https://pubmed.ncbi.nlm.nih.gov/36541813/ biliary atresia

Pediatr Int. 2022 Dec 21;e15454.
doi: 10.1111/ped.15454. Online ahead of print.

The presence of high-risk varices after sclerotherapy in biliary atresia

Shinya Yokoyama 1, Yoji Ishizu 1, Takashi Honda 1, Norihiro Imai 1, Takanori Ito 1, Kenta Yamamoto 1, Chiyoe Shirota 2, Takahisa Tainaka 2, Wataru Sumida 2, Satoshi Makita 2, Aitaro Takimoto 2, Yoichi Nakagawa 2, Shunya Takada 2, Masatoshi Ishigami 1, Hiroo Uchida 2, Hiroki Kawashima 1

Abstract

Background: Esophagogastric varices (EGVs) may develop as a result of portal hypertension in children with biliary atresia (BA). Although endoscopic injection sclerotherapy (EIS) with ethanolamine oleate (EO) is reported useful for children, risk factors associated with the presence of high-risk EGVs after treatment remain unknown.

Methods: The subjects were BA patients under 15 years of age who underwent EO-EIS. We retrospectively reviewed a total of 28 treatment sessions of EGVs with red signs and those larger than F2, which were considered to be at high risk of bleeding. Survival analysis was performed for the presence of high-risk EGVs at the time of follow-up endoscopy as the occurrence of an event.

Results: Univariate analysis showed a significantly increased risk of the presence of high-risk EGVs post-EO-EIS in patients with increased liver stiffness (LS) and Mac-2 binding protein glycan isomer (M2BPGi), with hazard ratios of 1.48 and 1.15, respectively. The median presence-free period was significantly shorter in the LS ≥ 2.8 m/sec patients than in those with LS < 2.8 m/sec (189 vs. 266 days). Similarly, the median presence-free period was significantly shorter in patients with M2BPGi ≥ 4.0 than in those with M2BPGi < 4.0 (182 vs. 203 days). The results of multivariate analysis revealed that the risk of the presence of high-risk EGVs was significantly higher only in the high-LS group, with a hazard ratio of 2.76.

Conclusions: Increased LS is associated with risk of the presence of high-risk EGVs following EO-EIS in children with BA. (246 words).