Endoscopic variceal ligation as primary prophylaxis for upper GI bleeding in children

Quintero, Jesús; Juampérez, Javier; Mercadal-Hally, María; King, Mauricio Larrarte; Ortega, Juan José López; Molino, José-Andres; Abu-Suboh, Monder; Dot, Joan; Nuño, Rosario; Montferrer, N.; Armengol, J.-R.; Charco, Ramón

doi:10.1016/j.gie.2020.02.035

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…The risk of early rebleeding related to EVL in pediatric patients was reported to be 0-9%, [13][14][15][16] which is consistent with our study. However, the risk factors for this early rebleeding have not been sufficiently established yet.…”

Section: Discussionsupporting

confidence: 92%

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Factors associated with bleeding after endoscopic variceal ligation in children

Yokoyama

Ishizu

Ishigami

et al. 2021

Pediatrics International

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Background: Endoscopic variceal ligation (EVL) is a widely accepted treatment for esophagogastric varices in patients with portal hypertension (PHT). It is used for urgent treatment and prophylactic treatment of esophagogastric varices in pediatric as well as adult patients. However, major life-threatening adverse events such as early rebleeding can occur. Although early rebleeding after EVL among children and adolescents has been reported, the risk factors remain obscure. This study evaluated the risk factors for early rebleeding after EVL in children and adolescents. Methods: The subjects were children and adolescents (<18 years) with PHT who underwent EVL for esophagogastric varices. Early rebleeding was defined as hematemesis, active bleeding, or blood retention in the stomach, confirmed by esophagogastroduodenoscopy from 2 h to 5 days after EVL. Results: A total of 50 EVL sessions on 22 patients were eligible for this study. There were four episodes of early rebleeding. No other major adverse event has occurred. Multivariate analysis showed that EVL implemented at cardiac varices just below the esophagogastric junction (EGJ), within 5 mm from the EGJ, is the independent factor for a higher risk of early rebleeding: odds ratio 18.2 (95% confidence interval: 1.40-237.0), P = 0.02. Conclusions: Children and adolescents who undergo EVL for cardiac varices just below the EGJ have a higher risk of early rebleeding than those who do not.

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Section: Discussionsupporting

confidence: 92%

“…Although EVL in pediatric patients with PHT has been reported to be safe and effective, 13,14 early rebleeding after EVL may occur, 15,16 as it does in adults. In contrast to adult patients with PHT, however, the risk factors associated with early rebleeding after EVL in the pediatric population remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with bleeding after endoscopic variceal ligation in children

Yokoyama

Ishizu

Ishigami

et al. 2021

Pediatrics International

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“…Endoscopic treatment of high risk lesions reduces the risk of bleeding and the need for surgery ( 24 ). EVL is an effective and safe treatment for the prevention of upper gastrointestinal bleeding in patients with portal hypertension ( 25 ). Another multicenter randomized-controlled trial revealed that as one of the primary prophylaxis, EVL is an effective method for preventing variceal hemorrhage in liver cirrhosis patients ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Associations Between Endoscopic Primary Prophylaxis and Rebleeding in Liver Cirrhosis Patients with Esophagogastric Variceal Bleeding

et al. 2022

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AimTo identify the association between endoscopic primary prophylaxis and the risk of rebleeding in patients with liver cirrhosis receiving endoscopic therapy.MethodsThis cohort study involved in 944 liver cirrhosis patients with esophagogastric variceal bleeding (EGVB) receiving endoscopic therapy. All participants were divided into two groups: rebleeding group (n = 425) and non-rebleeding group (n = 519) according to the occurrence of rebleeding in patients. Rebleeding indicated any bleeding after endoscopic therapy for the first bleeding of esophagogastric varices in liver cirrhosis patients. Univariate and multivariate logistic analyses were employed to identify the association between endoscopic primary prophylaxis and rebleeding in patients with liver cirrhosis after endoscopic therapy.ResultsIn total, 425 patients rebleeded at the end of the follow-up. The risk of rebleeding in patients with endoscopic primary prophylaxis decreased by 0.773 times (OR = 0.227, 95%CI: 0.139–0.372, P < 0.001) after adjusting covariables. Subgroups were divided according to the Child-Pugh (CP) score, and the results revealed that the risk of rebleeding in patients with endoscopic primary prophylaxis decreased by 0.858 times in Grade A patients (OR = 0.142, 95%CI: 0.066–0.304, P < 0.001) and 0.804 times in Grade B patients (OR = 0.196, 95%CI: 0.085–0.451, P < 0.001) compared with patients without endoscopic primary prophylaxis, but showed no difference in Grade C patients.ConclusionEndoscopic primary prophylaxis was associated with a decreased risk of rebleeding in liver cirrhosis patients with EGVB after endoscopic therapy, which suggested that clinicians should pay more attention to endoscopic primary prophylaxis to prevent the occurrence of rebleeding in these patients.

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“…In children with portal hypertension, the question of endoscopic primary prophylaxis of bleeding from gastroesophageal varices is debated among pediatric gastroenterologists (1,2). 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).…”

mentioning

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).…”

mentioning

confidence: 99%

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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Endoscopic variceal ligation as primary prophylaxis for upper GI bleeding in children

Cited by 8 publications

References 24 publications

Factors associated with bleeding after endoscopic variceal ligation in children

Factors associated with bleeding after endoscopic variceal ligation in children

Associations Between Endoscopic Primary Prophylaxis and Rebleeding in Liver Cirrhosis Patients with Esophagogastric Variceal Bleeding

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

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