Natural progression and prediction markers in non-clinically significant oesophageal varices in children

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Clinical Research

Background:

• Limited data exists on non-clinically significant varices (nCSV) and their progression in pediatric portal hypertension (PHT).
• Understanding progression trends is crucial for effective management and surveillance strategies in affected children.

Purpose of the Study:

• To investigate the trends and predictive factors associated with variceal progression in children with nCSV and PHT.
• To evaluate the accuracy of various biomarkers and non-invasive methods in predicting progression across different etiologies of PHT.

Main Methods:

• Retrospective cohort study of 70 children with nCSV undergoing surveillance endoscopy.
• Analysis of laboratory parameters, established prediction scores, and spleen stiffness by fibroscan (SSM).
• Statistical analysis included Mann-Whitney U test, chi-squared test, and receiver operating characteristic (ROC) analysis.

Main Results:

• Variceal progression occurred in 35.7% of children, with median progression times of 3 years in portal vein thrombosis (PVT) and chronic liver disease (CLD), and 2 years in biliary atresia (BA).
• Hemoglobin (Hb), risk score, and SSM showed high accuracy in predicting progression in PVT and CLD.
• Biomarkers like von Willebrand Factor antigen score (vWFAg score) were highly accurate in CLD, while BA biomarkers showed suboptimal predictive accuracy.

Conclusions:

• Risk scores are reliable for monitoring variceal progression in pediatric CLD and PVT.
• Non-invasive scores warrant trial for validation alongside surveillance esophagogastroduodenoscopy (EGD).
• Extended endoscopy periods for children with BA require caution; larger studies are needed to validate SSM and vWFAg score in nCSV.