Related Experiment Videos
Management of portal hypertension
S K Yachha1, Kamal Chetri, Richa Lal
1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. skyachha@sgpgi.ac.in
Insights
Portal hypertension in children often leads to variceal bleeding. Endoscopic therapy and surgery are effective treatments, but beta-blocker efficacy for prevention needs more research.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Interventions
Background:
- Portal hypertension (PHT) is a significant pediatric concern, particularly in India, with extrahepatic portal venous obstruction and liver cirrhosis as common causes.
- Variceal bleeding, primarily from esophageal varices, is the main cause of morbidity and mortality in children with PHT.
Purpose of the Study:
- To review current management strategies for variceal bleeding in pediatric portal hypertension.
- To evaluate the efficacy of various endoscopic and surgical interventions for acute and chronic management.
Main Methods:
- Review of endoscopic therapies including sclerotherapy, band ligation, and tissue adhesive injection for gastric varices.
- Analysis of surgical options such as shunt surgery and devascularization based on PHT etiology.
- Discussion of pharmacotherapy, including somatostatin, octreotide, and beta-blockers.
Main Results:
- Endoscopic therapy is the primary treatment for acute variceal bleeding.
- Tissue adhesive injection is effective for gastric variceal bleeding.
- Surgical portosystemic shunts are successful in non-cirrhotic PHT for portal decompression and reducing bleeding recurrence.
- Eradication of esophageal varices via endoscopic methods prevents bleeding recurrence.
Conclusions:
- Acute variceal bleeding requires prompt endoscopic or surgical intervention.
- Surgical shunts offer long-term benefits in specific pediatric PHT cases.
- The role of beta-blockers in primary prophylaxis of variceal bleeding in children requires further investigation.
Abstract:
Portal hypertension (PHT) is common in children and a majority of cases in India are constituted by extrahepatic portal venous obstruction or cirrhosis of liver. Morbidity and mortality in this condition is related to variceal bleeding, most commonly from esophageal varices. Acute variceal bleeding is best controlled by endoscopic therapy. Somatostatin and octreotide are useful in acute variceal bleeding as a supplementary therapy. Acute variceal bleeding uncontrolled by medical therapy merits preferably a shunt surgery or devascularization depending upon etiology of PHT and expertise of the surgeon. Acute variceal bleeding originating from gastric varices can be effectively controlled by endoscopic injection of tissue adhesive agent (n-butyl 2 cyanoacrylate). Eradication of esophageal varices by endoscopic measures (sclerotherapy or band ligation) is successful in prevention of recurrence of bleeding. Surgical portosystemic shunts especially in non-cirrhotic PHT are successful in achieving portal decompression and significant reduction in recurrence of variceal bleeding. Role of beta-blockers in primary prophylaxis of variceal bleeding in children still remains to be substantiated.