Experience With Endoscopic Management of High-Risk Gastroesophageal Varices, With and Without Bleeding, in Children With Biliary Atresia

Duché, Mathieu; Ducot, B.; Ackermann, O.; Baujard, Catherine; Chevret, L.; Frank-Soltysiak, M.; Jacquemin, Emmanuel; Bernard, Olivier

doi:10.1053/j.gastro.2013.06.022

Cited by 58 publications

(52 citation statements)

References 23 publications

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“…Moreover, variceal hemorrhage episodes were not fatal in any of the infants with BA in this series. This is in contrast to recent reports highlighting a relatively high frequency of esophageal varices in infants with BA and the potential need for primary endoscopic prophylaxis of varices in infants with BA 33, 34 . It is possible that the use of early LT may have altered the natural history of GI bleeding in these patients compared with other studies.…”

Section: Discussioncontrasting

confidence: 99%

Total Serum Bilirubin within 3 Months of Hepatoportoenterostomy Predicts Short-Term Outcomes in Biliary Atresia

Shneider

Magee

Karpen

et al. 2016

The Journal of Pediatrics

109

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Objectives To prospectively assess the value of serum total bilirubin (TB) within 3 months of hepatoportoenterostomy (HPE) in infants with biliary atresia (BA) as a biomarker predictive of clinical sequelae of liver disease in the first two years of life. Study design Infants with BA undergoing HPE between June 2004-January 2011 were enrolled in a prospective, multicenter study. Complications were monitored until 2 years of age or the earliest of liver transplant (LT), death, or study withdrawal. TB below 2 mg/dL (34.2 μM) at any time in the first 3 months (TB<2.0, all others = TB≥2) after HPE was examined as a biomarker, using Kaplan-Meier survival and logistic regression. Results Fifty percent (68/137) of infants had TB<2.0 in the first 3 months after HPE. Transplant-free survival at 2 years was significantly higher in the TB<2.0 group vs. TB≥2 (86% vs. 20%, p<0.0001). Infants with TB≥2 had diminished weight gain (p<0.0001), greater probability of developing ascites (OR 6.4, 95% CI 2.9–14.1, p<0.0001), hypoalbuminemia (OR 7.6, 95% CI 3.2–17.7, p< 0.0001), coagulopathy (OR 10.8, 95% CI 3.1–38.2, p=0.0002), LT (OR 12.4, 95% CI 5.3–28.7, p<0.0001), or LT or death (OR 16.8, 95% CI 7.2–39.2, p<0.0001). Conclusions Infants whose TB does not fall below 2.0 mg/dL within 3 months of HPE were at high risk for early disease progression, suggesting they should be considered for LT in a timely fashion. Interventions increasing the likelihood of achieving TB <2.0 mg/dL within 3 months of HPE may enhance early outcomes.

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Section: Discussioncontrasting

confidence: 99%

Total Serum Bilirubin within 3 Months of Hepatoportoenterostomy Predicts Short-Term Outcomes in Biliary Atresia

Shneider

Magee

Karpen

et al. 2016

The Journal of Pediatrics

109

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“…One of the important cirrhotic complications is esophageal varices. Since more than 50% of the patients with biliary atresia suffer from esophageal varices before the age of 2 years [3], endoscopic surveillance and prophylactic endoscopic therapy are needed to prevent variceal bleeding [4]. Liver transplantation is the only curative treatment for biliary atresia patients showing complications associated with cirrhosis [1,5] It can achieve satisfactory short-and long-term outcomes [6].…”

Section: Introductionmentioning

confidence: 99%

“…Liver transplantation is the only curative treatment for biliary atresia patients showing complications associated with cirrhosis [1,5] It can achieve satisfactory short-and long-term outcomes [6]. Thus, monitoring liver fibrosis and esophageal varices is essential for patients with biliary atresia to prevent fatal bleeding from esophageal varices [4], and to determine the optimal timing for liver transplantation [7].…”

Section: Introductionmentioning

confidence: 99%

Diagnosing native liver fibrosis and esophageal varices using liver and spleen stiffness measurements in biliary atresia: a pilot study

et al. 2016

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“…Despite therapeutic advances, mortality due to acute episodes of upper gastrointestinal bleeding (UGIB) secondary to esophageal varices occurs in 5%19% of children with PH (1,3,5,10,12,22) . Mortality rates of 19% have been reported within 35 days after episodes of bleeding varices among North American children with liver disease of several etiologies (5) . Thus, it is essential to establish measures to prevent new UGIB episodes due to rupture of varices in these patients.…”

Section: Introductionmentioning

confidence: 99%

“…According to the Baveno V Consensus Workshop, which in volved adult patients with cirrhosis, treatment with betablockers in combination with band ligation is the most efficient method of secondary prophylaxis, although such results and recommen dations cannot be extrapolated to patients in the pediatric age group (1,2,3,4,5,10,12,13,14,22) . Studies involving secondary prophylaxis in children and adolescents are predominantly case series.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of endoscopic secondary prophylaxis in children and adolescents with esophageal varices

Pimenta

Ferreira

Fagundes

et al. 2017

Arq. Gastroenterol.

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-Background -Bleeding of esophageal varices is the main cause of morbidity and mortality in children and adults with portal hypertension and there are few studies involving secondary prophylaxis in children and adolescents. Objective -To evaluate the efficacy of endoscopic secondary prophylaxis in prevention of upper gastrointestinal bleeding in children and adolescents with esophageal varices. Methods -This is a prospective analysis of 85 patients less than 18 years of age with or without cirrhosis, with portal hypertension. Participants underwent endoscopic secondary prophylaxis with sclerotherapy or band ligation. Eradication of varices, incidence of rebleeding, number of endoscopic sessions required for eradication, incidence of developing gastric fundus varices and portal hypertensive gastropathy were evaluated. Results -Band ligation was performed in 34 (40%) patients and sclerotherapy in 51 (60%) patients. Esophageal varices were eradicated in 81.2%, after a median of four endoscopic sessions. Varices relapsed in 38 (55.1%) patients. Thirtysix (42.3%) patients experienced rebleeding, and it was more prevalent in the group that received sclerotherapy. Gastric varices and portal hypertensive gastropathy developed in 38.7% and 57.9% of patients, respectively. Patients undergoing band ligation showed lower rebleeding rates (26.5% vs 52.9%) and fewer sessions required for eradication of esophageal varices (3.5 vs 5). Conclusion -Secondary prophylaxis was effective in eradicating esophageal varices and controlling new upper gastrointestinal bleeding episodes due to the rupture of esophageal varices. Band ligation seems that resulted in lower rebleeding rates and fewer sessions required to eradicate varices than did sclerotherapy. HEADINGS -Esophageal and gastric varices. Portal hypertension. Ligation. Sclerotherapy. Child. Adolescent.

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Experience With Endoscopic Management of High-Risk Gastroesophageal Varices, With and Without Bleeding, in Children With Biliary Atresia

Cited by 58 publications

References 23 publications

Total Serum Bilirubin within 3 Months of Hepatoportoenterostomy Predicts Short-Term Outcomes in Biliary Atresia

Total Serum Bilirubin within 3 Months of Hepatoportoenterostomy Predicts Short-Term Outcomes in Biliary Atresia

Diagnosing native liver fibrosis and esophageal varices using liver and spleen stiffness measurements in biliary atresia: a pilot study

Evaluation of endoscopic secondary prophylaxis in children and adolescents with esophageal varices

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