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Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction.
J Pediatr Gastroenterol Nutr. 2006 Feb; 42(2):196-200.JP

Abstract

OBJECTIVES

To find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensive gastropathy (PHG) and risk of rebleeding following esophageal variceal eradication.

METHODS

Between 1992 and 2002, children with extrahepatic portal venous obstruction (EHPVO) and bleeding from esophageal varices received endoscopic injection sclerotherapy until eradication. Surveillance endoscopy was performed initially at 3 months and subsequently at intervals of 6 months to one year to detect esophageal and gastric varices, and PHG. Gastric varices were classified as gastroesophageal (GOV) or isolated gastric varices (IGV). Gastroesophageal varices included types GOV1 and GOV2 that extend along lesser and greater curvatures respectively. Patients who had recurrence of bleeding were evaluated by emergency upper gastrointestinal endoscopy.

RESULTS

163 of 183 children who achieved esophageal variceal eradication were evaluated. Esophageal varices recurred in 40% cases. Primary gastric varices (before sclerotherapy) were seen in 61% cases [GOV 98% (83% GOV1, 15% GOV2) and IGV 2%] and secondary (after sclerotherapy) in 28% [GOV 71% (47% GOV1, 24% GOV2) and IGV 29%]. Secondary gastric varices were distributed as 20% GOV1, 42% GOV2 and 87% IGV. Frequency of gastric varices before sclerotherapy and at the last follow up showed decrease in GOV1 from 82 to 56 (P = 0.02), increase in GOV2 from 15 to 23 and increase in IGV from 2 to 15 (P < 0.001). PHG increased in frequency from 12% to 41% (P < 0.001) and severity from one patient to 12 (P < 0.001). Eleven cases had rebleeding from gastric varices (5 GOV1, 4 GOV2 and 2 IGV).

CONCLUSIONS

Following esophageal variceal eradication in children with EHPVO a significant decrease in GOV1, increase in IGV and increased frequency and severity of PHG takes place. Small rebleeding risk persists from gastric varices irrespective of the type.

Authors+Show Affiliations

Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16456415

Citation

Itha, Srivenu, and Surender Kumar Yachha. "Endoscopic Outcome Beyond Esophageal Variceal Eradication in Children With Extrahepatic Portal Venous Obstruction." Journal of Pediatric Gastroenterology and Nutrition, vol. 42, no. 2, 2006, pp. 196-200.
Itha S, Yachha SK. Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction. J Pediatr Gastroenterol Nutr. 2006;42(2):196-200.
Itha, S., & Yachha, S. K. (2006). Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction. Journal of Pediatric Gastroenterology and Nutrition, 42(2), 196-200.
Itha S, Yachha SK. Endoscopic Outcome Beyond Esophageal Variceal Eradication in Children With Extrahepatic Portal Venous Obstruction. J Pediatr Gastroenterol Nutr. 2006;42(2):196-200. PubMed PMID: 16456415.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction. AU - Itha,Srivenu, AU - Yachha,Surender Kumar, PY - 2006/2/4/pubmed PY - 2006/7/25/medline PY - 2006/2/4/entrez SP - 196 EP - 200 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 42 IS - 2 N2 - OBJECTIVES: To find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensive gastropathy (PHG) and risk of rebleeding following esophageal variceal eradication. METHODS: Between 1992 and 2002, children with extrahepatic portal venous obstruction (EHPVO) and bleeding from esophageal varices received endoscopic injection sclerotherapy until eradication. Surveillance endoscopy was performed initially at 3 months and subsequently at intervals of 6 months to one year to detect esophageal and gastric varices, and PHG. Gastric varices were classified as gastroesophageal (GOV) or isolated gastric varices (IGV). Gastroesophageal varices included types GOV1 and GOV2 that extend along lesser and greater curvatures respectively. Patients who had recurrence of bleeding were evaluated by emergency upper gastrointestinal endoscopy. RESULTS: 163 of 183 children who achieved esophageal variceal eradication were evaluated. Esophageal varices recurred in 40% cases. Primary gastric varices (before sclerotherapy) were seen in 61% cases [GOV 98% (83% GOV1, 15% GOV2) and IGV 2%] and secondary (after sclerotherapy) in 28% [GOV 71% (47% GOV1, 24% GOV2) and IGV 29%]. Secondary gastric varices were distributed as 20% GOV1, 42% GOV2 and 87% IGV. Frequency of gastric varices before sclerotherapy and at the last follow up showed decrease in GOV1 from 82 to 56 (P = 0.02), increase in GOV2 from 15 to 23 and increase in IGV from 2 to 15 (P < 0.001). PHG increased in frequency from 12% to 41% (P < 0.001) and severity from one patient to 12 (P < 0.001). Eleven cases had rebleeding from gastric varices (5 GOV1, 4 GOV2 and 2 IGV). CONCLUSIONS: Following esophageal variceal eradication in children with EHPVO a significant decrease in GOV1, increase in IGV and increased frequency and severity of PHG takes place. Small rebleeding risk persists from gastric varices irrespective of the type. SN - 0277-2116 UR - https://www.unboundmedicine.com/medline/citation/16456415/Endoscopic_outcome_beyond_esophageal_variceal_eradication_in_children_with_extrahepatic_portal_venous_obstruction_ L2 - https://doi.org/10.1097/01.mpg.0000189351.55666.45 DB - PRIME DP - Unbound Medicine ER -