Evaluation of the re bleeding average in pediatric patients with portal vein thrombosis that used endoscopic and/or prophylactic drug therapy

Abstract

Introduction: Portal hypertension is a consequence of extra-hepatic portal vein obstruction , and portal vein thrombosis is its main etiology in pediatric age. The most feared portal hypertension complication is upper digestive hemorrhage caused by rupture of esophageal varicose veins. It´s estimated that over 70-79 per cent of children with deep vein thrombosis (DVT) will present at least one episode of upper digestive hemorrhage on their lives. The approach is divided in: primary prophylaxis, treatment of acute hemorrhage episode and secondary prophylaxis. Available prophylactic methods are: pharmacologic, endoscopic therapy, and surgery. Objectives: Evaluate the rebleeding rate due to esophageal and/or gastric varicose veins rupture in patients using secondary prophylaxis with propanolol and/or endoscopic procedures/methods, followed up in IMIP’s pediatric hepatology ambulatorial service. Methods: It's an analytical, and retrospective study, with the analysis of patient’s medical records. A computer software “R” version 3.3.1. was used for the statistical analysis. Results: Rebleeding global rate was 1,5 times, in spite of prophylaxis’s type used. The most utilized procedures for bleeding control were endoscopic treatment with sclerotherapy and elastic ligature (N=10) followed by endoscopic and drug therapy with propanolol (N=9). Analyzing rebleeding frequency, it can be noticed that patients which the only treatment realized was sclerotherapy presented re-bleed average of 2,16 times. Patients who realized only elastic ligature (N=2) or propanolol (N=3) had not presented new bleeding episodes. Conclusions: The present study reveals a small average of rebleeding in patients that used only elastic ligature or propanolol. However, new studies in pediatric age group are needed to evaluate the security and efficacy of specific methods.