https://www.ncbi.nlm.nih.gov/pubmed/32119939 Upper GI bleeding

Gastrointest Endosc. 2020 Feb 28. pii: S0016-5107(20)30211-X. doi: 10.1016/j.gie.2020.02.035. [Epub ahead of print]

Endoscopic variceal ligation as primary prophylaxis for upper GI bleeding in children.

Bernabeu JQ1, Juampérez J2, Mercadal-Hally M2, King ML2, Ortega J3, Molino JA4, Abu-Suboh M5, Dot J5, Nuño R5, Montferrer N5, Armengol JR5, Charco R6.

Abstract

BACKGROUND AND AIMS:
Variceal hemorrhage can be a life-threatening adverse event of chronic liver disease. In contrast to the well described guidelines for the management of portal hypertension (PH) in adults, there is limited evidence about the optimal prophylactic management of variceal bleeding in children. The study was carried out to assess the efficacy of endoscopic variceal ligation (EVL) as primary prophylaxis to prevent upper GI bleeding in children with PH.

METHODS:
From January 2014 to April 2018, all pediatric patients with PH disease and medium to large esophageal varices or reddish spots, regardless of the grade of the varix, were prospectively included in the protocol of primary prophylaxis with EVL. A second retrospective group of patients was made after reviewing medical records of 32 pediatric patients with PH that presented esophageal varices in the upper endoscopy and had received propranolol as primary prophylaxis.

RESULTS:
Twenty-four patients (75%) reach varices eradication in the EVL group with a median number of procedures before eradication of 2 (1-4) and a median time to eradication of 3.40 months (1.10-13.33). No EVL-related adverse events were observed. Statistically significant differences were observed in the bleeding rate at 3 years between propranolol and EVL groups (6/32, 21.9% vs 1/32, 3.2%; P < 0.02). The hazard ratio for bleeding for patients treated with propranolol compared with those treated with EVL was 2.6 (1.53-3.67; IC 95%).

CONCLUSIONS:
EVL is a safe and effective treatment to prevent upper GI bleeding in pediatric patients with PH.