Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction

Oliveira, Ana Paula Pereira de; Ferreira, Alexandre Rodrígues; Fagundes, Eleonora Druve Tavares; Queiroz, Thaís Costa Nascentes; Carvalho, Simone Diniz; Neto, José Andrade Franco; Bittencourt, Paulo Fernando Souto

doi:10.1016/j.jped.2019.08.010

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…Angelico et al [ 8 ] conducted their study on children with PH due to BA who were waiting to undergo transplantation. In contrast, de Oliveira et al [ 9 ] performed their study on children with EHPVO, Prasad et al [ 10 ] on children with noncirrhotic portal fibrosis, and Lee et al [ 2 ] on children with varying underlying diseases (BA, nonbiliary atresia cirrhosis, and EHPVO). The characteristics of the study population are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Endoscopic Primary Prophylaxis to Prevent Bleeding in Children with Esophageal Varices: A Systematic Review and Meta-Analysis

Alatas,

Monica,

Ongko

et al. 2023

Pediatr Gastroenterol Hepatol Nutr

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Purpose This systematic review and meta-analysis aimed to compare endoscopy as primary versus secondary prophylaxis to prevent future bleeding in children with esophageal varices. Methods A systematic literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was conducted using the Scopus, PubMed, and Cochrane databases for relevant studies on the outcome of rebleeding events after endoscopy in primary prophylaxis compared to that in secondary prophylaxis. The following keywords were used: esophageal varices, children, endoscopy, primary prophylaxis and bleeding. The quality of eligible articles was assessed using the Newcastle–Ottawa Scale and statistically analyzed using RevMan 5.4 software. Results A total of 174 children were included from four eligible articles. All four studies were considered of high-quality based on the Newcastle-Ottawa Quality Assessment Scale. Patients who received primary prophylaxis had 79% lower odds of bleeding than those who received secondary prophylaxis (odds ratio, 0.21; 95% confidence interval [CI], 0.07–0.66; I 2 =0%, p =0.008). Patients in the primary prophylaxis group underwent fewer endoscopic procedures to eradicate varices than those in the secondary prophylaxis group, with a mean difference of 1.73 (95% CI, 0.91–2.56; I 2 =62%, p <0.0001). Conclusion Children with high-risk varices who underwent primary prophylaxis were less likely to experience future bleeding episodes and required fewer endoscopic procedures to eradicate the varices than children who underwent secondary prophylaxis.

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Section: Resultsmentioning

confidence: 99%

Endoscopic Primary Prophylaxis to Prevent Bleeding in Children with Esophageal Varices: A Systematic Review and Meta-Analysis

Alatas,

Monica,

Ongko

et al. 2023

Pediatr Gastroenterol Hepatol Nutr

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“…Therefore, primary prophylaxis of bleeding deserves to be taken into serious consideration in children at risk. The risk of spontaneous variceal bleeding depends primarily on the endoscopic pattern of gastroesophageal varices, regardless of the cause of liver disease (12,(24)(25)(26)(27). This may result, in part, from the presence, in children with many cirrhotic as well as noncirrhotic causes of portal hypertension, of lesions and\or obstruction of the intrahepatic branches of the portal vein (32)(33)(34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

“…disease and others limited to one cause (3)(4)(5)(6)(7)(8)(12)(13)(14)(15)(16). We have previously reported the feasibility and safety of endoscopic primary prophylaxis of bleeding in small children with biliary atresia and high-risk gastroesophageal varices (17,18).…”

Section: What Is Newmentioning

confidence: 99%

“…and the criteria for recording the endoscopic signs remained unchanged throughout the study period. Based on previous experience both in adults and children (12,(23)(24)(25)(26)(27) the endoscopic patterns carrying a high risk of bleeding [high-risk varices (HRV)] included grade 3 esophageal varices, grade 2 esophageal varices with red wale markings and/or gastric varices along the cardia, or gastric varices with and/or without esophageal varices.…”

Section: Selection Of Children With High-risk Varicesmentioning

confidence: 99%

“…In Europe and Brazil, there is a growing trend towards endoscopic screening and primary prophylaxis of varices at risk of bleeding, whereas this approach is not commonly used in North America (1–10). One of the issues is the relatively limited availability of data on the efficacy and safety of the primary prophylaxis method (11); there have been papers reporting primary prophylaxis by endoscopic management, albeit with various numbers of patients in each report, various age ranges, different levels of detail, various endoscopic criteria for deciding upon treatment, some encompassing many causes of liver disease and others limited to one cause (3–8,12–16). We have previously reported the feasibility and safety of endoscopic primary prophylaxis of bleeding in small children with biliary atresia and high‐risk gastroesophageal varices (17,18).…”

