We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
How to suspect the presence of high‐risk esophageal varices and when to start endoscopic surveillance in children with biliary atresia?
- Authors
Poddar, Ujjal; Samanta, Arghya; Sarma, Moinak Sen; Kumar, Basant; Lal, Richa; Srivastava, Anshu; Upadhyaya, Vijay Datta; Yachha, Surender Kumar; Mandelia, Ankur
- Abstract
Background and Aim: Portal hypertension determines the outcome of children with biliary atresia (BA) and is common even after a successful Kasai portoenterostomy (KPE). However, there are no clear‐cut guidelines on the age of starting surveillance and the modality (endoscopy vs non‐invasive tests [NITs]). In this cohort study, we analyzed our database to find out the utility of NITs in detecting high‐risk esophageal varices in BA. Methods: From June 2010 to May 2022, consecutive children of BA who underwent upper gastrointestinal (UGI) endoscopy were included. Esophageal varices were classified as high‐risk (grade II with red‐color signs or grade III or IV irrespective of red‐color signs. NITs such as splenomegaly (clinical and USG), platelet count, aspartate transaminase to platelet ratio index (APRI), and platelet‐to‐spleen diameter ratio were compared between cases with high‐risk and low‐risk varices. Results: A total of 110 children, 75 boys (66 successful KPE and 44 failed/KPE not performed) were enrolled. The median age at KPE was 85 days (IQR 63–98). Thirteen (11.8%) children presented with UGI bleeding. The first endoscopy revealed gastroesophageal varices in 75.4% of cases, and 32% of them had high‐risk varices. Multivariate analysis revealed failed KPE, history of UGI bleeding, bigger spleen size (> 3.5 cm), lower platelet count (< 150 000), and higher APRI (> 2) are independent predictors of the presence of high‐risk esophageal varices. Conclusion: Endoscopy is the best in predicting the presence of high‐risk varices that might bleed; hence, early surveillance endoscopy should be started in children with splenomegaly, thrombocytopenia, and high APRI score to prevent variceal bleeding.
- Subjects
BILIARY atresia; ESOPHAGEAL varices; PORTAL hypertension; ASPARTATE aminotransferase; PLATELET count; MULTIVARIATE analysis
- Publication
Journal of Gastroenterology & Hepatology, 2023, Vol 38, Issue 9, p1610
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/jgh.16267