Original article
Clinical endoscopy
Endoscopic variceal ligation as primary prophylaxis for upper GI bleeding in children

https://doi.org/10.1016/j.gie.2020.02.035Get rights and content

Background and Aims

Variceal hemorrhage can be a life-threatening adverse event of chronic liver disease. In contrast to the well-described guidelines for the management of portal hypertension (PH) in adults, there is limited evidence about the optimal prophylactic management of variceal bleeding in children. This study was carried out to assess the efficacy of endoscopic variceal ligation (EVL) as primary prophylaxis to prevent upper GI bleeding in children with PH.

Methods

From January 2014 to April 2018, all pediatric patients with PH disease and medium to large esophageal varices or reddish spots, regardless of the grade of the varix, were prospectively included in the protocol of primary prophylaxis with EVL. A second retrospective group of patients was made after reviewing medical records of 32 pediatric patients with PH that presented esophageal varices in the upper endoscopy and had received propranolol as primary prophylaxis.

Results

Twenty-four patients (75%) reached varices eradication in the EVL group, with a median of 2 procedures (range, 1-4) before eradication and a median time to eradication of 3.40 months (range, 1.10-13.33). No EVL-related adverse events were observed. Statistically significant differences were observed in the bleeding rate at 3 years between propranolol and EVL groups (6/32 [21.9%] vs 1/32 [3.2%], P < .02). The hazard ratio for bleeding for patients treated with propranolol compared with those treated with EVL was 2.6 (95% confidence interval, 1.53-3.67).

Conclusions

EVL is a safe and effective treatment to prevent upper GI bleeding in pediatric patients with PH. (Clinical trial registration number: NCT03943784.)

Section snippets

Study design

The aim of this study was to evaluate the efficacy and safety of primary prophylaxis with EVL to prevent UGIB compared with NSBB prophylaxis. Therefore, an ambispective single-center cohort study of pediatric patients with PH and EV was designed, and 2 study groups were assigned: EVL and propranolol groups.

The study was conducted in compliance with the provisions of the Declaration of Helsinki and Good Clinical Practice guidelines. This study was approved by the Hospital Vall d'Hebron

Results

From January 2014 to April 2018, 32 patients with EV and PH received EVL as a primary prophylaxis of UGIB (EVL group). They were compared with 32 consecutive patients who received propranolol from March 2009 to December 2013 (propranolol group). No differences were observed between groups in terms of gender, age, weight, etiology of PH, and follow-up. The overall endoscopic pattern was also comparable between both groups. No other differences were found in laboratory data or in radiologic

Discussion

Primary prophylaxis of variceal hemorrhage, while generally accepted for adults, has not been endorsed for children with PH.3,11 The risk of bleeding and the efficacy of primary prophylactic therapy for children with varices have been inadequately quantified, and therefore no overall recommendation for prophylactic treatment of children can be provided.11

Propranolol has been used anecdotally in children with PH. All previous studies using propranolol as primary prophylactic for UGIB were case

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  • Cited by (0)

    DISCLOSURE: All authors disclosed no financial relationships.

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