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

Abstract

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.

Living donor liver transplantation with direct collateral portal vein anastomosis in a pediatric patient with congenital absence of the portal vein

“…The second method is to use a venous interposition graft through an end-to-side anastomosis to the PCS [3,5]. In our four CAPV cases, the PV stump was absent [10,12,13,17], thus direct anastomosis was technically impossible. Therefore, we used vein conduit interposition as an end-to-side anastomosis to the PCS.…”

“…In the present case, as in our previous cases, portal hypertension and collateral veins were observed. To prevent variceal bleeding, endoscopic variceal ligation was performed in the present patient, as in the usual adult patients with advanced liver cirrhosis [12].…”

“…Since surgical reconstruction of the portal vein structures of the native liver is impossible, LT is indicated for most patients with type I PCS. Although LT for symptomatic CAPV has been reported in the literature [1][2][3]5,9,[11][12][13][14][15][16], techniques for portal vein reconstruction have not yet been well established. There are two methods of PV reconstruction in LT for CAPV.…”

Living donor liver transplantation with pericholedochal collateral vein anastomosis in a pediatric patient with congenital absence of the portal vein

“…Since surgical reconstruction of the PV structures of the native liver is impossible, LT is indicated for most patients with type I PCS. Although LT for symptomatic CAPV has been reported in the literature [1][2][3]5,12,[14][15][16][17][18][19], techniques for PV reconstruction have not yet been well established. There are two methods of PV reconstruction in LT for CAPV.…”

“…The second method is to use a venous interposition graft through an endto-side anastomosis to the PCS [3,5]. In our previous four CAPV cases, the PV stump was absent [13,15,16,20], thus direct anastomosis was technically impossible. Therefore, we used vein conduit interposition as an end-to-side anastomosis to the PCS.…”