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Semin Liver Dis 2012; 32(04): 288-297
DOI: 10.1055/s-0032-1329897
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Advances in the Evaluation and Management of Children with Portal Hypertension

Simon C. Ling
1   Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
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Publication History

Publication Date:
08 February 2013 (online)

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Abstract

Portal hypertension commonly accompanies advanced liver disease and gives rise to severe and life-threatening complications, including hemorrhage from esophageal varices. Diagnosis of portal hypertension in children currently relies on finding evidence of splenomegaly and the formation of portosystemic collaterals. There is a paucity of pediatric data to support the use of primary prophylaxis against variceal hemorrhage. A combination of vasoactive drug and endoscopic therapy should be used to manage variceal bleeding. Prevention of rebleeding is best achieved by endoscopic variceal ligation. Rex bypass surgery is the optimal therapy for prevention of further bleeding from portal vein thrombosis. Options to manage recurrent bleeding while on preventative therapy include surgical portosystemic shunt, Rex bypass, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. Management of gastric varices may require injection of cyanoacrylate glue or TIPS.

Keywords

portal hypertension - esophageal varices - gastric varices - variceal hemorrhage
 

  • References

  • 1 Ling SC, Pfeiffer A, Avitzur Y, Ng VL. Portal hypertension after liver transplantation: long term follow-up. J Pediatr Gastroenterol Nutr 2005; 41 (4) 526-527 Ref Type
    PubMedGoogle Scholar
  • 2 Lykavieris P, Gauthier F, Hadchouel P, Duche M, Bernard O. Risk of gastrointestinal bleeding during adolescence and early adulthood in children with portal vein obstruction. J Pediatr 2000; 136 (6) 805-808
    PubMedGoogle Scholar
  • 3 Gana JC, Valentino PL, Morinville V, O'Connor C, Ling SC. Variation in care for children with esophageal varices: a study of physicians', patients', and families' approaches and attitudes. J Pediatr Gastroenterol Nutr 2011; 52 (6) 751-755
    CrossrefPubMedGoogle Scholar
  • 4 Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology 2004; 39 (2) 280-282
    CrossrefPubMedGoogle Scholar
  • 5 Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol 2009; 6 (10) 573-582
    CrossrefPubMedGoogle Scholar
  • 6 de Franchis R. Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53 (4) 762-768
    CrossrefPubMedGoogle Scholar
  • 7 Miraglia R, Luca A, Maruzzelli L , et al. Measurement of hepatic vein pressure gradient in children with chronic liver diseases. J Hepatol 2010; 53 (4) 624-629
    CrossrefPubMedGoogle Scholar
  • 8 Sogni P, Garnier P, Gadano A , et al. Endogenous pulmonary nitric oxide production measured from exhaled air is increased in patients with severe cirrhosis. J Hepatol 1995; 23 (4) 471-473
    CrossrefPubMedGoogle Scholar
  • 9 Matsumoto A, Ogura K, Hirata Y , et al. Increased nitric oxide in the exhaled air of patients with decompensated liver cirrhosis. Ann Intern Med 1995; 123 (2) 110-113
    CrossrefPubMedGoogle Scholar
  • 10 Assy N, Paizi M, Gaitini D, Baruch Y, Spira G. Clinical implication of VEGF serum levels in cirrhotic patients with or without portal hypertension. World J Gastroenterol 1999; 5 (4) 296-300
    PubMedGoogle Scholar
