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Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()

OBJECTIVES: This study aimed to evaluate factors associated with upper digestive hemorrhage and primary and secondary endoscopic prophylaxis outcomes in children with extrahepatic portal vein obstruction. METHODS: This observational and prospective study included 72 children with extrahepatic portal...

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Autores principales: Oliveira, Ana Paula Pereira de, Ferreira, Alexandre Rodrigues, Fagundes, Eleonora Druve Tavares, Queiroz, Thaís Costa Nascentes, Carvalho, Simone Diniz, Neto, José Andrade Franco, Bittencourt, Paulo Fernando Souto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9432056/
https://www.ncbi.nlm.nih.gov/pubmed/31666182
http://dx.doi.org/10.1016/j.jped.2019.08.010
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author Oliveira, Ana Paula Pereira de
Ferreira, Alexandre Rodrigues
Fagundes, Eleonora Druve Tavares
Queiroz, Thaís Costa Nascentes
Carvalho, Simone Diniz
Neto, José Andrade Franco
Bittencourt, Paulo Fernando Souto
author_facet Oliveira, Ana Paula Pereira de
Ferreira, Alexandre Rodrigues
Fagundes, Eleonora Druve Tavares
Queiroz, Thaís Costa Nascentes
Carvalho, Simone Diniz
Neto, José Andrade Franco
Bittencourt, Paulo Fernando Souto
author_sort Oliveira, Ana Paula Pereira de
collection PubMed
description OBJECTIVES: This study aimed to evaluate factors associated with upper digestive hemorrhage and primary and secondary endoscopic prophylaxis outcomes in children with extrahepatic portal vein obstruction. METHODS: This observational and prospective study included 72 children with extrahepatic portal vein obstruction who were followed from 2005 to 2017. Risk factors associated with upper digestive hemorrhage and the results of primary and secondary prophylaxis of these patients were evaluated. RESULTS: Fifty patients (69.4%) had one or more episodes of bleeding during follow-up, with a median age at first hemorrhage of 4.81 years. The multivariate analysis showed that medium- to large-caliber esophageal varices were associated with an 18-fold risk of upper digestive hemorrhage (95% CI: 4.33–74.76; p < 0.0001). Primary prophylaxis was administered to 14 patients, with eradication in 85.7%; however, 14.3% of these patients had hemorrhages during the follow-up period and 41.7% had a relapse of varices. Secondary prophylaxis was administered to 41 patients. Esophageal varices were eradicated in 90.2% of patients. There were relapse and re-bleeding of esophageal varices in 45.9% and 34.1% of the children, respectively. CONCLUSION: Primary and secondary endoscopic prophylaxes showed high rates of esophageal varix eradication, but with significant relapses. Eradication of esophageal varices cannot definitively prevent recurrent upper digestive hemorrhage, since bleeding from alternate sites can occur. Medium- and large-caliber esophageal varices were associated with upper digestive hemorrhage in patients with extrahepatic portal vein obstruction. To the best of the authors’ knowledge, this study is the first to evaluate bleeding risk factors in children with extrahepatic portal vein obstruction.
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spelling pubmed-94320562022-09-08 Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction() Oliveira, Ana Paula Pereira de Ferreira, Alexandre Rodrigues Fagundes, Eleonora Druve Tavares Queiroz, Thaís Costa Nascentes Carvalho, Simone Diniz Neto, José Andrade Franco Bittencourt, Paulo Fernando Souto J Pediatr (Rio J) Original Article OBJECTIVES: This study aimed to evaluate factors associated with upper digestive hemorrhage and primary and secondary endoscopic prophylaxis outcomes in children with extrahepatic portal vein obstruction. METHODS: This observational and prospective study included 72 children with extrahepatic portal vein obstruction who were followed from 2005 to 2017. Risk factors associated with upper digestive hemorrhage and the results of primary and secondary prophylaxis of these patients were evaluated. RESULTS: Fifty patients (69.4%) had one or more episodes of bleeding during follow-up, with a median age at first hemorrhage of 4.81 years. The multivariate analysis showed that medium- to large-caliber esophageal varices were associated with an 18-fold risk of upper digestive hemorrhage (95% CI: 4.33–74.76; p < 0.0001). Primary prophylaxis was administered to 14 patients, with eradication in 85.7%; however, 14.3% of these patients had hemorrhages during the follow-up period and 41.7% had a relapse of varices. Secondary prophylaxis was administered to 41 patients. Esophageal varices were eradicated in 90.2% of patients. There were relapse and re-bleeding of esophageal varices in 45.9% and 34.1% of the children, respectively. CONCLUSION: Primary and secondary endoscopic prophylaxes showed high rates of esophageal varix eradication, but with significant relapses. Eradication of esophageal varices cannot definitively prevent recurrent upper digestive hemorrhage, since bleeding from alternate sites can occur. Medium- and large-caliber esophageal varices were associated with upper digestive hemorrhage in patients with extrahepatic portal vein obstruction. To the best of the authors’ knowledge, this study is the first to evaluate bleeding risk factors in children with extrahepatic portal vein obstruction. Elsevier 2019-10-27 /pmc/articles/PMC9432056/ /pubmed/31666182 http://dx.doi.org/10.1016/j.jped.2019.08.010 Text en © 2019 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Oliveira, Ana Paula Pereira de
Ferreira, Alexandre Rodrigues
Fagundes, Eleonora Druve Tavares
Queiroz, Thaís Costa Nascentes
Carvalho, Simone Diniz
Neto, José Andrade Franco
Bittencourt, Paulo Fernando Souto
Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()
title Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()
title_full Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()
title_fullStr Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()
title_full_unstemmed Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()
title_short Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()
title_sort endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction()
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9432056/
https://www.ncbi.nlm.nih.gov/pubmed/31666182
http://dx.doi.org/10.1016/j.jped.2019.08.010
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