Journal of Pediatric Gastroenterology and Nutrition

Original Articles: Hepatology and Nutrition

Ultrasonographic Predictors of Esophageal Varices

Corresponding Author

Roberta V. de Alcantara

[email protected]

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

Address correspondence and reprint requests to Roberta V. de Alcantara, Departamento de Pediatria/FCM/UNICAMP, Rua Tessália Vieira de Camargo, 126 Barão Geraldo, Campinas, Sao Paulo 13083-887, Brazil (e-mail: [email protected]).Search for more papers by this author

Roberto M. Yamada,

Roberto M. Yamada

Department of Medicine, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil

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Sílvia R. Cardoso,

Sílvia R. Cardoso

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

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Maria de Fátima,

Maria de Fátima

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C.P. Servidoni,

C.P. Servidoni

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

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Gabriel Hessel,

Gabriel Hessel

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

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Roberta V. de Alcantara,

Corresponding Author

Roberta V. de Alcantara

[email protected]

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

Roberto M. Yamada,

Roberto M. Yamada

Department of Medicine, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil

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Sílvia R. Cardoso,

Sílvia R. Cardoso

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

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Maria de Fátima,

Maria de Fátima

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C.P. Servidoni,

C.P. Servidoni

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

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Gabriel Hessel,

Gabriel Hessel

Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

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First published: 01 December 2013

https://doi.org/10.1097/MPG.0b013e3182a7bc2e

Citations: 13

The authors report no conflict of interest.

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ABSTRACT

Objective:

The aim of this study was to identify ultrasonographic predictors of esophageal varices (EVs) in children and adolescents with chronic liver disease (CLD) and extrahepatic portal venous obstruction (EHPVO).

Methods:

This study evaluates 53 patients younger than 20 years with CLD or EHPVO and no history of bleeding or prophylactic EVs treatment. They were divided into 2 groups: group I (35 with CLD) and group II (18 with EHPVO). Splenorenal shunt (SS), gallbladder wall varices, gallbladder wall thickening (GT), and lesser omental thickness (LOT) were compared with the presence of EVs, gastric varices, and portal hypertensive gastropathy (PHG). Univariate (χ² test, Fisher exact test, and Wilcoxon signed rank test) and multivariate (logistic regression) analyses were performed. The area under the receiver operating curve was calculated.

Results:

EVs were observed in 48.5% of patients with CLD and in 83.3% of patients with EHPVO. SS (P = 0.0329) and LOT (P = 0.0151) predicted EV among patients with CLD. A median of 5.3 mm of LOT was considered a predictor of EVs among these patients. Multivariate analysis showed SS as an independent predictor of EVs in patients with EHPVO (odds ratio 15). Gallbladder varices (P = 0.0245) and GT (P = 0.0289) predicted EVs among patients with EHPVO. PHG occurred more often among patients with CLD who had SS (P = 0.0384) and greater LOT (P = 0.0226).

Conclusions:

SS and a greater LOT were indicative of EV among children and adolescents with CLD. Gallbladder varices and GT were indicative of EVs among patients with EHPVO. SS and a greater LOT were indicative of PHG among patients with CLD.

