Endoscopy 2018; 50(04): S139
DOI: 10.1055/s-0038-1637448
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

HIGH RISK OF ESOPHAGEAL VARICES IN PATIENTS WITH FONTAN SURGERY: A PROSPECTIVE MULTICENTER PILOT STUDY

, VALDIG FONLIVER
E Rodríguez de Santiago
1   Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD, Gastroenterology and Hepatology, Madrid, Spain
,
L Téllez Villajos
1   Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD, Gastroenterology and Hepatology, Madrid, Spain
,
E Garrido-Lestache
2   Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Pediatric Cardiology Department, Madrid, Spain
,
E Garrido Gómez
1   Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD, Gastroenterology and Hepatology, Madrid, Spain
,
L Aguilera Castro
1   Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD, Gastroenterology and Hepatology, Madrid, Spain
,
V La Mura
3   IRCCS Policlinico San Donato. University of Milan, Internal Medicine. Department of Biomedical Sciences for Health, Milán, Italy
,
R Romera
4   Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Radiology, Madrid, Spain
,
A Olavarría
4   Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Radiology, Madrid, Spain
,
M Álvarez
2   Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Pediatric Cardiology Department, Madrid, Spain
,
E Llop
5   Hospital Universitario Puerta de Hierro, Gastroenterology and Hepatology, Madrid, Spain
,
JC García-Pagán
6   Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Liver Unit, Barcelona, Spain
,
E Vázquez Sequeiros
1   Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD, Gastroenterology and Hepatology, Madrid, Spain
,
I Sánchez
2   Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Pediatric Cardiology Department, Madrid, Spain
,
F Gea
1   Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD, Gastroenterology and Hepatology, Madrid, Spain
,
MJ Del Cerro
2   Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Pediatric Cardiology Department, Madrid, Spain
,
A Albillos
1   Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBEREHD, Gastroenterology and Hepatology, Madrid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Fontan surgery (FS) allows the venous return to reach the pulmonary circulation bypassing the ventricle in patients with single ventricle. This results in sustained systemic venous hypertension and liver damage in long-term. Nevertheless, natural history of liver disease in these patients has been poorly studied; prevalence and features of esophageal varices (EV) are unknown. The AIM of this study is to estimate the prevalence and characterize EV in this special population.

Methods:

Multicentre, observational, transversal, prospective and analytical study. 32 patients with > 5yr since FS underwent Doppler US, Fibroscan®, cardiac and hepatic catheterization, blood test and upper endoscopy. Haemorrhagic risk EV was defined according to Baveno VI criteria

Results:

32 patients were included. Age: median 27.9 yr, IQR: 11; 34% were females. Time from FS was: median 21, IQR 8.3 yr. Prevalence of EV was 53% (17/32; CI 95%: 36 – 69%). 18% (6/32; CI 95%: 9 – 35%) had high-risk stigmata and 1 patient presented with variceal haemorrhage. The most frequent location was the mid-lower esophagus. There were not gastric varices. In the univariant analysis, inferior vena cava pressure> 16 mmHg (p = 0.09), platelets< 125000/mm3 (p = 0.06) and Fibroscan® > 30 kPa (p = 0.04) were associated with the presence of EV. The most relevant incidental finding was diffuse gastritis (16/32, 50%), followed by peptic ulcer in 4 patients (13%). Sedation conducted by experienced endoscopist had more sedation-related complications than expected (2/6, severe hypoxemia and sustained hypotension). Sedation guided by anaesthesiologists (22/32,69%) was safe

Conclusions:

Prevalence of EV is very high in patients after FS. Some of them have high-risk EV and haemorrhage may occur. Screening with upper endoscopy in patients with liver stiffness > 30kPa and platelets < 125000/ml is highly advisable.