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Portal hypertensive gastropathy after surgery for biliary atresia

Takashi Sasaki1, Toshimichi Hasegawa, Yoshiyuki Shimizu

  • 1Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.

Surgery Today
|May 3, 2005
PubMed

Insights

Portal hypertensive gastropathy (PHG) affects 33% of children post-biliary atresia (BA) surgery. PHG is linked to more frequent endoscopic variceal treatments, liver dysfunction, and hypersplenism.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Surgical Outcomes

Background:

  • Biliary atresia (BA) is a severe neonatal liver disease requiring surgical intervention.
  • Portal hypertension is a known complication following BA surgery.
  • Portal hypertensive gastropathy (PHG) is a potential gastrointestinal manifestation of portal hypertension.

Purpose of the Study:

  • To investigate the correlation between portal hypertensive gastropathy (PHG) and clinical features in children who have undergone surgery for biliary atresia (BA).

Main Methods:

  • A retrospective review of upper gastrointestinal endoscopy findings in 27 children post-BA surgery over 3 years.
  • Diagnosis of PHG based on McCormack's criteria.
  • Comparison of clinical features, including endoscopic variceal treatment history and laboratory test results, between PHG and non-PHG groups.

Main Results:

  • PHG was diagnosed in 33% (9 of 27) of the children.
  • The PHG group showed a significantly higher frequency of past endoscopic variceal treatments (3.0 vs 0.6 times).
  • Children with PHG exhibited lower white blood cell and platelet counts, indicative of hypersplenism.
  • Elevated liver enzymes (AST), total bile acids, and total bilirubin, along with decreased prothrombin time, albumin, and cholinesterase levels, indicated liver dysfunction in the PHG group.

Conclusions:

  • Portal hypertensive gastropathy is a significant finding in one-third of children following biliary atresia surgery.
  • Frequent endoscopic treatment for gastroesophageal varices is a key factor associated with PHG development.
  • Liver dysfunction and hypersplenism are contributing factors to the occurrence of PHG in this pediatric population.
Abstract

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