  • 11 Thabut D, Moreau R, Lebrec D. Noninvasive assessment of portal hypertension in patients with cirrhosis. Hepatology 2011; 53 (2) 683-694
    CrossrefPubMedGoogle Scholar
  • 12 Ling SC, Shneider BL. Portal hypertension in children: Current practice and the need for evidence. In: de Franchis R, , ed. Portal Hypertension V: Proceedings of the Fifth Baveno International Consensus Workshop. 5 ed. Oxford: Wiley-Blackwell; 2011: 189-196
    CrossrefGoogle Scholar
  • 13 Shneider BL, Bosch J, de FR et al. Portal hypertension in children: expert pediatric opinion on the report of the Baveno V Consensus Workshop on methodology of diagnosis and therapy in portal hypertension. Pediatr Transplant 2012; 16 (5) 426-437
    CrossrefPubMedGoogle Scholar
  • 14 North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319 (15) 983-989
    CrossrefPubMedGoogle Scholar
  • 15 Burtin P, Calès P, Oberti F , et al. Endoscopic ultrasonographic signs of portal hypertension in cirrhosis. Gastrointest Endosc 1996; 44 (3) 257-261
    CrossrefPubMedGoogle Scholar
  • 16 Paquet KJ. Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices —a prospective controlled randomized trial. Endoscopy 1982; 14 (1) 4-5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Calès P, Zabotto B, Meskens C , et al. Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociations, and relationship to hepatic dysfunction. Gastroenterology 1990; 98 (1) 156-162
    PubMedGoogle Scholar
  • 18 Duché M, Ducot B, Tournay E , et al. Prognostic value of endoscopy in children with biliary atresia at risk for early development of varices and bleeding. Gastroenterology 2010; 139 (6) 1952-1960
    CrossrefPubMedGoogle Scholar
  • 19 Perri RE, Chiorean MV, Fidler JL , et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology 2008; 47 (5) 1587-1594
    CrossrefPubMedGoogle Scholar
  • 20 Calès P, Oberti F, Bernard-Chabert B, Payen JL. Evaluation of Baveno recommendations for grading esophageal varices. J Hepatol 2003; 39 (4) 657-659
    CrossrefPubMedGoogle Scholar
  • 21 Gana JC, Turner D, Mieli-Vergani G , et al. A clinical prediction rule and platelet count predict esophageal varices in children. Gastroenterology 2011; 141 (6) 2009-2016
    CrossrefPubMedGoogle Scholar
  • 22 Barritt IV AS, Arguedas MR. Practice patterns in screening for varices: an American survey. Dig Liver Dis 2009; 41 (9) 676-682
    CrossrefPubMedGoogle Scholar
  • 23 Arguedas MR, McGuire BM, Fallon MB, Abrams GA. The use of screening and preventive therapies for gastroesophageal varices in patients referred for evaluation of orthotopic liver transplantation. Am J Gastroenterol 2001; 96 (3) 833-837
    CrossrefPubMedGoogle Scholar
  • 24 Moodley J, Lopez R, Carey W. Compliance with practice guidelines and risk of a first esophageal variceal hemorrhage in patients with cirrhosis. Clin Gastroenterol Hepatol 2010; 8 (8) 703-708
    CrossrefPubMedGoogle Scholar
  • 25 de Franchis R. Non-invasive (and minimally invasive) diagnosis of oesophageal varices. J Hepatol 2008; 49 (4) 520-527
    CrossrefPubMedGoogle Scholar
  • 26 Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46 (3) 922-938
    CrossrefPubMedGoogle Scholar
  • 27 Schreiber RA. Propranolol and portal hypertension: should kids be on the block?. J Pediatr Gastroenterol Nutr 1999; 29 (1) 10-11
    CrossrefPubMedGoogle Scholar
  • 28 Stringer MD, Howard ER, Mowat AP. Endoscopic sclerotherapy in the management of esophageal varices in 61 children with biliary atresia. J Pediatr Surg 1989; 24 (5) 438-442
    CrossrefPubMedGoogle Scholar
