The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children
Extrahepatic portal vein obstruction is a major cause of pediatric symptomatic portal hypertension and can lead to profuse variceal hemorrhaging. Purpose - to evaluate the role of primary prophylaxis of the variceal bleeding in children with extrahepatic portal vein obstruction. Materials and...
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| Format: | Article |
| Language: | English |
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Group of Companies Med Expert, LLC, Kyev, Ukraine
2023-12-01
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| Series: | Хірургія дитячого віку |
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| Online Access: | http://psu.med-expert.com.ua/article/view/298855 |
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| author | O.S. Godik D.I. Voroniak D.S. Diehtiarova |
| author_facet | O.S. Godik D.I. Voroniak D.S. Diehtiarova |
| author_sort | O.S. Godik |
| collection | DOAJ |
| description | Extrahepatic portal vein obstruction is a major cause of pediatric symptomatic portal hypertension and can lead to profuse variceal hemorrhaging.
Purpose - to evaluate the role of primary prophylaxis of the variceal bleeding in children with extrahepatic portal vein obstruction.
Materials and methods. A one-center prospective cohort clinical study involved 120 patients with extrahepatic portal vein obstruction who underwent primary or secondary variceal bleeding prophylaxis in 2016-2021. The laboratory, ultrasound, and endoscopy data before and after treatment were collected and evaluated.
Results. Variceal bleeding episodes occurred in 5.8% (n=3) of patients who underwent primary prophylaxis and rebleeding occurred in 27.9% (n=19) of those who underwent secondary prophylaxis. Bleeding episodes occurred less frequently in patients from primary prophylaxis group (p=0.013). In patients treated endoscopically (n=53, 44.17%) Variceal bleeding appeared less frequently (n=3, 5.66%) after treatment compared to patients who underwent surgery (n=67 (55.83%), 19 had rebleeding (28.35%)) (p=0.001). In 69.17% patients (n=83) esophageal varices eradication was achieved: in 53.01% (n=44) patients from the primary prophylaxis group and 46.99% (n=39) from the secondary prophylaxis group. Bleeding episodes occurred less frequently after the eradication achievement (p<0.001). The primary prophylaxis led to varices eradication more often than secondary (p=0.003). The varices recurrence episodes rates after the eradication achievement were not different between groups (p=0.51).
Conclusions. Primary prophylaxis can reduce the bleeding risk in extrahepatic portal vein obstruction with high risk of variceal bleeding. The prophylaxis by endoscopic variceal banding is an important bridge in the treatment for pediatric patients with portal hypertension that along with portosystemic shunting could potentially improve prophylactic treatment results.
The Committee on Clinical Investigation of Bogomolets National Medical University approved this study (Protocol No.141, 27.01.2021). All the studies were conducted according to implemented guidelines in consideration of GCP-ICH and Declaration of Helsinki. The written informed consent of all participants’ parents/guardians was achieved.
No conflict of interests was declared by the authors. |
| first_indexed | 2024-04-24T23:49:43Z |
| format | Article |
| id | doaj.art-6334eb62312c48388dac17da22e89488 |
| institution | Directory Open Access Journal |
| issn | 2304-0041 2521-1358 |
| language | English |
| last_indexed | 2024-04-24T23:49:43Z |
| publishDate | 2023-12-01 |
| publisher | Group of Companies Med Expert, LLC, Kyev, Ukraine |
| record_format | Article |
| series | Хірургія дитячого віку |
| spelling | doaj.art-6334eb62312c48388dac17da22e894882024-03-14T19:55:02ZengGroup of Companies Med Expert, LLC, Kyev, UkraineХірургія дитячого віку2304-00412521-13582023-12-014(81)243010.15574/PS.2023.81.24337207The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in childrenO.S. Godik0https://orcid.org/0000-0002-1084-9484D.I. Voroniak1https://orcid.org/0000-0003-3201-6632D.S. Diehtiarova2https://orcid.org/0000-0002-2356-0874Bogomolets National Medical University, KyivNational Specialized Children’s Hospital “OKHMATDYT”, KyivNational Specialized Children’s Hospital “OKHMATDYT”, KyiExtrahepatic portal vein obstruction is a major cause of pediatric symptomatic portal hypertension and can lead to profuse variceal hemorrhaging. Purpose - to evaluate the role of primary prophylaxis of the variceal bleeding in children with extrahepatic portal vein obstruction. Materials and methods. A one-center prospective cohort clinical study involved 120 patients with extrahepatic portal vein obstruction who underwent primary or secondary variceal bleeding prophylaxis in 2016-2021. The laboratory, ultrasound, and endoscopy data before and after treatment were collected and evaluated. Results. Variceal bleeding episodes occurred in 5.8% (n=3) of patients who underwent primary prophylaxis and rebleeding occurred in 27.9% (n=19) of those who underwent secondary prophylaxis. Bleeding episodes occurred less frequently in patients from primary prophylaxis group (p=0.013). In patients treated endoscopically (n=53, 44.17%) Variceal bleeding appeared less frequently (n=3, 5.66%) after treatment compared to patients who underwent surgery (n=67 (55.83%), 19 had rebleeding (28.35%)) (p=0.001). In 69.17% patients (n=83) esophageal varices eradication was achieved: in 53.01% (n=44) patients from the primary prophylaxis group and 46.99% (n=39) from the secondary prophylaxis group. Bleeding episodes occurred less frequently after the eradication achievement (p<0.001). The primary prophylaxis led to varices eradication more often than secondary (p=0.003). The varices recurrence episodes rates after the eradication achievement were not different between groups (p=0.51). Conclusions. Primary prophylaxis can reduce the bleeding risk in extrahepatic portal vein obstruction with high risk of variceal bleeding. The prophylaxis by endoscopic variceal banding is an important bridge in the treatment for pediatric patients with portal hypertension that along with portosystemic shunting could potentially improve prophylactic treatment results. The Committee on Clinical Investigation of Bogomolets National Medical University approved this study (Protocol No.141, 27.01.2021). All the studies were conducted according to implemented guidelines in consideration of GCP-ICH and Declaration of Helsinki. The written informed consent of all participants’ parents/guardians was achieved. No conflict of interests was declared by the authors.http://psu.med-expert.com.ua/article/view/298855childrenportal hypertensionliverhepatocytesbleedingshunt surgery |
| spellingShingle | O.S. Godik D.I. Voroniak D.S. Diehtiarova The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children Хірургія дитячого віку children portal hypertension liver hepatocytes bleeding shunt surgery |
| title | The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children |
| title_full | The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children |
| title_fullStr | The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children |
| title_full_unstemmed | The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children |
| title_short | The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children |
| title_sort | role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children |
| topic | children portal hypertension liver hepatocytes bleeding shunt surgery |
| url | http://psu.med-expert.com.ua/article/view/298855 |
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