Primary endoscopic prophylaxis prevents pediatric variceal hemorrhage
Click Here to Manage Email Alerts
Both primary endoscopic prophylaxis and secondary endoscopic prophylaxis were safe for the prevention of variceal hemorrhage among pediatric patients with portal hypertension, according to a presentation.
“Portal hypertension is the obstruction of portal venous blood flow through the liver. ... It's associated with multiple complications but the most pertinent to this project is variceal bleeding. ... In adults, prevention of bleeding is indicated with beta blockage and endoscopy; however, that's a good segue into the gaps of knowledge in pediatrics,” Voytek R. Slowik, MD, a pediatric gastroenterologist at Children’s Mercy Hospitals and Clinics in Kansas City, Missouri, said during the presentation. “We wanted to contribute to the conversation that's ongoing about what's the best way of handling pediatric portal hypertension.”
In a retrospective study, researchers aimed to investigate prophylactic endoscopy for the prevention of gastrointestinal bleeding among pediatric patients with portal hypertension. The study population included 87 pediatric patients (median age at endoscopy, 8.48 years; 55% girls) who underwent surveillance endoscopy prior to GI bleeding (primary prophylactic endoscopy) and 52 pediatric patients (median age at endoscopy, 4.93 years; 58% girls) who underwent surveillance following an episode of GI bleeding (secondary prophylactic endoscopy).
According to study results, patients who underwent primary prophylaxis had a lower mean number of endoscopies (3.897 vs. 6.269; P = .001) as well as fewer pediatric ICU admissions at the time of endoscopy (1% vs. 7%; P < .001) compared with patients who underwent secondary prophylaxis. Further, primary prophylaxis resulted in a lower likelihood for portosystemic shunt placement (6% vs. 15%; P < .001) with no difference in immediate complications (1% vs. 2%), 2-week complications (1% vs. 2%), need for transplantation (24% vs. 27%) or death (5% vs. 13%). Slowik noted no deaths related to endoscopy or variceal bleeding occurred.
“Prophylactic endoscopy should be considered a safe management strategy in pediatric patients with portal hypertension. Complications were rare and most often resolved with supportive care,” Slowik concluded. “Further studies need to compare primary and secondary prophylaxis; it's a reasonable question that we should address if primary prophylaxis truly is associated with improved outcomes.”
Collapse
Slowik V, et al. Abstract 256. Presented at: North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting; Dec. 12-18, 2021 (virtual meeting).
Read more about
Click Here to Manage Email Alerts