  • 29 Eroglu Y, Emerick KM, Whitingon PF, Alonso EM. Octreotide therapy for control of acute gastrointestinal bleeding in children. J Pediatr Gastroenterol Nutr 2004; 38 (1) 41-47
    CrossrefPubMedGoogle Scholar
  • 30 van Heurn LW, Saing H, Tam PK. Portoenterostomy for biliary atresia: Long-term survival and prognosis after esophageal variceal bleeding. J Pediatr Surg 2004; 39 (1) 6-9
    CrossrefPubMedGoogle Scholar
  • 31 Pagliaro L, D'Amico G, Sörensen TI , et al. Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med 1992; 117 (1) 59-70
    CrossrefPubMedGoogle Scholar
  • 32 Hayes PC, Davis JM, Lewis JA, Bouchier IA. Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet 1990; 336 (8708) 153-156
    CrossrefPubMedGoogle Scholar
  • 33 D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology 1995; 22 (1) 332-354
    PubMedGoogle Scholar
  • 34 Lebrec D. Pharmacological treatment of portal hypertension: hemodynamic effects and prevention of bleeding. Pharmacol Ther 1994; 61 (1-2) 65-107
    CrossrefPubMedGoogle Scholar
  • 35 García-Pagán JC, Bosch J, Rodés J. The role of vasoactive mediators in portal hypertension. Semin Gastrointest Dis 1995; 6 (3) 140-147
    PubMedGoogle Scholar
  • 36 Ballet F, Chretien Y, Rey C, Poupon R. Differential response of normal and cirrhotic liver to vasoactive agents. A study in the isolated perfused rat liver. J Pharmacol Exp Ther 1988; 244 (1) 283-289
    PubMedGoogle Scholar
  • 37 Westaby D, Bihari DJ, Gimson AE, Crossley IR, Williams R. Selective and non-selective beta receptor blockade in the reduction of portal pressure in patients with cirrhosis and portal hypertension. Gut 1984; 25 (2) 121-124
    CrossrefPubMedGoogle Scholar
  • 38 Lebrec D, Hillon P, Muńoz C, Goldfarb G, Nouel O, Benhamou JP. The effect of propranolol on portal hypertension in patients with cirrhosis: a hemodynamic study. Hepatology 1982; 2 (5) 523-527
    PubMedGoogle Scholar
  • 39 Ozsoylu S, Koçak N, Yüce A. Propranolol therapy for portal hypertension in children. J Pediatr 1985; 106 (2) 317-321
    PubMedGoogle Scholar
  • 40 Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001; 33 (4) 802-807
    CrossrefPubMedGoogle Scholar
  • 41 Bosch J, Garcia-Tsao G. Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: and the winner is... Hepatology 2009; 50 (3) 674-677
    CrossrefPubMedGoogle Scholar
  • 42 Celińska-Cedro D, Teisseyre M, Woynarowski M, Socha P, Socha J, Ryzko J. Endoscopic ligation of esophageal varices for prophylaxis of first bleeding in children and adolescents with portal hypertension: preliminary results of a prospective study. J Pediatr Surg 2003; 38 (7) 1008-1011
    CrossrefPubMedGoogle Scholar
  • 43 Gonçalves ME, Cardoso SR, Maksoud JG. Prophylactic sclerotherapy in children with esophageal varices: long-term results of a controlled prospective randomized trial. J Pediatr Surg 2000; 35 (3) 401-405
    CrossrefPubMedGoogle Scholar
  • 44 Duché M, Habès D, Roulleau P, Haas V, Jacquemin E, Bernard O. Prophylactic endoscopic sclerotherapy of large esophagogastric varices in infants with biliary atresia. Gastrointest Endosc 2008; 67 (4) 732-737
    CrossrefPubMedGoogle Scholar
  • 45 de Ville de Goyet J, Alberti D, Clapuyt P , et al; de Ville de GJ. Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension. J Pediatr Surg 1998; 33 (4) 597-601
    CrossrefPubMedGoogle Scholar
  • 46 Mack CL, Superina RA, Whitington PF. Surgical restoration of portal flow corrects procoagulant and anticoagulant deficiencies associated with extrahepatic portal vein thrombosis. J Pediatr 2003; 142 (2) 197-199
