EHPVOExtra-Hepatic Portal Vein Obstruction
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Gastric varices are mostly prevalent in patients with portal hypertension particularly with extra hepatic portal venous thrombosis (EHPVO) in children.16 Our study is a retrospective analysis.
(3, 7) Chronic PVT (EHPVO), on the other hand, requires the management of PH as such with a role for anticoagulation in the setting of underlying prothrombotic state.
The study population comprised 70 children: 29 with EHPVO and 41 with intrahepatic causes of portal hypertension.
Gastric varices were identified in 22/59 (37.3%) patients--slightly more than in the EHPVO group, but not statistically significant.
Among children in the intrahepatic disease group, 53.3% had initial or first oesophageal bleeding before age 2 years, compared with 37.9% in the EHPVO group, although this difference was not statistically significant.
However, 2 of these patients with EHPVO presented as re-bleeders after previous variceal sclerosis and were managed by additional sclerotherapy sessions.
Eighteen of 29 (62.1%) EHPVO patients were offered surgical shunts.
A greater number of confirmed sepsis cases were reported among intrahepatic disease patients (17/30 (56.7%) compared with 9/29 (31%) EHPVO patients; p=0.067).
The study cohort had a nearly even distribution of EHPVO and intrahepatic disease as a cause of varices, allowing us to compare modes of sclerotherapy and determine if outcome was influenced by underlying aetiology.
Early portoenterostomy and LT availability have contributed to a higher incidence of children requiring sclerotherapy for intrahepatic portal hypertension compared with the Hill and Bowie (8) study where most patients had EHPVO.
In this study, more children with intrahepatic disease than EHPVO bled within the first 2 years of life.
In contrast to other studies, (2,9,10) the success rate with sclerotherapy alone on EHPVO was 20.7%, which was low.