Duché Mathieu, Ducot Béatrice, Ackermann Oanez, Jacquemin Emmanuel, Bernard Olivier
*Hépatologie Pédiatrique and Centre de Référence National de l'atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP †Santé Publique et Epidémiologie, Hôpital Bicêtre, AP-HP, Orsay, France.
J Pediatr Gastroenterol Nutr. 2015 May;60(5):664-8. doi: 10.1097/MPG.0000000000000710.
Biliary atresia carries a risk of bleeding because of portal hypertension. Our goal was to define the factors associated with the emergence of endoscopic signs carrying a high risk of bleeding in children who did not display these signs at the first upper gastrointestinal endoscopy.
From 1989 to 2013, a total of 225 children with low-risk signs at the first endoscopic examination underwent ≥2 upper gastrointestinal endoscopic examinations. The emergence of high-risk gastroesophageal varices was observed in 76 children in the 10 years following the first endoscopic examination. A survival study using the occurrence of high-risk varices as an event was performed to identify factors related to the emergence of these varices and to describe the probability of their emergence in 2 groups of children ages older than 18 months and 18 months or younger at the time of the first endoscopy.
High total serum bilirubin concentration, young age, and high number/grade of esophageal varices at the first endoscopy were significantly related to the emergence of high-risk varices. The probability of the emergence of high-risk signs was higher and these signs appeared faster in infants 12 months of age or younger and/or when the first endoscopic examination displayed >1 grade 1 or grade 2 varices. Progression to high-risk varices was also related to bilirubinemia in children older than 18 months at the first endoscopy.
The results allow defining a program of repeat endoscopies to detect high-risk varices and to discuss endoscopic primary prophylaxis of bleeding or hasten liver transplantation when these signs are found.
由于门静脉高压，胆道闭锁存在出血风险。我们的目标是确定在首次上消化道内镜检查时未出现高出血风险内镜征象的儿童中，与出现此类征象相关的因素。
1989年至2013年，共有225名在首次内镜检查时具有低风险征象的儿童接受了≥2次上消化道内镜检查。在首次内镜检查后的10年中，观察到76名儿童出现了高风险的胃食管静脉曲张。以高风险静脉曲张的出现作为事件进行生存研究，以确定与这些静脉曲张出现相关的因素，并描述在首次内镜检查时年龄大于18个月和18个月及以下的两组儿童中出现高风险静脉曲张的概率。
总血清胆红素浓度高、年龄小以及首次内镜检查时食管静脉曲张的数量/分级高与高风险静脉曲张的出现显著相关。在12个月及以下的婴儿中，以及/或者当首次内镜检查显示>1个1级或2级静脉曲张时，出现高风险征象的概率更高，且这些征象出现得更快。在首次内镜检查时年龄大于18个月的儿童中，进展为高风险静脉曲张也与胆红素血症有关。
这些结果有助于确定重复内镜检查的方案，以检测高风险静脉曲张，并在发现这些征象时讨论内镜下出血的一级预防或加快肝移植。
