Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass: Summary of the Baveno VI Pediatric Satellite Symposium

Benjamin L. Shneider*, Jean de Ville de Goyet, Daniel H. Leung, Anshu Srivastava, Simon C. Ling, Mathieu Duché, Patrick Mckiernan, Riccardo Superina, Robert H. Squires, Jaime Bosch, Roberto Groszmann, Shiv K. Sarin, Roberto de Franchis, George V. Mazariegos

*Corresponding author for this work

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

Approaches to the management of portal hypertension and variceal hemorrhage in pediatrics remain controversial, in large part because they are not well informed by rigorous clinical studies. Fundamental biological and clinical differences preclude automatic application of approaches used for adults to children. On April 11-12, 2015, experts in the field convened at the first Baveno Pediatric Satellite Meeting to discuss and explore current available evidence regarding indications for MesoRex bypass (MRB) in extrahepatic portal vein obstruction and the role of primary prophylaxis of variceal hemorrhage in children. Consensus was reached regarding MRB. The vast majority of children with extrahepatic portal vein obstruction will experience complications that can be prevented by successful MRB surgery. Therefore, children with extrahepatic portal vein obstruction should be offered MRB for primary and secondary prophylaxis of variceal bleeding and other complications, if appropriate surgical expertise is available, if preoperative and intraoperative evaluation demonstrates favorable anatomy, and if appropriate multidisciplinary care is available for postoperative evaluation and management of shunt thrombosis or stenosis. In contrast, consensus was not achieved regarding primary prophylaxis of varices. Although variceal hemorrhage is a concerning complication of portal hypertension in children, the first bleed appears to be only rarely fatal and the associated morbidity has not been well characterized. Conclusion: There are few pediatric data to indicate the efficacy and safety of pharmacologic or endoscopic therapies as primary prophylaxis or that prevention of a sentinel variceal bleed will ultimately improve survival; therefore, no recommendation for primary prophylaxis with endoscopic variceal ligation, sclerotherapy, or nonspecific beta-blockade in children was proposed.

Original languageEnglish (US)
Pages (from-to)1368-1380
Number of pages13
JournalHepatology
Volume63
Issue number4
DOIs
StatePublished - Apr 1 2016

ASJC Scopus subject areas

  • Hepatology

Fingerprint Dive into the research topics of 'Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass: Summary of the Baveno VI Pediatric Satellite Symposium'. Together they form a unique fingerprint.

  • Cite this

    Shneider, B. L., de Ville de Goyet, J., Leung, D. H., Srivastava, A., Ling, S. C., Duché, M., Mckiernan, P., Superina, R., Squires, R. H., Bosch, J., Groszmann, R., Sarin, S. K., de Franchis, R., & Mazariegos, G. V. (2016). Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass: Summary of the Baveno VI Pediatric Satellite Symposium. Hepatology, 63(4), 1368-1380. https://doi.org/10.1002/hep.28153