Extrahepatic portal vein obstruction in children. The diagnosis is established - what is next?
DOI:
https://doi.org/10.15574/SP.2024.5(141).1622Keywords:
extrahepatic portal vein obstruction, bleeding esophageal varices, primary prevention, endoscopic variceal ligation, surgical treatment indications, childrenAbstract
Extrahepatic portal vein obstruction (EHPVO) is the most common cause of portal hypertension in children, the most life-threatening manifestation of which is variceal bleeding, with a mortality rate of 4-19%.
The aim of the study is to determine the treatment tactics for children with symptomatic portal hypertension from the moment of diagnosis of EHPVO, indications for the endoscopic prevention and surgical procedures; to study the risk factors that influence the esophageal variceal bleeding to become the first sign of EHPVO.
Materials and methods. The data of patients, which was collected retrospectively from 245 case histories between January 2011 and January 2022, revealed 55 (22.4%) children with EHPVO, who had not undergone surgical procedures. The median follow-up period was 25 (95% CI 20-35) months. Statistical analysis was performed using IBM SPSS for Windows version 24.0 and EZR(R-statistics). A P-value˂0.05 was considered statistically significant. Scheffe’s method, Kruskal-Wallis and Dunn’s tests were used to compare the follow-up results. Chi-square test was used to assess varices grade dynamics.
Results. The mean age of patients in the group was 5.1±0.54 years, 34 (61.8%) patients were males. 36 (65.5%) patients had complicated delivery with subsequent umbilical catheter insertion. 27 (47.1%) patients manifested bleeding episodes. Endoscopic ligation showed good results in improving varices grade (p<0.001). The logistic regression model identified factors connected to the bleeding risks: “way of delivery” (p=0.027) and “hemoglobin level” (p=0.0015). Indications for surgical intervention were failure to decrease the esophageal varices grade (n=4; 7.2%) and an increase in the volume of the spleen with thrombocytopenia progression (n=6; 10,9%).
Conclusion. The most careful medical attention to babies of the risk group is required. Endoscopic ligation has shown good results in variceal grade decrease. Indications for surgical treatment are failure to decrease the grade of esophageal varices, an increase in the volume of the spleen with thrombocytopenia progression.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
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