Non-invasive predictors of esophageous varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction

Alcantara, Roberta Vacari de; Yamada, Roberto Massao; Tommaso, Adriana María Alves De; Bellomo-Brandão, Maria Ângela; Hessel, Gabriel

doi:10.2223/jped.2205

Cited by 11 publications

(5 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To avoid unnecessary endoscopy, especially in low-risk patients, many studies have been carried out to identify noninvasive factors that may predict the presence of gastroesophageal varices [20e22]. Thus, the number of noninvasive tools for gastroesophageal varices has been growing rapidly over the years, including biochemical, clinical, and ultrasonography parameters [23,24]. However, in our series we did not find difference in variables such as platelet count, spleen measure, and reversal flow in portal vein.…”

Section: Discussioncontrasting

confidence: 63%

Primary Prophylaxis for Gastrointestinal Bleeding in Children With Biliary Atresia and Portal Hypertension Candidates for Liver Transplantation: A Single-Center Experience

Angelico

Pietrobattista

Candusso

et al. 2019

Transplantation Proceedings

View full text Add to dashboard Cite

Background. Cirrhosis for biliary atresia (BA) is associated with risk of gastrointestinal bleeding (GB) from gastroesophageal varices due to portal hypertension. Primary prophylaxis of GB is controversial in children who are candidates for liver transplantation (LT). The aim of the study was to define the management of gastroesophageal varices and to identify the benefit of primary prophylaxis for GB in BA children waiting for LT. Methods. A retrospective single-center study including all BA children listed for LT in 2008e2016. Clinical, endoscopical, and biochemical data were analyzed. Results. Of 82 children, 50 (61%) did not receive primary prophylaxis and did not present any episode of bleeding, 16 (19.5%) underwent primary prophylaxis, and 16 (19.5%) presented spontaneous GB and received secondary prophylaxis. Children without primary prophylaxis and GB were younger than patients with primary prophylaxis and those with GB (7.7 years [range, 4.1e37.9 years] vs 11.2 years [range, 5.1e43 years]; P ¼ .03 vs 10.7 years [range, 6.9e39.9 years], respectively; P ¼ .004). Seventy-five percent of GB occurred in children older than 8 months. Fifteen (93.8%) children with GB presented esophageal varices (grade III ¼ 10 [62.5%]) and 10 (62.5%) required endoscopic treatments, consisting mainly of sclerotherapy. Median time to LT was similar for children with or without bleeding (2 months [range, 0e17.7 months] vs 2.2 months [0e17.9 months], respectively; P ¼ .89). After 45.5 months (range, 13.7e105.5 months) of follow-up, the overall patient survival was 97.6%. At the intention-to-treat analysis, the survival rate was 100% for patients without bleeding episode and 87.5% for children with GB (P ¼ .16). Conclusions. Despite the risk of GB being not clinically predictable in children with BA waiting for LT, our experience suggests that primary prophylaxis of GB might be unnecessary in children younger than 6 months, while it should be considered in older children. Thus, the occurrence of GB does not delay the timing of transplantation. B ILIARY atresia (BA) is a progressive fibro-obliterative cholangiopathy presenting only in infancy with a prevalence ranging from 1 in 5000 to 18,000 newborns [1]. The hepatoportoenterostomy (HPE), also known as Kasai procedure, provides a means of relieving extrahepatic biliary obstruction to permit bile flow; however, it is not a curative procedure [2,3]. Despite HPE being performed in a timely fashion, advancing fibrosis of the liver is associated with Grant information: no funding or grant to declare.

show abstract

Section: Discussioncontrasting

confidence: 63%

Primary Prophylaxis for Gastrointestinal Bleeding in Children With Biliary Atresia and Portal Hypertension Candidates for Liver Transplantation: A Single-Center Experience

Angelico

Pietrobattista

Candusso

et al. 2019

Transplantation Proceedings

View full text Add to dashboard Cite

show abstract

“…We found a strong positive relation between the presence of EV and the reduction of platelets count, with the cutoff point of 117,000.mm³. Alcântara et al [21] in their retrospective study with Brazilian children and adolescents with PH found the platelets cutoffs points of 92,000/mm³ for patients with EV and of 118,000/mm³ for those without EV.…”

Section: Discussionsupporting

confidence: 59%

Prospective Evaluation of Predictive Indexes for Esophageal Varices in Children and Adolescents with Portal Hypertension

2022

Br J Gastroenterol

View full text Add to dashboard Cite

Introduction: Esophageal varices (EV) are a consequence of portal hypertension (PH) that could lead to death if a rupture occurs. The EV survey is performed with the use of esophagogastroduodenoscopy (EGD), aiming at diagnosis and early treatment. It is important to establish noninvasive predictive indexes of EV that could help avoid unnecessary UE.Objectives: to evaluate the accuracy of noninvasive predictive indexes, when compared to UE, to diagnose EV in children and adolescents with PH; follow-up the patients with initial diagnosis of EV that is considered treatable (grades 2 and 3) in three consecutive moments; to correlate the increasing of the portal gastropathy (PG) with the eradication of the EV.Methods: Prospective, single-center study, in pediatric patients diagnosed with PH from 2014 to 2017. The variables platelet count, albumin, Z score of the spleen, APRI (AST to platelet radio index), P/SSAZ (platelet to spleen Z score radio) and CPR (clinical prediction rule) were evaluated. Values <0.05 were considered significant different. Sensitivity was calculated based on the cutoff points for the different predictive variables. ROC curve area was calculated with the corresponding 95% Mean Confidence Interval. Results: 69 patients were included, 46 with and 23 without EV at the first UGD. Prematurity, splenomegaly and umbilical catheterization were risk factors associated with EV. Platelet count < 117,000 mm³, albumin < 3.9 mg/dL, z score of the spleen >3.67, APRI > 0.64, P/SSAZ< 24.86 and CPR< 108.2 were the cutoff values for EV graded as treatable (grades 2 and 3). During the follow-up of 14 patients that received EBL in 3 consecutive UEs, the accuracy of the evaluated variables was maintained. The eradication of varices was positively correlated with the increase of the HG. Conclusion: Platelet count, albumin, z score of the spleen, APRI, P/SSAZ and CPR were good predictive indexes of EV, and should be used to select the patients for UE, avoiding unnecessary exams.

show abstract

“… 64 67 Other blood tests that were determined to predict varices were platelet count (sensitivity 56-76%; specificity 64-88%) and AST-to-platelet Index (sensitivity 59-86%; specificity 64-81%). 62 64 68 69 70 Among the doppler ultrasound parameters only hepatic artery resistive index was found to be associated with presence of varices. 55 57 …”

Section: Varicesmentioning

confidence: 96%

Personalized management of cirrhosis by non-invasive tests of liver fibrosis

2015

View full text Add to dashboard Cite

Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted.

show abstract

Non-invasive predictors of esophageous varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction

Cited by 11 publications

References 31 publications

Primary Prophylaxis for Gastrointestinal Bleeding in Children With Biliary Atresia and Portal Hypertension Candidates for Liver Transplantation: A Single-Center Experience

Primary Prophylaxis for Gastrointestinal Bleeding in Children With Biliary Atresia and Portal Hypertension Candidates for Liver Transplantation: A Single-Center Experience

Prospective Evaluation of Predictive Indexes for Esophageal Varices in Children and Adolescents with Portal Hypertension

Personalized management of cirrhosis by non-invasive tests of liver fibrosis

Contact Info

Product

Resources

About