Long-term follow-up of children with extrahepatic portal vein obstruction: impact of an endoscopic sclerotherapy program on bleeding episodes, hepatic function, hypersplenism, and mortality

Aim Extrahepatic portal vein obstruction (EHPVO) is a frequent cause of noncirrhotic portal hypertension in children. The aim of this study is to analyze long-term results after diversion surgery. Patients and Methods Retrospective review of EHPVO patients who underwent diversion surgery analyzing number of platelets, leukocytes, prothrombin activity, splenomegaly, and gastrointestinal bleeding 10 years after surgery. Results Thirty-three patients were evaluated, mostly males (64%) and presenting with gastrointestinal bleeding (46%). Mesoportal shunt (Rex) was performed in 19 patients, mesocaval in 7, distal splenorenal in 7, and proximal splenorenal in 3. While comparing mesoportal shunt to the other portosystemic shunts, an increase in platelets was found with every technique, but it was clearly higher in mesoportal shunt. The highest increase was 6 months after surgery (p = 0.0015) as well as prothrombin activity (p = 0.0003). Leukocytes level also increased without statistical significance. Spleen size (cm) and spleen size Z score (SSAZ) decreased significantly 6 months after mesoportal shunt (p = 0.0168). Before surgery, over 94% patients suffered gastrointestinal bleeding, which reduced significantly afterward with bleeding episodes in only four (12%) of them. Conclusion Diversion surgery in EHPVO, especially mesoportal shunt of Rex, improves hepatic function (prothrombin activity), reduces hypersplenism (platelets, leukocytes, and spleen size), and decreases gastrointestinal bleeding episodes.

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Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass

Surgical Endoscopy ◽

10.1007/s00464-013-3376-7 ◽

2014 ◽

Vol 28 (5) ◽

pp. 1454-1459 ◽

Cited By ~ 15

Author(s):

Magdy Giurgius ◽

Nicole Fearing ◽

Alexandra Weir ◽

Lada Micheas ◽

Archana Ramaswamy

Keyword(s):

Gastric Bypass ◽

Endoscopic Sclerotherapy ◽

Long Term Follow Up

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Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes

The Scientific World JOURNAL ◽

10.1155/2013/498535 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Fumio Uchiyama ◽

Satoru Murata ◽

Shiro Onozawa ◽

Ken Nakazawa ◽

Fumie Sugihara ◽

...

Keyword(s):

Hepatic Function ◽

Gastric Varices ◽

Gastroesophageal Varices ◽

Before And After ◽

Complete Obliteration ◽

Long Term Follow Up ◽

The Mean ◽

Serum Ammonia

Our aim was to evaluate the long-term efficacy and safety of percutaneous transhepatic obliteration (PTO) alone and combined with balloon-occluded retrograde transvenous obliteration (BRTO) for gastroesophageal varices refractory to BRTO alone. Between July 1999 and December 2010, 13 patients with gastroesophageal varices refractory to BRTO were treated with PTO (n= 6) or a combination of PTO and BRTO (n= 7). We retrospectively investigated the rates of survival, recurrence, or worsening of the varices; hepatic function before and after the procedure; and complications. The procedure achieved complete obliteration or significant reduction of the varices in all 13 patients without major complications. During follow-up, the varices had recurred in 2 patients, of which one had hepatocellular carcinoma, and the other died suddenly from variceal rebleeding 7 years after PTO. The remaining 11 patients did not experience worsening of the varices and showed significant improvements in the serum ammonia levels and prothrombin time. The mean follow-up period was 90 months, and the cumulative survival rate at 1, 3, and 5 years was 92.9%, 85.7%, and 85.7%, respectively. Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

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Partial Splenic Embolization UsingBletilla striataParticles for Hypersplenism in Cirrhosis: A Prospective Study

The American Journal of Chinese Medicine ◽

10.1142/s0192415x11008804 ◽

2011 ◽

Vol 39 (02) ◽

pp. 261-269 ◽

Cited By ~ 4

Author(s):

Rong Liu ◽

Xiao-Jun Teng ◽

Jiang-Fu He ◽

Shao-Shu Xiao ◽

Zhi-Bing Yuan ◽

...

