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Childhood portal hypertension in Jamaica
P S Ramphal1, M G Lee, D A Rose
1Department of Surgery, U.W.I., Jamaica.
Insights
Endoscopic sclerotherapy is often unsuccessful for managing childhood portal hypertension and esophageal varices. Surgical interventions, alone or combined with sclerotherapy, may offer better long-term outcomes for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Portal hypertension in children presents significant challenges, particularly concerning bleeding from esophageal varices.
- Extra-hepatic portal hypertension is a common etiology in pediatric cases.
Purpose of the Study:
- To review the clinical course and management outcomes of children diagnosed with portal hypertension.
- To evaluate the efficacy of endoscopic sclerotherapy versus surgical interventions for pediatric portal hypertension.
Main Methods:
- Retrospective review of pediatric patients with portal hypertension over a 14-year period.
- Analysis of treatment modalities including endoscopic sclerotherapy and surgical options (splenectomy, spleno-renal shunt).
- Assessment of outcomes including bleeding episodes, hypersplenism, and long-term management success.
Main Results:
- Five female and two male patients, with a mean age of 3.6 years, were analyzed.
- Endoscopic sclerotherapy (mean 9 sessions/patient) did not achieve complete variceal obliteration; four patients rebled.
- Surgical management (splenectomy or splenectomy with shunt) in three patients resulted in no mortality.
Conclusions:
- Endoscopic sclerotherapy alone may not provide complete long-term resolution for childhood portal hypertension and esophageal varices.
- Surgical therapy, or a combined approach of sclerotherapy and surgery, appears to be a more effective strategy for managing this condition in children.
Abstract:
Portal hypertension and bleeding from oesophageal varices in children remain a difficult medical problem. The clinical course and management of children with portal hypertension seen over a 14-year period was reviewed. There were 5 females and 2 males with a mean age of 3.6 years at presentation. Five patients presented with severe upper gastrointestinal bleeding and two with severe hypersplenism. All patients had extra-hepatic portal hypertension. Five patients were treated with endoscopic sclerotherapy, including one who had bleeding five years post-splenectomy. A mean of 9 sclerotherapy sessions was performed in each patient. Complete obliteration of varices was not achieved in any patient and a single rebleeding episode occurred in four. Three children underwent operative management consisting of splenectomy in two and splenectomy and central spleno-renal shunt in one. There was no mortality in either group after a mean follow-up of 4.3 years. Sclerotherapy may not be totally successful in long-term management of childhood portal hypertension. Surgical therapy or a combination of sclerotherapy and surgery may be the best approach.