REFERENCES

1Bernard O, Alvarez F, Brunelle F, et al. Portal hypertension in children. Clin Gastroenterol 1985; 14: 33–55.
10.1016/S0300-5089(21)00636-2
CAS PubMed Web of Science® Google Scholar
2Irigoyen I. A importância da medida ecográfica do pequeno epíplon no diagnóstico da hipertensäo porta em pediatria. Rev Imagem 1991; 13: 145–148.
Google Scholar
3Goncalves ME, Cardoso SR, Maksoud JG. Prophylactic sclerotherapy in children with esophageal varices: long-term results of a controlled prospective randomized trial. J Pediatr Surg 2000; 35: 401–405.
10.1016/S0022-3468(00)90203-3
CAS PubMed Web of Science® Google Scholar
4Celinska-Cedro D, Teisseyre M, Woynarowski M, et al. Endoscopic ligation of esophageal varices for prophylaxis of first bleeding in children and adolescents with portal hypertension: preliminary results of a prospective study. J Pediatr Surg 2003; 38: 1008–1011.
10.1016/S0022-3468(03)00181-7
PubMed Web of Science® Google Scholar
5Fagundes ED, Ferreira AR, Roquete ML, et al. Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome. J Pediatr Gastroenterol Nutr 2008; 46: 178–183.
10.1097/MPG.0b013e318156ff07
PubMed Web of Science® Google Scholar
6Gana JC, Turner D, Roberts EA, et al. Derivation of a clinical prediction rule for the noninvasive diagnosis of varices in children. J Pediatr Gastroenterol Nutr 2010; 50: 188–193.
10.1097/MPG.0b013e3181b64437
PubMed Web of Science® Google Scholar
7Yachha SK. Portal hypertension in children: an Indian perspective. J Gastroenterol Hepatol 2002; suppl 3: 228–231.
Google Scholar
8Rumack CM, Wilson SR, Charboeaer JW. Edi[REPLACEMENT CHARACTER]ao-tradu[REPLACEMENT CHARACTER]ao T. Elsevier, Tratado de Ultrassonografia Diagnóstica. Rio de Janeiro: 2006.
Google Scholar
9Berzigotti A, Merkel C, Magalotti D, et al. New abdominal collaterals at ultrasound: a clue of progression of portal hypertension. Dig Liver Dis 2008; 40: 62–67.
10.1016/j.dld.2007.08.011
CAS PubMed Web of Science® Google Scholar
10De Giacomo C, Tomasi G, Gatti C, et al. Ultrasonographic prediction of the presence and severity of esophageal varices in children. J Pediatr Gastroenterol Nutr 1989; 9: 431–435.
10.1002/j.1536-4801.1989.tb09898.x
CAS PubMed Web of Science® Google Scholar
11Chalasani N, Kahi C, Francois F, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 2003; 98: 653–659.
10.1111/j.1572-0241.2003.07294.x
PubMed Web of Science® Google Scholar
12Garcia-Tsao G, Groszmann RJ, Fisher RL, et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 1985; 5: 419–424.
10.1002/hep.1840050313
CAS PubMed Web of Science® Google Scholar
13Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 2003; 38: 266–272.
10.1016/S0168-8278(02)00420-8
PubMed Web of Science® Google Scholar
14Ng FH, Wong SY, Loo CK, et al. Prediction of oesophagogastric varices in patients with liver cirrhosis. J Gastroenterol Hepatol 1999; 14: 785–790.
10.1046/j.1440-1746.1999.01949.x
CAS PubMed Web of Science® Google Scholar
15Zaman A, Hapke R, Flora K, et al. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol 1999; 94: 3292–3296.
10.1111/j.1572-0241.1999.01540.x
CAS PubMed Web of Science® Google Scholar
16Giannini E, Botta F, Borro P, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003; 52: 1200–1205.
10.1136/gut.52.8.1200
CAS PubMed Web of Science® Google Scholar
17de Bem RS, Lora FL, de Souza RC, et al. Correlation of Doppler ultrasound of the portal system with endoscopic changes caused by portal hypertension in cirrhotic patients. Arq Gastroenterol 2006; 43: 178–183.
10.1590/S0004-28032006000300005
PubMed Google Scholar
18Bosch J, Berzigotti A, Garcia-Pagan JC, et al. The management of portal hypertension: rational basis, available treatments and future options. J Hepatol 2008; 48 (suppl 1): S68–92.
10.1016/j.jhep.2008.01.021
CAS PubMed Web of Science® Google Scholar
19D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology 1995; 22: 332–354.
10.1002/hep.1840220145
PubMed Web of Science® Google Scholar
20Duche M, Ducot B, Tournay E, et al. Prognostic value of endoscopy in children with biliary atresia at risk for early development of varices and bleeding. Gastroenterology 2010; 139: 1952–1960.
10.1053/j.gastro.2010.07.004
PubMed Web of Science® Google Scholar
21Gana JC, Turner D, Mieli-Vergani G, et al. A clinical prediction rule and platelet count predict esophageal varices in children. Gastroenterology 2011; 141: 2009–2016.
10.1053/j.gastro.2011.08.049
PubMed Web of Science® Google Scholar
22de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53: 762–768.
10.1016/j.jhep.2010.06.004
PubMed Web of Science® Google Scholar
23Howard ER, Stringer MD, Mowat AP. Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices. Br J Surg 1988; 75: 404–408.
10.1002/bjs.1800750504
CAS PubMed Web of Science® Google Scholar
24Maksoud JG, Goncalves ME, Porta G, et al. The endoscopic and surgical management of portal hypertension in children: analysis of 123 cases. J Pediatr Surg 1991; 26: 178–181.
10.1016/0022-3468(91)90904-8
CAS PubMed Web of Science® Google Scholar
25Sasaki T, Hasegawa T, Nakajima K, et al. Endoscopic variceal ligation in the management of gastroesophageal varices in postoperative biliary atresia. J Pediatr Surg 1998; 33: 1628–1632.
10.1016/S0022-3468(98)90595-4
CAS PubMed Web of Science® Google Scholar
