Sclerotherapy for lymphatic malformations in children: a scoping review

J Pediatr Surg. 2011 May;46(5):912-22. doi: 10.1016/j.jpedsurg.2011.02.027.


Purpose: This scoping review assesses the literature and summarizes the current evidence on sclerotherapy for the treatment of lymphatic malformations in pediatric patients.

Methods: A comprehensive search of published and unpublished literature was conducted using multiple databases. Title, abstract, and full-text screening was conducted by 2 independent clinicians. All discrepancies were resolved during consensus meetings.

Results: A total of 182 articles were retrieved. Forty-four articles were removed as duplicates, and 11 articles were added after reviewing prominent studies. After full-text abstraction, 44 articles and 2 conference proceedings (N = 882 patients) were included in the final results. Twelve articles were classified as level II and 34 articles as level IV evidence. Picibanil (OK-432) was the primary agent used in most included studies. Postinjection symptoms with OK-432 were primarily fever, swelling, and erythema at the site. Life-threatening complications were uncommon and involved postinjection swelling of cervical lesions causing airway compromise.

Conclusions: The literature regarding sclerotherapy for lymphatic malformations is of a low level of evidence and suffers from a lack of standardization. Randomized clinical trials focused on OK-432, bleomycin, or alcoholic solution of zein; standardized dosing protocols; and consistent and reliable outcome reporting will be necessary for further development of treatment guidelines.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Bleomycin / adverse effects
  • Bleomycin / therapeutic use
  • Child
  • Child, Preschool
  • Diatrizoate / adverse effects
  • Diatrizoate / therapeutic use
  • Drug Combinations
  • Evidence-Based Medicine
  • Fatty Acids / adverse effects
  • Fatty Acids / therapeutic use
  • Female
  • Humans
  • Infant
  • Lymphatic Abnormalities / therapy*
  • Male
  • Middle Aged
  • Picibanil / adverse effects
  • Picibanil / therapeutic use
  • Propylene Glycols / adverse effects
  • Propylene Glycols / therapeutic use
  • Prospective Studies
  • Retrospective Studies
  • Sclerosing Solutions / adverse effects
  • Sclerosing Solutions / therapeutic use
  • Sclerotherapy* / adverse effects
  • Treatment Outcome
  • Young Adult
  • Zein / adverse effects
  • Zein / therapeutic use


  • Drug Combinations
  • Fatty Acids
  • Propylene Glycols
  • Sclerosing Solutions
  • Bleomycin
  • Diatrizoate
  • Picibanil
  • Zein
  • alcoholic prolamine solution