    CrossrefPubMedGoogle Scholar
  • 47 Mack CL, Zelko FA, Lokar J , et al. Surgically restoring portal blood flow to the liver in children with primary extrahepatic portal vein thrombosis improves fluid neurocognitive ability. Pediatrics 2006; 117 (3) e405-e412
    CrossrefPubMedGoogle Scholar
  • 48 Chiu B, Superina RA. Encephalopathy caused by a splenorenal shunt can be reversed by performing a mesenteric-to-left portal vein bypass. J Pediatr Surg 2006; 41 (6) 1177-1179
    CrossrefPubMedGoogle Scholar
  • 49 Lautz TB, Sundaram SS, Whitington PF, Keys L, Superina RA. Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass. J Pediatr Surg 2009; 44 (11) 2067-2070
    CrossrefPubMedGoogle Scholar
  • 50 Fuchs J, Warmann S, Kardorff R , et al. Mesenterico-left portal vein bypass in children with congenital extrahepatic portal vein thrombosis: a unique curative approach. J Pediatr Gastroenterol Nutr 2003; 36 (2) 213-216
    CrossrefPubMedGoogle Scholar
  • 51 Rouette J, Trottier H, Ducruet T, Beaunoyer M, Lacroix J, Tucci M. Canadian Critical Care Trials Group; PALISI Network. Red blood cell transfusion threshold in postsurgical pediatric intensive care patients: a randomized clinical trial. Ann Surg 2010; 251 (3) 421-427
    CrossrefPubMedGoogle Scholar
  • 52 Lacroix J, Hébert PC, Hutchison JS , et al; TRIPICU Investigators; Canadian Critical Care Trials Group; Pediatric Acute Lung Injury and Sepsis Investigators Network. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 2007; 356 (16) 1609-1619
    CrossrefPubMedGoogle Scholar
  • 53 Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365 (2) 147-156
    CrossrefPubMedGoogle Scholar
  • 54 Bosch J, Thabut D, Albillos A , et al; International Study Group on rFVIIa in UGI Hemorrhage . Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial. Hepatology 2008; 47 (5) 1604-1614
    CrossrefPubMedGoogle Scholar
  • 55 Brown JB, Emerick KM, Brown DL, Whitington PF, Alonso EM. Recombinant factor VIIa improves coagulopathy caused by liver failure. J Pediatr Gastroenterol Nutr 2003; 37 (3) 268-272
    CrossrefPubMedGoogle Scholar
  • 56 Bureau C, Garcia-Pagan JC, Otal P , et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology 2004; 126 (2) 469-475
    CrossrefPubMedGoogle Scholar
  • 57 Bureau C, Pagan JC, Layrargues GP , et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int 2007; 27 (6) 742-747
    CrossrefPubMedGoogle Scholar
  • 58 Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology 2010; 51 (1) 306
    CrossrefPubMedGoogle Scholar
  • 59 Zargar SA, Javid G, Khan BA , et al. Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Hepatology 2002; 36 (3) 666-672
    CrossrefPubMedGoogle Scholar
  • 60 Poddar U, Thapa BR, Singh K. Band ligation plus sclerotherapy versus sclerotherapy alone in children with extrahepatic portal venous obstruction. J Clin Gastroenterol 2005; 39 (7) 626-629
    CrossrefPubMedGoogle Scholar
  • 61 Poddar U, Thapa BR, Rao KL, Singh K. Etiological spectrum of esophageal varices due to portal hypertension in Indian children: is it different from the West?. J Gastroenterol Hepatol 2008; 23 (9) 1354-1357
    CrossrefPubMedGoogle Scholar
  • 62 Di Giorgio A, Agazzi R, Alberti D, Colledan M, D'Antiga L. Feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in children. J Pediatr Gastroenterol Nutr 2012; 54 (5) 594-600
    CrossrefPubMedGoogle Scholar
  • 63 Sarin SK, Kumar A. Gastric varices: profile, classification, and management. Am J Gastroenterol 1989; 84 (10) 1244-1249
