Clinical Outcomes and Transitional Care Following Endoscopic Variceal Treatment in Pediatric Portal Hypertension

ABSTRACT Background Esophagogastric variceal (EGV) bleeding is a serious complication of pediatric‐onset liver disease; however, evidence regarding endoscopic management and long‐term outcomes remains limited. This study aimed to evaluate clinical outcomes following endoscopic therapy for pediatric EGV and to clarify challenges related to adherence and transitional care. Methods We retrospectively reviewed patients with pediatric‐onset liver disease who underwent endoscopic treatment for EGV between 2012 and 2024. Patients were categorized into a childhood group (≤ 15 years) and a young adult group (> 15 years). Clinical characteristics, treatment outcomes, retreatment, survival, and adherence during the transition to adult care were analyzed. Results Emergency endoscopy for hematemesis was common in the childhood group. Despite frequent recurrence, endoscopic therapy was effective and no rebleeding or deaths occurred. In contrast, young adults showed significantly poorer survival (1‐year 84.6%; 2‐year 69.2%; and p = 0.045), primarily due to hepatic decompensation. Nearly half self‐discontinued follow‐up during the transition period, and nonadherence was associated with higher Child–Pugh and MELD scores and markedly reduced survival (5‐year 33.3% and p = 0.038). Some young adults later developed alcohol‐related liver disease, with significantly worse outcomes than the childhood group ( p = 0.023). Conclusions Endoscopic therapy is effective and safe for pediatric EGV, although recurrence is common. In young adults, long‐term outcomes are determined more by adherence and successful transitional care than by variceal severity. Structured transitional programs are essential for preventing loss to follow‐up and improving survival in pediatric‐onset portal hypertension.