,and 21.27% of the children were low weight when they were admitted to hospital.Univariate analysis showed that variceal diameter and erythema were related risk factors of esophagogastric variceal bleeding in children.The success rate of endoscopic hemostasis in hemostasis group was 93.3%.No bleeding occurred in the selective treatment group.There was no significant difference in rebleeding between the two groups(P =1.0)Postoperative fever is the most common adverse reaction,and adverse reactions are prone to occur after hemostasis.The adverse reactions of the patients were mild,and the symptoms of the adverse reactions were basically relieved after 3-4 days of symptomatic treatment.The rebleeding rate within 6 weeks and 1 year was 6.7%,43.8% of patients had more than 2 consecutive endoscopic reexaminations,a total of3.71 endoscopic reexaminations,and an average of 3 endoscopic treatments,and the re-examination lasted 19.8 times.month.The average maximum diameter of varicose veins before treatment was 1.64 cm,and the average diameter of varicose veins under the last endoscopy was 0.47 cm.According to the average diameter before and after treatment,P=0.003<0.05.It is considered that the difference of varicose veins between the two groups before and after treatment is statistically significant.Two children achieved complete eradication of esophagus and gastric varices after 1.5times of endoscopic treatment.During the long-term follow-up of the patient,there were no deaths.Conclusion:1.The most common cause of esophageal and gastric varices in children in our hospital in the past 10 years is cavernous transformation of the portal vein.2.Esophageal and gastric varices bleeding is the second leading cause of upper gastrointestinal bleeding in children in our hospital in the past 10 years,second only to duodenal ulcer.3.Regardless of the endoscopic technique used,endoscopic treatment/prevention of esophageal varices bleeding in children is safe and effective4.Varicose vein diameter and erythema are risk factors for bleeding from esophageal gastric varices in children. |
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