Endoscopic variceal bleeding prophylaxis in children with cirrhotic portal hypertension
DOI:
https://doi.org/10.15574/PS.2025.3(88).2633Keywords:
cirrhotic portal hypertension, bleeding, endoscopic band-ligation, endoscopic sclerotherapy, liver transplantation, childrenAbstract
Cirrhotic portal hypertension (CPH) is an increase in intravascular pressure in the portal vein due to increased resistance of the liver parenchyma in so-called "cirrhotic liver diseases". In the context of the pretransplantation period, endoscopy is focused on the prevention or management of bleeding from esophageal varices, which are present in 40-60% of patients with CPH.
Aim - to analyze our experience of bleeding control by means of endoscopic options in children with CPH, optimizing the timing for procedures and ways to reduce the recurrent bleeding in the course of pretransplant management.
Materials and methods. A total of 303 case histories were analyzed retrospectively in the period from January 2011 to December 2023; 63 (22.4%) patients with CPH were identified. Patients were divided into 2 groups: a prospective study (n=43; 68.2%) and a control group (n=20; 31.8%).
Results. The most common causes of CPH were: idiopathic fibrosis (n=17; 26.9%), and biliary atresia (n=12; 19.1%). High-grade esophageal varices were revealed in 46 (73.1%) children, and 19 (30.1%) children had bleeding episodes. 20 patients underwent endoscopic band ligation. The endoscopic band ligation allowed for the reduction of the varices to grade I in 5 (25.0%) patients, while no significant influence on patients with high-grade varices number was achieved. Endoscopic sclerotherapy was performed in 6 (13.9%) children without a significant effect on the varices grade.
Conclusion. Endoscopic band ligation allowed for the reduction of the varices grade in a small number of patients in the prospective study group. Endoscopic sclerotherapy is useful where a ligation device cannot be transferred through the esophagus, though it did not significantly affect the number of patients with high-grade esophageal varices. In children with CPH screening endoscopy is mandatory, especially for those who are listed for liver transplantation.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of parents (or their guardians) and children was obtained for the study.
The author declares no conflict of interest.
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