Keyword(s):

Abdominal Pain ◽

Esophageal Varices ◽

Embolic Material ◽

Cell Counts ◽

Significant Difference ◽

Long Term Follow Up ◽

Bleeding Episodes ◽

The Mean

The article evaluates the long-term follow-up results of PSE using Bletilla striata (BS) particles for hypersplenism in cirrhosis, as compared to PSE using gelfoam particles. Fifty-nine patients with cirrhosis-induced hypersplenism were treated with PSE. The patients were randomly assigned into two groups: gelfoam group, which includes 32 patients using gelfoam particles as the embolic material, and BS group, which includes 27 patients using BS particles. The peripheral blood cell counts and parameters for complications associated with PSE were measured during the follow-up. The mean values of leukocyte and thrombocyte, but not hemoglobin, were significantly increased after PSE (p < 0.01) in both groups. The values of leukocyte and thrombocyte during the long-term follow-up were significantly improved in BS group than that in gelfoam group (both p < 0.01). The frequency of bleeding episodes from esophageal varices in both groups was significantly reduced after PSE (both p < 0.01), but the post-PSE bleeding episodes showed no remarkable differences between the two groups (p = 0.084). Post-embolization syndrome consisted mainly of fever, nausea and vomiting, and abdominal pain in the two groups. The incidence of grade II to III abdominal pain in BS group (82.8%, 27/33) was significantly higher than in gelfoam group (57.9%, 33/57) (p = 0.020). The mean survival time was 61.5 ± 9.1 (median 60, 1–157) months in gelfoam group and 63.4 ± 9.9 (median 52, 0–161) months in BS group, which showed no significant difference (p = 0.930).In conclusion, BS particles could be used as the embolic material in PSE. Compared to gelfoam used in PSE, BS can achieve even better efficacy in alleviating hypersplenism. It provides a long-term effect on the hematological parameters, bleeding from esophageal varices and good palliation, and improved clinical status contributing to symptomatic control.

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Long‐term results of variceal bleeding management in 302 patients with chronic extrahepatic portal vein obstruction

Journal of Gastroenterology and Hepatology ◽

10.1111/jgh.14902 ◽

2019 ◽

Vol 35 (6) ◽

pp. 1049-1056 ◽

Cited By ~ 1

Author(s):

Hui Chen ◽

Chuangye He ◽

Yong Lv ◽

Jiahao Fan ◽

Shihao Tang ◽

...

Keyword(s):

Portal Vein ◽

Variceal Bleeding ◽

Long Term Results ◽

Extrahepatic Portal Vein Obstruction ◽

Bleeding Management ◽

Portal Vein Obstruction

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Portal-vein embolization after sclerotherapy treatment of bleeding gastric varices: report of a case with long-term follow-up

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2008.07.006 ◽

2009 ◽

Vol 69 (6) ◽

pp. 1176-1178 ◽

Cited By ~ 4

Author(s):

Kai-Lun Shih ◽

Hsu-Heng Yen ◽

Maw-Soan Soon

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Gastric Varices ◽

Long Term Follow Up

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LONG-TERM FOLLOW-UP OF CYTOMEGALIC INCLUSION DISEASE OF INFANCY

PEDIATRICS ◽

10.1542/peds.46.3.403 ◽

1970 ◽

Vol 46 (3) ◽

pp. 403-410

Author(s):

William Berenberg ◽

George Nankervis

Keyword(s):

Hepatic Function ◽

Late Mortality ◽

Previous Child ◽

Cytomegalic Inclusion Disease ◽

Long Term Follow Up ◽

Neurologic Disability ◽

Motor Retardation ◽

Affected Infant

Twelve children with cytomegalic inclusion disease (CID) of infancy were reevaluated at ages ranging from 3 to 12 years. Nine manifested significant mental and/or motor retardation while three did not have significant neuromuscular residual deficit. In general those infants with CID who demonstrated microcephaly, chorioretinitis, and intracranial calcification continued to exhibit these changes on follow-up while those free of these phenomena in infancy did not subsequently develop such changes. No significant abnormalities were encountered in studies of hematologic, renal, or hepatic function. Late mortality did not occur except as a consequence of severe neurologic disability. Fifteen children born of mothers who had had a previous child afflicted with CID were normal. The mothers remained well, although they had nine miscarriages after the birth of the affected infant, while none had occurred previously.

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