    PubMedGoogle Scholar
  • 64 Tan PC, Hou MC, Lin HC , et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology 2006; 43 (4) 690-697
    CrossrefPubMedGoogle Scholar
  • 65 Rivet C, Robles-Medranda C, Dumortier J, Le Gall C, Ponchon T, Lachaux A. Endoscopic treatment of gastroesophageal varices in young infants with cyanoacrylate glue: a pilot study. Gastrointest Endosc 2009; 69 (6) 1034-1038
    CrossrefPubMedGoogle Scholar
  • 66 Fuster S, Costaguta A, Tobacco O. Treatment of bleeding gastric varices with tissue adhesive (Histoacryl) in children. Endoscopy 1998; 30 (3) S39-S40
    PubMedGoogle Scholar
  • 67 Wai CT, Lin M, Tan KC. Hepatobiliary and pancreatic: pulmonary embolism after injection therapy for gastric varices. J Gastroenterol Hepatol 2008; 23 (8 Pt 1) 1306
    CrossrefPubMedGoogle Scholar
  • 68 Berry PA, Cross TJ, Orr DW. Clinical challenges and images in GI. Pulmonary embolization of histoacryl “glue” causing hypoxia and cardiovascular instability. Gastroenterology 2007; 133 (5) 1413 , 1748
    CrossrefPubMedGoogle Scholar
  • 69 Rickman OB, Utz JP, Aughenbaugh GL, Gostout CJ. Pulmonary embolization of 2-octyl cyanoacrylate after endoscopic injection therapy for gastric variceal bleeding. Mayo Clin Proc 2004; 79 (11) 1455-1458
    CrossrefPubMedGoogle Scholar
  • 70 Sonomura T, Sato M, Kishi K , et al. Balloon-occluded retrograde transvenous obliteration for gastric varices: a feasibility study. Cardiovasc Intervent Radiol 1998; 21 (1) 27-30
    CrossrefPubMedGoogle Scholar
  • 71 Takahashi T, Yoshida H, Mamada Y, Taniai N, Tajiri T. Balloon-occluded retrograde transvenous obliteration for gastric varices in a child with extrahepatic portal venous obstruction. J Nihon Med Sch 2009; 76 (3) 173-178
    CrossrefPubMedGoogle Scholar
  • 72 Dadabhai AS, Fenkel JM, Brown DB, Laine L. Balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices. Hepatology 2012; 55 (4) 1301-1304
    CrossrefPubMedGoogle Scholar
  • 73 Ling SC, Walters T, McKiernan PJ, Schwarz KB, Garcia-Tsao G, Shneider BL. Primary prophylaxis of variceal hemorrhage in children with portal hypertension: a framework for future research. J Pediatr Gastroenterol Nutr 2011; 52 (3) 254-261
    CrossrefPubMedGoogle Scholar
  • 74 Shneider B, Emre S, Groszmann R , et al. Expert pediatric opinion on the Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Pediatr Transplant 2006; 10 (8) 893-907
    CrossrefPubMedGoogle Scholar
  • 75 Takahashi T, Kobayashi H, Kuwatsuru R, Lane GJ, Yamataka A. Magnetic resonance angiography versus endoscopy for the assessment of gastroesophageal varices in biliary atresia. Pediatr Surg Int 2007; 23 (10) 931-934
    CrossrefPubMedGoogle Scholar
  • 76 Chang HK, Park YJ, Koh H , et al. Hepatic fibrosis scan for liver stiffness score measurement: a useful preendoscopic screening test for the detection of varices in postoperative patients with biliary atresia. J Pediatr Gastroenterol Nutr 2009; 49 (3) 323-328
    CrossrefPubMedGoogle Scholar
  • 77 Fagundes ED, Ferreira AR, Roquete ML , et al. Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome. J Pediatr Gastroenterol Nutr 2008; 46 (2) 178-183
    CrossrefPubMedGoogle Scholar
  • 78 Shashidhar H, Langhans N, Grand RJ. Propranolol in prevention of portal hypertensive hemorrhage in children: a pilot study. J Pediatr Gastroenterol Nutr 1999; 29 (1) 12-17
    CrossrefPubMedGoogle Scholar
  • 79 Ozsoylu S, Koçak N, Demir H, Yüce A, Gürakan F, Ozen H. Propranolol for primary and secondary prophylaxis of variceal bleeding in children with cirrhosis. Turk J Pediatr 2000; 42 (1) 31-33
