Sclerotherapy in extrahepatic portal venous obstruction.

Chawla, Yogesh; Dilawari, J. B.; Ramesh, Ganesh; Kaur, Upinder; Mitra, Suvradeep; Walia, B. N. S.

doi:10.1136/gut.31.2.213

Cited by 44 publications

(26 citation statements)

References 30 publications

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“…1 2 EHPVO is a common cause of major upper-gastrointestinal bleeding among children. [2][3][4] The most common presentation in children is well-tolerated variceal bleeding and splenomegaly. In adults, EHPVO is often recognised when evaluating for other disorders or with uncommon presentations such as jaundice, pruritus, acute cholecystitis-like syndrome, ascites and so on, resulting from prolonged portal hypertension.…”

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confidence: 99%

Portal hypertensive biliopathy

Dhiman

Behera

Chawla

et al. 2007

Gut

171

209

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__________________________ E xtrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertension in the developing countries, and constitutes up to 40% of all patients with portal hypertension. 1 2 EHPVO is a common cause of major upper-gastrointestinal bleeding among children.2-4 The most common presentation in children is well-tolerated variceal bleeding and splenomegaly. In adults, EHPVO is often recognised when evaluating for other disorders or with uncommon presentations such as jaundice, pruritus, acute cholecystitis-like syndrome, ascites and so on, resulting from prolonged portal hypertension. [5][6][7] The portal vein in EHPVO is transformed into a cavernoma, which is a bunch of multiple collateral veins around the obstructed portion of portal vein (fig 1). Marked improvements in the management of variceal bleeding in patients with EHPVO have resulted in an improved survival, thus presenting with unusual symptoms in adulthood.The reasons for EHPVO are obscure in approximately half of the patients. Omphalitis and intraabdominal sepsis are the common causes in neonates and children. Adults develop EHPVO due to increased blood coagulability, local inflammation, intra-abdominal sepsis, myeloproliferative disorders, underlying cirrhosis, or tumours in the liver, bile ducts or pancreas. 7-10Gibson et al 11 first reported the relationship between EHPVO and jaundice in 1965. Since then, several cases of obstructive jaundice due to common bile duct (CBD) obstruction caused by cavernomatous transformation of portal vein (portal cavernoma) have been described. Williams et al 12 were the first to report cholangiographic changes caused by choledochal varices. We, for the first time, describe abnormalities on endoscopic retrograde cholangiography (ERC) in a prospective study.13 These abnormalities were similar to those of primary sclerosing cholangitis and the term ''pseudosclerosing cholangitis'' was then coined to describe them. However, unlike primary sclerosing cholangitis, biliary strictures in patients with EHPVO were smooth rather than irregular (figs 2, 3A). Since then, several case series have described biliary abnormalities among patients with portal hypertension on ERC.14-22

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confidence: 99%

Portal hypertensive biliopathy

Dhiman

Behera

Chawla

et al. 2007

Gut

171

209

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“…In a series of 207 cases of EHPVO reported from India, splenomegaly was present in 82%, with hypersplenism in 22%; however, symptomatic hypersplenism was seen only in 6% of the patients, similar to our series. 14 As a result of the effective management of esophageal varices in children by EST 3,4 or endoscopic banding, 5,15 the number of referrals for surgery has decreased remarkably in recent years. Endoscopic sclerotherapy had successfully controlled acute variceal bleeding in all of our patients and none had experienced any further bleeding prior to surgery.…”

Section: Discussionmentioning

confidence: 98%

“…1,2 In most centers, varices are now effectively managed with endoscopic sclerotherapy (EST), [3][4][5] and surgical intervention is rarely required. However, as some of these children grow older, the effects of the PH persist, causing the spleen to enlarge gradually, accompanied by hypersplenism with decreasing cell lines in the peripheral blood.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Massive Splenomegaly and Severe Hypersplenism Secondary to Extrahepatic Portal Venous Obstruction in Children

et al. 2006

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“…El tratamiento endoscópico ha mostrado ser eficaz en la profilaxis secundaria 47,48 . Un estudio prospectivo presentado en forma de resumen por Kumar et al (comunicación personal) evalúa la eficacia en la profilaxis secundaria de los betabloqueantes y la ligadura endoscópica de varices.…”

Section: Cavernomatosis Portalunclassified

Trombosis portal

Seijo-Ríos

García‐Pagán

2010

Gastroenterología y Hepatología

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Sclerotherapy in extrahepatic portal venous obstruction.

Cited by 44 publications

References 30 publications

Portal hypertensive biliopathy

Portal hypertensive biliopathy

Surgical Treatment of Massive Splenomegaly and Severe Hypersplenism Secondary to Extrahepatic Portal Venous Obstruction in Children

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