Hépatologie Pédiatrique and Centre de Référence National de l'Atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; Université Paris-Sud 11, Le Kremlin-Bicêtre, France; Radiologie Pédiatrique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.
Gastroenterology. 2013 Oct;145(4):801-7. doi: 10.1053/j.gastro.2013.06.022. Epub 2013 Jun 19.
BACKGROUND & AIMS: Biliary atresia, the most common cause of childhood cirrhosis, increases the risks for portal hypertension and gastrointestinal bleeding. We report the results from a single-center study of primary and secondary prophylaxis of bleeding in children with portal hypertension and high-risk varices.
We collected data from 66 children with major endoscopic signs of portal hypertension, including grade 3 esophageal varices or grade 2 varices with red wale markings and/or gastric varices, treated consecutively from February 2001 through May 2011. Thirty-six children (mean age, 22 mo) underwent primary prophylaxis (sclerotherapy and/or banding, depending on age and weight). Thirty children (mean age, 24 mo) who presented with gastrointestinal bleeding received endoscopic treatment to prevent a relapse of bleeding (secondary prophylaxis).
In the primary prophylaxis group, a mean number of 4.2 sessions were needed to eradicate varices; no bleeding from gastroesophageal varices was observed after eradication. Varices reappeared in 37% of children, and 97% survived for 3 years. In the secondary prophylaxis group, a mean number of 4.6 sessions was needed to eradicate varices. Varices reappeared in 45%, and 10% had breakthrough bleeding; 84% survived for 3 years. There were no or only minor complications of either form of prophylaxis.
Endoscopic therapy as primary or secondary prophylaxis of bleeding appears to be well tolerated and greatly reduces the risk of variceal bleeding in children with biliary atresia and high-risk gastroesophageal varices. However, there is a risk that varices will recur, therefore continued endoscopic surveillance is needed.
胆道闭锁是儿童肝硬化最常见的原因，增加了门静脉高压和胃肠道出血的风险。我们报告了一项针对伴有门静脉高压和高危静脉曲张儿童的出血一级和二级预防的单中心研究结果。
我们收集了 2001 年 2 月至 2011 年 5 月连续治疗的 66 例有主要内镜门静脉高压征象的儿童的数据，包括 3 级食管静脉曲张或伴有红色标记和/或胃静脉曲张的 2 级静脉曲张。36 例儿童（平均年龄 22 个月）接受了一级预防（根据年龄和体重进行硬化治疗和/或套扎）。30 例（平均年龄 24 个月）有胃肠道出血表现的儿童接受了内镜治疗以预防再次出血（二级预防）。
在一级预防组中，平均需要 4.2 次治疗才能消除静脉曲张；消除后没有胃食管静脉曲张出血。37%的儿童静脉曲张再次出现，97%的儿童在 3 年内存活。在二级预防组中，平均需要 4.6 次治疗才能消除静脉曲张。静脉曲张再次出现的比例为 45%，有 10%的儿童出现突破性出血；84%的儿童在 3 年内存活。两种预防形式都没有或只有轻微的并发症。
作为一级或二级预防出血的内镜治疗似乎耐受良好，并大大降低了伴有胆道闭锁和高危胃食管静脉曲张儿童的静脉曲张出血风险。然而，静脉曲张有再次出现的风险，因此需要继续进行内镜监测。