    PubMedGoogle Scholar
  • 80 Erkan T, Cullu F, Kutlu T , et al. Management of portal hypertension in children: a retrospective study with long-term follow-up. Acta Gastroenterol Belg 2003; 66 (3) 213-217
    PubMedGoogle Scholar
  • 81 Paquet KJ. Ten years experience with paravariceal injection sclerotherapy of esophageal varices in children. J Pediatr Surg 1985; 20 (2) 109-112
    CrossrefPubMedGoogle Scholar
  • 82 Howard ER, Stringer MD, Mowat AP. Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices. Br J Surg 1988; 75 (5) 404-408
    CrossrefPubMedGoogle Scholar
  • 83 Maksoud JG, Gonçalves ME, Porta G, Miura I, Velhote MC. The endoscopic and surgical management of portal hypertension in children: analysis of 123 cases. J Pediatr Surg 1991; 26 (2) 178-181
    CrossrefPubMedGoogle Scholar
  • 84 Duché M, Habès D, Roulleau P, Haas V, Jacquemin E, Bernard O. Prophylactic endoscopic sclerotherapy of large esophagogastric varices in infants with biliary atresia. Gastrointest Endosc 2008; 67 (4) 732-737
    CrossrefPubMedGoogle Scholar
  • 85 Cano I, Urruzuno P, Medina E , et al. Treatment of esophageal varices by endoscopic ligation in children. Eur J Pediatr Surg 1995; 5 (5) 299-302
    Article in Thieme ConnectPubMedGoogle Scholar
  • 86 Sasaki T, Hasegawa T, Nakajima K , et al. Endoscopic variceal ligation in the management of gastroesophageal varices in postoperative biliary atresia. J Pediatr Surg 1998; 33 (11) 1628-1632
    CrossrefPubMedGoogle Scholar
  • 87 Celińska-Cedro D, Teisseyre M, Woynarowski M, Socha P, Socha J, Ryzko J. Endoscopic ligation of esophageal varices for prophylaxis of first bleeding in children and adolescents with portal hypertension: preliminary results of a prospective study. J Pediatr Surg 2003; 38 (7) 1008-1011
    CrossrefPubMedGoogle Scholar
  • 88 Tuggle DW, Bennett KG, Scott J, Tunell WP. Intravenous vasopressin and gastrointestinal hemorrhage in children. J Pediatr Surg 1988; 23 (7) 627-629
    CrossrefPubMedGoogle Scholar
  • 89 Sokal EM, Van Hoorebeeck N, Van Obbergh L, Otte JB, Buts JP. Upper gastro-intestinal tract bleeding in cirrhotic children candidates for liver transplantation. Eur J Pediatr 1992; 151 (5) 326-328
    CrossrefPubMedGoogle Scholar
  • 90 Goenka AS, Dasilva MS, Cleghorn GJ, Patrick MK, Shepherd RW. Therapeutic upper gastrointestinal endoscopy in children: an audit of 443 procedures and literature review. J Gastroenterol Hepatol 1993; 8 (1) 44-51
    CrossrefPubMedGoogle Scholar
  • 91 Siafakas C, Fox VL, Nurko S. Use of octreotide for the treatment of severe gastrointestinal bleeding in children. J Pediatr Gastroenterol Nutr 1998; 26 (3) 356-359
    CrossrefPubMedGoogle Scholar
  • 92 Lam JC, Aters S, Tobias JD. Initial experience with octreotide in the pediatric population. Am J Ther 2001; 8 (6) 409-415
    CrossrefPubMedGoogle Scholar
  • 93 Hou MC, Lin HC, Liu TT , et al. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 2004; 39 (3) 746-753
    CrossrefPubMedGoogle Scholar
  • 94 Fernández J, Ruiz del Arbol L, Gómez C , et al. Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology 2006; 131 (4) 1049-1056 , quiz 1285
    CrossrefPubMedGoogle Scholar
  • 95 Sarin SK, Misra SP, Singal AK, Thorat V, Broor SL. Endoscopic sclerotherapy for varices in children. J Pediatr Gastroenterol Nutr 1988; 7 (5) 662-666
    CrossrefPubMedGoogle Scholar
