Long-term follow-up of children with extrahepatic portal vein obstruction: impact of an endoscopic sclerotherapy program on bleeding episodes, hepatic function, hypersplenism, and mortality

Maksoud‐Filho, João Gilberto; Gonçalves, Manuel Ernesto Peçanha; Cardoso, Sílvia Helena; Gibelli, Nelson Elias Mendes; Tannuri, Uenis

doi:10.1016/j.jpedsurg.2009.02.074

Cited by 41 publications

(31 citation statements)

References 22 publications

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“…Endoscopic hemostatic techniques are performed by pediatric gastroenterologists but have not been prospectively studied in children. 56 Sclerotherapy of esophageal varices has been shown to be effective but not superior to endoscopic variceal ligation in infants and children [89][90][91][92] and is associated with more complications such as esophageal ulceration and stricture. 57,59,61,63,[93][94][95] Data are mixed regarding the efficacy of wire-guided bougie dilators compared with balloon dilators in the treatment of esophageal strictures, and safety appears to be comparable.…”

Section: Efficacy and Comparative Studiesmentioning

confidence: 99%

Equipment for pediatric endoscopy

Barth

Banerjee²,

Bhat³

et al. 2012

Gastrointestinal Endoscopy

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Section: Efficacy and Comparative Studiesmentioning

confidence: 99%

Equipment for pediatric endoscopy

Barth

Banerjee²,

Bhat³

et al. 2012

Gastrointestinal Endoscopy

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“…The adults' treatment includes the use of drugs such as propranolol, endoscopic measures (sclerotherapy or EBL) and portosystemic shunts (10,13,56) . As there are few studies in pediatrics, the treatment for this age group has been based on extrapolations of treatment in adults and in experience reported in the few pediatric casuistics found in the literature (10,27,28,46,56) . Thirty-two patients (58.2%) underwent secondary endoscopic prophylaxis in our service.…”

Section: Varices Classification N (%)mentioning

confidence: 99%

“…However, sclerotherapy still has room in the treatment of younger children, mainly in those who it is not possible the accomplishment of EBL due to technical limitations. Maksoud-Filho et al (27) , in recent study, showed that sclerotherapy is effective and safe for the treatment of varices in children. Among the major complications of endoscopic treatment, esophageal stenosis is the most common.…”

Section: Varices Classification N (%)mentioning

confidence: 99%

Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center

Ferri

Ferreira

Fagundes

et al. 2012

Arq. Gastroenterol.

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-Context -Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication -the upper gastrointestinal bleeding. Objective -To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. Methods -This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. Results -Of the 55 studied patients, 30 (54.5%) were male. In 29 patients (52.7%), none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%). In 20 patients (36.4%), the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9%) showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. Conclusions -The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an appropriate diagnostic and treatment approach is desirable in an attempt to reduce morbidity and mortality.

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“…Unlike previous work, we did not see clear trends toward decreasing platelet and WBC count and increasing spleen size in patients managed conservatively for noncirrhotic portal hypertension. 15 This may have been related to our small sample size. It is also important to note that previous work suggests that >90% patency can be achieved with meso-Rex shunt operations.…”

Section: Conflicts Of Interestmentioning

confidence: 92%

“…Consideration of these risks is important, given that many patients have been reported to do well long-term without any surgical intervention. 1,15 While surgery is often recommended following a GI bleed requiring blood transfusion, specific indications for surgical intervention are unclear. Further, with the development of advanced endovascular techniques, clinical decision-making has become even more complex.…”

mentioning

confidence: 99%

Progression of Noncirrhotic Portal Hypertension in a Pediatric Population

Wojcik¹,

Zahid²,

Cai³

et al. 2011

Journal of Clinical and Experimental Hepatology

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P ortal hypertension is classically caused by cirrhotic liver disease. However, there are several etiologies of portal hypertension that do not coincide with liver failure. Noncirrhotic portal hypertension may manifest clinically by upper gastrointestinal (GI) bleeding from esophageal varices, leukopenia, and thrombocytopenia from splenomegaly. 1,2 While studies have shown that certain liver functions are affected as a result of reduced portal venous flow, ascites and clinical encephalopathy are not common given the lack of intrinsic liver dysfunction.1-8 Noncirrhotic etiologies of portal hypertension are classified as prehepatic, hepatic, and posthepatic. Prehepatic causes are associated with thrombosis within the portal venous system. Hepatic causes include noncirrhotic portal fibrosis and schistosomiasis. Finally, Budd-Chiari syndrome, inferior vena cava (IVC) thrombosis/occlusion, and constrictive pericarditis are posthepatic etiologies of portal hypertension.In pediatric patients, portal vein thrombosis (PVT), or extrahepatic portal vein obstruction (EHPVO), is the most common cause of noncirrhotic portal hypertension. The pathophysiology of PVT is poorly understood, although studies have identified several pre-disposing factors, including neonatal umbilical vein catheterization and hypercoagulable states.9,10 Indications for surgical intervention on these complex children are controversial, but include refractory variceal hemorrhage, severe thrombocytopenia, severe leukopenia, encephalopathy, and porto-pulmonary hypertension.2 There are various surgical interventions available that attempt to improve the portal flow, including the meso-Rex bypass, 11 distal splenorenal shunt, 12,13 splenectomy followed by proximal splenorenal shunt, and the mesocaval shunt. 14 The aforementioned procedures are all significant operations and have a broad range of potential complications, including shunt thrombosis. Consideration of these risks is important, given that many patients have been reported to do well long-term without any surgical intervention. 1,15While surgery is often recommended following a GI bleed requiring blood transfusion, specific indications for surgical intervention are unclear. Further, with the development of advanced endovascular techniques, clinical decision-making has become even more complex. We have recently established a pediatric portal hypertension program at our institution, which includes hepatologists, interventional radiologists, radiologists, and surgeons. As we develop our own protocols for the management of children with noncirrhotic portal hypertension, we have reviewed Background/Objectives: The optimal management of children with noncirrhotic portal hypertension is controversial. Some groups suggest early and aggressive surgical intervention, while others report long-term success with conservative management. Methods: We conducted a retrospective study of 26 patients with noncirrhotic portal hypertension treated at our institution. We compared platelet counts, white blood cell (WBC...

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Long-term follow-up of children with extrahepatic portal vein obstruction: impact of an endoscopic sclerotherapy program on bleeding episodes, hepatic function, hypersplenism, and mortality

Cited by 41 publications

References 22 publications

Equipment for pediatric endoscopy

Equipment for pediatric endoscopy

Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center

Progression of Noncirrhotic Portal Hypertension in a Pediatric Population

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