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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Management of portal hypertension in children
Elizabeth Mileti1, Philip Rosenthal
1University of California, San Francisco, San Francisco, CA 94143-0136, USA. MiletiE@peds.ucsf.edu
Insights
Managing pediatric portal hypertension requires tailored treatments based on the cause and liver function. Gastroesophageal variceal bleeding is a serious risk, managed with interventions like sclerotherapy and band ligation.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Portal hypertension in children stems from intrahepatic or extrahepatic origins.
- Effective management strategies have evolved significantly over decades.
- Key considerations include etiology and hepatic functional status.
Purpose of the Study:
- To outline current management approaches for pediatric portal hypertension.
- To highlight treatment strategies for gastroesophageal variceal bleeding.
- To discuss the role of various endoscopic, medical, and surgical interventions.
Main Methods:
- Review of current literature and clinical practice guidelines.
- Analysis of treatment efficacy for gastroesophageal variceal bleeding.
- Evaluation of endoscopic therapies (sclerotherapy, band ligation) and shunts.
Main Results:
- Gastroesophageal variceal bleeding is the most critical complication, with up to 30% mortality.
- β-Blockers lack proven efficacy in preventing variceal bleeding in children.
- Sclerotherapy and band ligation are effective for active bleeding and prevention.
- Shunts (TIPS, surgical) are reserved for non-transplant candidates or refractory cases.
Conclusions:
- Treatment for pediatric portal hypertension must be individualized.
- Endoscopic interventions are crucial for managing variceal bleeding.
- Surgical and shunt procedures offer alternatives for complex cases.
Abstract:
Management of portal hypertension in children has evolved over the past several decades. Portal hypertension can result from intrahepatic or extrahepatic causes. Management should be tailored to the child based on the etiology of the portal hypertension and on the functionality of the liver. The most serious complication of portal hypertension is gastroesophageal variceal bleeding, which has a mortality of up to 30%. Initial treatment of bleeding focuses on stabilizing the patient. Further treatment measures may include endoscopic, medical, or surgical interventions as appropriate for the child, depending on the cause of the portal hypertension. β-Blockers have not been proven to effectively prevent primary or secondary variceal bleeding in children. Sclerotherapy and variceal band ligation can be used to stop active bleeding and can prevent bleeding from occurring. Transjugular intrahepatic portosystemic shunts and surgical shunts may be reserved for those who are not candidates for transplant or have refractory bleeding despite medical or endoscopic treatment.
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