26Ozsoylu S, Kocak N, Demir H, et al. Propranolol for primary and secondary prophylaxis of variceal bleeding in children with cirrhosis. Turk J Pediatr 2000; 42: 31–33.
CAS PubMed Web of Science® Google Scholar
27Shashidhar H, Langhans N, Grand RJ. Propranolol in prevention of portal hypertensive hemorrhage in children: a pilot study. J Pediatr Gastroenterol Nutr 1999; 29: 12–17.
10.1002/j.1536-4801.1999.tb02354.x
CAS PubMed Web of Science® Google Scholar
28Alvarez F, Bernard O, Brunelle F, et al. Portal obstruction in children. I. Clinical investigation and hemorrhage risk. J Pediatr 1983; 103: 696–702.
10.1016/S0022-3476(83)80460-0
CAS PubMed Web of Science® Google Scholar
29Abd El-Hamid N, Taylor RM, Marinello D, et al. Aetiology and management of extrahepatic portal vein obstruction in children: King's College Hospital experience. J Pediatr Gastroenterol Nutr 2008; 47: 630–634.
10.1097/MPG.0b013e31817b6eea
PubMed Web of Science® Google Scholar
30Gurakan F, Eren M, Kocak N, et al. Extrahepatic portal vein thrombosis in children: etiology and long-term follow-up. J Clin Gastroenterol 2004; 38: 368–372.
10.1097/00004836-200404000-00013
PubMed Web of Science® Google Scholar
31Sarin SK, Sollano JD, Chawla YK, et al. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006; 26: 512–519.
10.1111/j.1478-3231.2006.01269.x
CAS PubMed Web of Science® Google Scholar
32de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005; 43: 167–176.
10.1016/j.jhep.2005.05.009
PubMed Web of Science® Google Scholar
33Bittencourt PL, Farias AQ, Strauss E, et al. Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology. Arq Gastroenterol 2010; 47: 202–216.
10.1590/S0004-28032010000200017
PubMed Google Scholar
34Pilette C, Oberti F, Aube C, et al. Non-invasive diagnosis of esophageal varices in chronic liver diseases. J Hepatol 1999; 31: 867–873.
10.1016/S0168-8278(99)80288-8
CAS PubMed Web of Science® Google Scholar
35Schepis F, Camma C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology 2001; 33: 333–338.
10.1053/jhep.2001.21410
CAS PubMed Web of Science® Google Scholar
36Zaman A, Becker T, Lapidus J, et al. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med 2001; 161: 2564–2570.
10.1001/archinte.161.21.2564
CAS PubMed Web of Science® Google Scholar
37Madhotra R, Mulcahy HE, Willner I, et al. Prediction of esophageal varices in patients with cirrhosis. J Clin Gastroenterol 2002; 34: 81–85.
10.1097/00004836-200201000-00016
CAS PubMed Web of Science® Google Scholar
38Sharma SK, Aggarwal R. Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters. J Gastroenterol Hepatol 2007; 22: 1909–1915.
10.1111/j.1440-1746.2006.04501.x
CAS PubMed Web of Science® Google Scholar
39Cherian JV, Deepak N, Ponnusamy RP, et al. Non-invasive predictors of esophageal varices. Saudi J Gastroenterol 2011; 17: 64–68.
10.4103/1319-3767.74470
PubMed Web of Science® Google Scholar
40Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60: 646–649.
10.1002/bjs.1800600817
CAS PubMed Web of Science® Google Scholar
41McGahan JP, Phillips HE, Cox KL. Sonography of the normal pediatric gallbladder and biliary tract. Radiology 1982; 144: 873–875.
10.1148/radiology.144.4.7111740
CAS PubMed Web of Science® Google Scholar
42Idezuki Y. General rules for recording endoscopic findings of esophagogastric varices (1991). Japanese Society for Portal Hypertension. World J Surg 1995; 19: 420–423.
10.1007/BF00299178
CAS PubMed Web of Science® Google Scholar
43Sarin SK, Mishra SR. Endoscopic therapy for gastric varices. Clin Liver Dis 2010; 14: 263–279.
10.1016/j.cld.2010.03.007
CAS PubMed Web of Science® Google Scholar
44Cubillas R, Rockey DC. Portal hypertensive gastropathy: a review. Liver Int 2010; 30: 1094–1102.
10.1111/j.1478-3231.2010.02286.x
CAS PubMed Web of Science® Google Scholar
45Patriquin H, Tessier G, Grignon A, et al. Lesser omental thickness in normal children: baseline for detection of portal hypertension. AJR Am J Roentgenol 1985; 145: 693–696.
10.2214/ajr.145.4.693
CAS PubMed Web of Science® Google Scholar
46Moubarak E, Bouvier A, Boursier J, et al. Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review. Abdom Imaging 2012; 37: 746–766.
10.1007/s00261-011-9811-0
PubMed Web of Science® Google Scholar
47Cho KC, Patel YD, Wachsberg RH, et al. Varices in portal hypertension: evaluation with CT. Radiographics 1995; 15: 609–622.
10.1148/radiographics.15.3.7624566
CAS PubMed Web of Science® Google Scholar
48Chawla Y, Dilawari JB, Katariya S. Gallbladder varices in portal vein thrombosis. AJR Am J Roentgenol 1994; 162: 643–645.
10.2214/ajr.162.3.8109513
CAS PubMed Web of Science® Google Scholar
49Chawla A, Dewan R, Sarin SK. The frequency and influence of gallbladder varices on gallbladder functions in patients with portal hypertension. Am J Gastroenterol 1995; 90: 2010–2014.
CAS PubMed Web of Science® Google Scholar
50Yamada RM, Hessel G. Ultrasonographic assessment of the gallbladder in 21 children with portal vein thrombosis. Pediatr Radiol 2005; 35: 290–294.
10.1007/s00247-004-1343-0
PubMed Web of Science® Google Scholar

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Volume57, Issue6

December 2013

Pages 700-703

Ultrasonographic Predictors of Esophageal Varices

ABSTRACT

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Results:

Conclusions:

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