Gastroenterol Hepatol. 2023 Aug 8:S0210-5705(23)00379-5. doi: 10.1016/j.gastrohep.2023.08.001. Online ahead of print.
ABSTRACT
INTRODUCTION: portal vein thrombosis (PVT) is the most frequent cause of portal hypertension in paediatric population. Baveno VI Consensus considers endoscopic variceal ligation (EVL) as the second therapeutic option after Meso-Rex bypass (surgical shunt).
AIM: analyse the diagnostic profitability of non-invasive scales in order to predict the risk of oesophageal varices (OV) in children with PVT.
MATERIALS AND METHODS: descriptive retrospective study where every upper gastrointestinal endoscopy (UGE) carried on patients <15 years old with non-cirrhotic PVT were included. There were divided according to the presence of OV and sex, cause, age, previous gastrointestinal bleeding or treatments, results of UGE and scales (Clinical Prediction Rule-CPR), Varices Prediction Rule-VPR), King’s Variceal Prediction Score-K-VaPS) and Platelet count / Spleen diameter Ratio-PSR). Qualitative variables were expressed as absolute frequency and percentage, and quantitative variables as median and intercuartilic range. U Man-Whitney and Hanley-McNeil tests were used for comparisons.
RESULTS: 45 UGE were analysed. 80%(n=36) presented OV: median of 3(2 – 3) and 33,3%(n=12) required EVL. Statistical differences were demonstrated between both groups: CPR (142,39 (132,22 – 166,53) vs. 122,75 (115,24 – 133,15); p=0,003), VPR (9,91 (9,36 – 11,75) vs. 5,6 (3,34 – 8,39) p=0,001), K-VaPS (117,86 (99,66 – 126,58) vs. 99,64 (94,88 – 110,18) p=0,019), PSR (2384,62 (1902,22 – 3201,63) vs. 1252,5 (579,6 – 2144,42) p=0,05), with and area under the curve AUROC>75%, without statistical differences between scales.
CONCLUSIONS: in paediatric patients with non-cirrotic PVT non-invasive scales can be used as a tool to predict the presence of OV and raise the indication of UGE.
PMID:37562768 | DOI:10.1016/j.gastrohep.2023.08.001