  • 96 McKiernan PJ, Beath SV, Davison SM. A prospective study of endoscopic esophageal variceal ligation using a multiband ligator. J Pediatr Gastroenterol Nutr 2002; 34 (2) 207-211
    CrossrefPubMedGoogle Scholar
  • 97 Johnson SP, Leyendecker JR, Joseph FB , et al. Transjugular portosystemic shunts in pediatric patients awaiting liver transplantation. Transplantation 1996; 62 (8) 1178-1181
    CrossrefPubMedGoogle Scholar
  • 98 Heyman MB, LaBerge JM, Somberg KA , et al. Transjugular intrahepatic portosystemic shunts (TIPS) in children. J Pediatr 1997; 131 (6) 914-919
    PubMedGoogle Scholar
  • 99 Hackworth CA, Leef JA, Rosenblum JD, Whitington PF, Millis JM, Alonso EM. Transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience. Radiology 1998; 206 (1) 109-114
    PubMedGoogle Scholar
  • 100 Huppert PE, Goffette P, Astfalk W , et al. Transjugular intrahepatic portosystemic shunts in children with biliary atresia. Cardiovasc Intervent Radiol 2002; 25 (6) 484-493
    CrossrefPubMedGoogle Scholar
  • 101 Pozler O, Krajina A, Vanicek H , et al. Transjugular intrahepatic portosystemic shunt in five children with cystic fibrosis: long-term results. Hepatogastroenterology 2003; 50 (52) 1111-1114
    PubMedGoogle Scholar
  • 102 Mermuys K, Maleux G, Heye S, Lombaerts R, Nevens F. Use of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience. Cardiovasc Intervent Radiol 2008; 31 (Suppl. 02) S192-S196
    CrossrefPubMedGoogle Scholar
  • 103 Lorenz JM. Placement of transjugular intrahepatic portosystemic shunts in children. Tech Vasc Interv Radiol 2008; 11 (4) 235-240
    CrossrefPubMedGoogle Scholar
  • 104 Hill ID, Bowie MD. Endoscopic sclerotherapy for control of bleeding varices in children. Am J Gastroenterol 1991; 86 (4) 472-476
    PubMedGoogle Scholar
  • 105 Karrer FM, Holland RM, Allshouse MJ, Lilly JR. Portal vein thrombosis: treatment of variceal hemorrhage by endoscopic variceal ligation. J Pediatr Surg 1994; 29 (8) 1149-1151
    CrossrefPubMedGoogle Scholar
  • 106 Stringer MD, Howard ER. Longterm outcome after injection sclerotherapy for oesophageal varices in children with extrahepatic portal hypertension. Gut 1994; 35 (2) 257-259
    CrossrefPubMedGoogle Scholar
  • 107 Fox VL, Carr-Locke DL, Connors PJ, Leichtner AM. Endoscopic ligation of esophageal varices in children. J Pediatr Gastroenterol Nutr 1995; 20 (2) 202-208
    CrossrefPubMedGoogle Scholar
  • 108 Price MR, Sartorelli KH, Karrer FM, Narkewicz MR, Sokol RJ, Lilly JR. Management of esophageal varices in children by endoscopic variceal ligation. J Pediatr Surg 1996; 31 (8) 1056-1059
    CrossrefPubMedGoogle Scholar
  • 109 Sökücü S, Süoglu OD, Elkabes B, Saner G. Long-term outcome after sclerotherapy with or without a beta-blocker for variceal bleeding in children. Pediatr Int 2003; 45 (4) 388-394
    CrossrefPubMedGoogle Scholar
  • 110 Itha S, Yachha SK. Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction. J Pediatr Gastroenterol Nutr 2006; 42 (2) 196-200
    CrossrefPubMedGoogle Scholar
  • 111 Maksoud-Filho JG, Gonçalves ME, Cardoso SR, Gibelli NE, Tannuri U. Long-term follow-up of children with extrahepatic portal vein obstruction: impact of an endoscopic sclerotherapy program on bleeding episodes, hepatic function, hypersplenism, and mortality. J Pediatr Surg 2009; 44 (10) 1877-1883
    CrossrefPubMedGoogle Scholar
  • 112 Yachha SK, Sharma BC, Kumar M, Khanduri A. Endoscopic sclerotherapy for esophageal varices in children with extrahepatic portal venous obstruction: a follow-up study. J Pediatr Gastroenterol Nutr 1997; 24 (1) 49-52
    CrossrefPubMedGoogle Scholar