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confidence: 99%

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Efficacy and Safety of Endoscopic Primary Prophylaxis of Bleeding in Children With High-Risk Gastroesophageal Varices

Ackermann

Darmellah-Remil

Bernard

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Primary prophylaxis of bleeding is debated in children with gastroesophageal varices; one of the reasons is the limited number of studies concerning its efficacy and safety. We report our experience with endoscopic primary prophylaxis. Methods: From 2006 to 2019, 145 children (median age, 3.5 years; cirrhosis, n = 116) with high-risk gastroesophageal varices underwent primary prophylaxis (banding, n = 114; sclerotherapy n = 31, primarily in smaller children). Results: We observed the eradication of varices in 93% of children after a mean of 6 months, at least one recurrence of varices in 45% after eradication, and gastrointestinal bleeding in 17% of children. Irrespective of the cause of portal hypertension, grade 3 esophageal varices, presence of gastric varices along the cardia and a lower composite score of endoscopic severity were associated with a worse probability of eradication, a longer time to eradication and a lower risk of a first recurrence and of bleeding following the procedure, respectively. Ten-year probabilities of overall survival and of bleeding-free survival were 95% and 75%, respectively. Conclusions: Endoscopic primary prophylaxis of variceal bleeding is reasonably effective and safe in children with high-risk gastroesophageal varices. Worse results are observed in children with more advanced endoscopic features. This pleads for endoscopic screening in children with portal hypertension and early detection of varices warranting primary prophylaxis.

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The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children

Godik,

Voroniak,

Diehtiarova

2023

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Extrahepatic portal vein obstruction is a major cause of pediatric symptomatic portal hypertension and can lead to profuse variceal hemorrhaging. Purpose - to evaluate the role of primary prophylaxis of the variceal bleeding in children with extrahepatic portal vein obstruction. Materials and methods. A one-center prospective cohort clinical study involved 120 patients with extrahepatic portal vein obstruction who underwent primary or secondary variceal bleeding prophylaxis in 2016-2021. The laboratory, ultrasound, and endoscopy data before and after treatment were collected and evaluated. Results. Variceal bleeding episodes occurred in 5.8% (n=3) of patients who underwent primary prophylaxis and rebleeding occurred in 27.9% (n=19) of those who underwent secondary prophylaxis. Bleeding episodes occurred less frequently in patients from primary prophylaxis group (p=0.013). In patients treated endoscopically (n=53, 44.17%) Variceal bleeding appeared less frequently (n=3, 5.66%) after treatment compared to patients who underwent surgery (n=67 (55.83%), 19 had rebleeding (28.35%)) (p=0.001). In 69.17% patients (n=83) esophageal varices eradication was achieved: in 53.01% (n=44) patients from the primary prophylaxis group and 46.99% (n=39) from the secondary prophylaxis group. Bleeding episodes occurred less frequently after the eradication achievement (p<0.001). The primary prophylaxis led to varices eradication more often than secondary (p=0.003). The varices recurrence episodes rates after the eradication achievement were not different between groups (p=0.51). Conclusions. Primary prophylaxis can reduce the bleeding risk in extrahepatic portal vein obstruction with high risk of variceal bleeding. The prophylaxis by endoscopic variceal banding is an important bridge in the treatment for pediatric patients with portal hypertension that along with portosystemic shunting could potentially improve prophylactic treatment results. The Committee on Clinical Investigation of Bogomolets National Medical University approved this study (Protocol No.141, 27.01.2021). All the studies were conducted according to implemented guidelines in consideration of GCP-ICH and Declaration of Helsinki. The written informed consent of all participants’ parents/guardians was achieved. No conflict of interests was declared by the authors.

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Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction

Cited by 4 publications

References 29 publications

Endoscopic Primary Prophylaxis to Prevent Bleeding in Children with Esophageal Varices: A Systematic Review and Meta-Analysis

Endoscopic Primary Prophylaxis to Prevent Bleeding in Children with Esophageal Varices: A Systematic Review and Meta-Analysis

Efficacy and Safety of Endoscopic Primary Prophylaxis of Bleeding in Children With High-Risk Gastroesophageal Varices

The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children

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