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Recent concepts regarding extra-hepatic portal hypertension
1Service de Chirurgie Pédiatrique, Centre Hospitalier Universitaire Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France. frederic.gauthier@bct.aphp.fr
Seminars in Pediatric Surgery
|October 18, 2005
Summary
Extra-hepatic portal hypertension (EHPH) presents a significant risk of gastro-intestinal bleeding from varices. Surgical intervention is preferred for radical cure, with endoscopic therapy as an alternative for specific cases.
Area of Science:
- Gastroenterology
- Hepatology
- Vascular Surgery
Background:
- Extra-hepatic portal hypertension (EHPH) is a non-cirrhotic condition affecting the portal vein.
- It leads to a high risk of gastro-intestinal bleeding (GIB), primarily from esophageal and gastric varices.
- Potential complications include cholangiopathy and protein-losing enteropathy.
Purpose of the Study:
- To outline the diagnostic and management strategies for EHPH.
- To emphasize the risk of GIB and the importance of variceal eradication.
- To discuss surgical and endoscopic treatment options.
Main Methods:
- Non-invasive imaging techniques for EHPH diagnosis.
- Endoscopic examination for assessing bleeding risk.
- Evaluation of surgical (bypass, shunt) and endoscopic therapies.
Main Results:
- EHPH diagnosis relies on non-invasive imaging.
- Endoscopic findings guide the assessment of GIB risk.
- Surgical procedures like bypass offer the best chance for radical cure.
- Endoscopic therapy is effective for acute GIB and in patients unsuitable for surgery.
Conclusions:
- EHPH necessitates vigilant management due to GIB risks.
- Vascular surgery is the primary treatment for radical cure.
- Endoscopic therapy serves as a crucial alternative and first-line treatment for bleeding episodes.