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Study of portal hypertension in children with special reference to sclerotherapy
S Ganguly1, J Dasgupta, A S Das
1Department of Paediatric Medicine, Institute of Post Graduate Medical Education and Research, Calcutta, India.
Insights
Portal hypertension in children often causes upper gastrointestinal bleeding. Non-cirrhotic portal fibrosis is a key cause in Eastern India, and endoscopic sclerotherapy is effective for managing variceal bleeding.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Portal hypertension (PH) is a significant cause of upper gastrointestinal bleeding in children.
- Extrahepatic portal venous obstruction (EHPVO) is frequently identified as the primary cause of PH in Indian pediatric populations.
- Limited data exists regarding PH etiology and management in Eastern India.
Purpose of the Study:
- To investigate the predominant causes of portal hypertension in children residing in Eastern India.
- To evaluate the efficacy of endoscopic sclerotherapy (EST) in managing pediatric portal hypertension and its associated variceal bleeding.
Main Methods:
- A cohort of 50 children (14 months to 10 years) with PH was studied.
- Etiological assessment included non-cirrhotic portal fibrosis (NCPF), EHPVO, and liver cirrhosis.
- Endoscopic sclerotherapy (EST) was administered to 45 children for variceal bleeding management, with follow-up assessments.
Main Results:
- Non-cirrhotic portal fibrosis (NCPF) was the most common cause (48%), followed by EHPVO (36%) and liver cirrhosis (16%).
- EST achieved variceal obliteration in 78% of cases and significant reduction in 13%, with a mean of 5.9 sessions.
- Rebleeding and recurrences occurred in 13% of patients; complications like dysphagia and strictures were managed conservatively.
Conclusions:
- Non-cirrhotic portal fibrosis (NCPF) represents a major etiological factor for pediatric portal hypertension in Eastern India.
- Endoscopic sclerotherapy (EST) demonstrates utility in controlling variceal bleeding in children with portal hypertension, regardless of the underlying cause.
- EST offers a viable management option for pediatric variceal bleeding, though rebleeding and complications require monitoring.
Abstract:
Portal Hypertension (PH) is the commonest cause of upper gastrointestinal bleeding in children. Most Indian studies have highlighted extrahepatic portal venous obstruction (EHPVO) as the major cause of PH in children. As there is paucity of data from the eastern part of the country we decided to study the major causes of PH in children in this region and to ascertain the efficacy of sclerotherapy for its management. Fifty children aged 14 months to 10 years with PH were studied from April 1990 to April 1995. Thorough examination and relevant investigations showed non-cirrhotic portal fibrosis (NCPF) in 24 (48%), EHPVO in 18 (36%) and cirrhosis of liver in 8 (16%) children. Forty six children had hematemesis and melaena of whom endoscopic sclerotherapy (EST) was done in 45 cases. One child having type 2 gastric varices was referred for surgery. Following eradication of varices the patients were followed-up at 3 monthly intervals. Number of sittings of sclerotherapy required for obliteration of varices was 5.9 +/- 1.6. A variceal state was achieved in 35 (78%) cases and varices were reduced to Grade I in 6 cases (13%). Two cases underwent surgery for EST failure. One patient of cirrhosis died within two weeks of bleeding episode due to hepatic encephalpathy. Rebleeding (13%) and recurrences (13%) were noted during the follow-up period. Retrosternal discomfort (22%), dysphagia (22%), stricture (13%), oesophageal ulceration (13%) and fever (11%) were the complications noted but these could be managed conservatively. The present study highlights that NCPF is an important cause of PH in eastern India. EST is useful in controlling variceal bleeding in children irrespective of their aetiology.