December 15, 2021
1 minute reading
Source/Disclosures Published by:
Source:
Slowik V, et al. Summary 256. Presented at: North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting; December 12-18, 2021 (virtual meeting).
disclosures:
Healio was unable to confirm the financial disclosures at the time of publication.
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According to a presentation, both primary endoscopic prophylaxis and secondary endoscopic prophylaxis were safe for the prevention of varicose veins in pediatric patients with portal hypertension.
“Portal hypertension is the obstruction of portal venous blood flow through the liver. … It is associated with multiple complications, but the most relevant for this project is varicose bleeding. … In adults, prevention of bleeding is indicated with beta blockade and endoscopy; however, that’s a good step into the knowledge gaps in pediatrics,” Voytek R. Slovakia, MD, said a pediatric gastroenterologist at Children’s Mercy Hospitals and Clinics in Kansas City, Missouri during the presentation. “We wanted to contribute to the ongoing conversation about what is the best way to manage pediatric portal hypertension.”
In a retrospective study, researchers wanted to investigate prophylactic endoscopy for the prevention of gastrointestinal bleeding in pediatric patients with portal hypertension. The study population included 87 pediatric patients (median age at endoscopy, 8.48 years; 55% girls) who underwent surveillance endoscopy prior to gastrointestinal bleeding (primary prophylactic endoscopy) and 52 pediatric patients (median age at endoscopy, 4.93 years; 58% girls) who were supervised after an episode of gastrointestinal bleeding (secondary prophylactic endoscopy).
According to study results, patients undergoing primary prophylaxis had a lower mean number of endoscopies (3,897 vs. 6,269; P = .001) and fewer pediatric ICU admissions at the time of endoscopy (1% vs. 7%; P < .001) compared to patients undergoing secondary prophylaxis. Furthermore, primary prophylaxis resulted in a lower probability of portosystemic shunt placement (6% vs. 15%; P < .001) with no difference in immediate complications (1% vs. 2%), 2-week complications (1% vs. 2%) , need for transplant (24% vs. 27%) or death (5% vs. 13%). Slowik noted that there were no deaths associated with endoscopy or varicose veins.
“Prophylactic endoscopy should be considered a safe management strategy in pediatric patients with portal hypertension. Complications were rare and usually resolved with supportive care,” concluded Slowik. “Further studies should compare primary and secondary prophylaxis; it’s a reasonable question we need to answer if primary prophylaxis is really associated with improved outcomes.”
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