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EVALUATION OF PRIMARY PROPHYLAXIS WITH PROPRANOLOL AND ELASTIC BAND LIGATION IN VARICEAL BLEEDING IN CIRRHOTIC
Júlio Rocha Pimenta1, Alexandre Rodrigues Ferreira1,2, Paulo Fernando Souto Bittencourt1
1Setor de Gastroenterologia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Insights
In cirrhotic children, propranolol prophylaxis for variceal bleeding showed high failure and side effect rates. Endoscopic prophylaxis with band ligation proved more effective in preventing bleeding events.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Trials
Background:
- Limited studies exist on primary prophylaxis of variceal hemorrhage in pediatric cirrhotic patients.
- Nonselective beta-blockers and endoscopic procedures are established in adults but understudied in children.
Purpose of the Study:
- To evaluate the efficacy of beta-blocker (propranolol) as primary prophylaxis for portal hypertension in cirrhotic children and adolescents.
- To compare outcomes between beta-blocker and endoscopic prophylaxis.
Main Methods:
- A cohort study of 26 cirrhotic patients receiving propranolol for primary prophylaxis.
- Patients with contraindications or side effects to propranolol were switched to endoscopic band ligation.
- Inclusion criteria for prophylaxis included medium/large varices or reddish spots.
Main Results:
- Nine patients (34.6%) required endoscopic prophylaxis due to propranolol contraindications or side effects.
- Six of 17 patients (35.3%) on propranolol experienced bleeding events within 1.9 years.
- Endoscopic prophylaxis resulted in zero bleeding episodes during follow-up.
Conclusions:
- Propranolol prophylaxis in this pediatric cohort was associated with significant bleeding, contraindications, and adverse effects.
- Endoscopic prophylaxis demonstrated superior efficacy in preventing upper gastrointestinal bleeding in cirrhotic children.
- Referral to endoscopic therapy is crucial for patients intolerant to beta-blockers.
Background:
The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies.
Objective:
The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension.
Methods:
This is a cohort study encompassing 26 cirrhotic patients. β-blocker prophylaxis was performed with propranolol. When contraindicated the use of β-blocker, or if side effects presents, the patients were referred to endoscopic therapy with band ligation. Patients were evaluated by endoscopy, and those who had varicose veins of medium and large caliber or reddish spots, regardless of the caliber of varices, received primary prophylaxis.
Results:
Of the 26 patients evaluated, 9 (34.6%) had contraindications to the use of propranolol and were referred for endoscopic prophylaxis. Six (35.3%) of the 17 patients who received β-blocker (propranolol), had bled after a median follow-up time of 1.9 years. β-blockage dosage varied from 1 mg/kg/day to 3.1 mg/kg/day and seven (41.2%) patients had the propranolol suspended due to fail of the β-blockage or adverse effects, such as drowsiness, bronchospasm and hypotension. Patients who received endoscopic prophylaxis (elastic bandage) had no bleeding during the follow-up period.
Conclusion:
All of the patients that had upper gastroinstestinal bleeding in this study were under propranolol prophylaxis. The use of propranolol showed a high number of contraindications and side effects, requiring referral to endoscopic prophylaxis. The endoscopic prophylaxis was effective in reducing episodes of bleeding.
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