Prophylactic sclerotherapy in children with esophageal varices: Long-term results of a controlled prospective randomized trial☆
Section snippets
Design of the trial
The trial to evaluate the value of PS in children with PH was designed under the following basic premises: (1) The sample size should be calculated based on the risk of having the first-time bleeding within a 24-month follow-up period, (2) they should be prerandomized by a computer program16 to avoid bias during the initial endoscopic examination,7, 8 (3) the minimum period of follow-up should be at least 18 months after cessation of the sessions of PS, (4) there should be no ongoing treatment
Results
The distribution of the patients allocated in the groups, according to the Pugh-Child classification is presented in Table 1. The groups were balanced in their clinical characteristics. There were no differences between groups relative to age, gender, and etiology of the PH. The etiology of the PH is presented in Table 2.Etiology PS (Group I) Controls (Group II) Total Biliary atresia 17 20 37 Portal vein
Discussion
Currently, the results of randomized, controlled trials in adult patients assessing PS for the prevention of variceal bleeding have been controversial. Although some studies have shown benefits,6, 14 many others showed no benefits.3, 7, 10, 20 There is not a randomized controlled study evaluating PS in children. The conflicting results observed in adult patients are owing to different methods of sclerotherapy and to factors related to patient selection, mainly size of varices and severity of
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Primary endoscopic variceal ligation reduced acute variceal bleeding events but not long-term mortality in pediatric-onset portal hypertension
2022, Journal of the Formosan Medical AssociationRole of primary prophylaxis in preventing variceal bleeding in children with gastroesophageal varices
2021, Pediatrics and NeonatologyCitation Excerpt :Life-threatening hemorrhage is a major complication in children. Goncalves et al. and Mitsunaga et al. did not observe any life-threatening hemorrhage in their cohort,17,19 but Duche et al. reported that 10% of their patients died following first major hemorrhage before LT.6 In the present study, no patient died as a result of hemorrhage while refractory bleeding was observed in one patient who subsequently needed a LT. These findings reinforced the importance of screening for varices and prophylactic endoscopic therapy. In our center, primary prophylaxis was performed mainly for socio-geographic reason.
Prevalence, nature, and predictors of colonic changes in children with extrahepatic portal vein obstruction
2020, Gastrointestinal EndoscopyCitation Excerpt :Similarly, higher PHC in patients who had undergone esophageal variceal obliteration after EST or EVL has been reported in adults with cirrhosis.33,34 An increase in PHG after endotherapy and variceal eradication occurs in EHPVO because of the redistribution of blood flow through the portal system, with an increased blood flow in the gastric microcirculation and attendant congestion.35,36 In addition, the same mechanism may be responsible for the increase in PHC.
Portal Hypertension
2020, Pediatric Gastrointestinal and Liver Disease, Sixth EditionEsophagogastroduodenoscopy and Related Techniques
2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
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Address reprints requests to João Gilberto Maksoud, MD, Professor of Pediatric Surgery, Division of Pediatric Surgery, University of São Paulo Medical School, Av. Dr Arnaldo, 455, room 4109, 01246-903—São Paulo, Brazil.