Efficacy and clinical outcomes of endoscopic variceal injection with N-butyl-2-cyanoacrylate in pediatric patients in a tertiary care center - A retrospective study

Acute variceal bleeding (AVB) from gastric varices represents a significant risk for pediatric patients with portal hypertension. Despite its severity, standardized treatment guidelines for managing gastric variceal bleeding in this population are lacking. Endoscopic variceal injection (EVI) with N-butyl-2-cyanoacrylate has been used in adults but remains underexplored in pediatric cases. This study aims to evaluate the efficacy and clinical outcomes of EVI with N-butyl-2-cyanoacrylate in pediatric patients with gastric varices, addressing the current gap in treatment knowledge for this critical condition.

A retrospective cohort analysis was conducted on pediatric patients aged 1–18 years who presented with AVB from gastric varices between 2011 and 2021 at a tertiary care center. Among 538 patients with portal hypertension, 13 pediatric cases (2.4%) with gastric variceal hemorrhage were identified and included in the study. Patients underwent standard care followed by EVI with N-butyl-2-cyanoacrylate. The primary outcomes were the achievement of hemostasis, rebleeding rates, and mortality.

All 13 (100%) patients achieved immediate hemostasis. Rebleeding occurred in 3 (23%) patients within one month, necessitating additional interventions. The procedure required 1–3 sessions for complete obliteration of gastric varices. No procedural complications, such as anaphylactic shock, infection, gastric perforation, or embolization, were reported. The most common etiology of portal hypertension was Extrahepatic Portal Venous Obstruction (EHPVO), observed in 7 (53.8%) of the cases. One patient succumbed to complications related to decompensated Wilson’s disease.

Endoscopic variceal injection with N-butyl-2-cyanoacrylate is a highly effective method for achieving hemostasis in pediatric patients with gastric varices. However, the occurrence of rebleeding in a subset of patients highlights the need for ongoing monitoring and possible additional interventions. This study underscores the importance of further multicenter research to establish comprehensive treatment guidelines and improve clinical outcomes for this vulnerable population.