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 A 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

35 Citations (Scopus)

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

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Pediatrics
Hemorrhage
Portal Vein
Portal Hypertension
Sclerotherapy
Varicose Veins
Ligation
Anatomy
Pathologic Constriction
Thrombosis
Morbidity
Safety
Therapeutics

ASJC Scopus subject areas

  • Hepatology

Cite this

Shneider, B. L., de Ville de Goyet, J., Leung, D. H., Srivastava, A., Ling, S. C., Duché, M., ... 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
Shneider, Benjamin L. ; de Ville de Goyet, Jean ; Leung, Daniel H. ; Srivastava, Anshu ; Ling, Simon C. ; Duché, Mathieu ; Mckiernan, Patrick ; Superina, Riccardo A ; Squires, Robert H. ; Bosch, Jaime ; Groszmann, Roberto ; Sarin, Shiv K. ; de Franchis, Roberto ; Mazariegos, George V. / Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass : Summary of the Baveno VI Pediatric Satellite Symposium. In: Hepatology. 2016 ; Vol. 63, No. 4. pp. 1368-1380.
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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.",
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Shneider, BL, de Ville de Goyet, J, Leung, DH, Srivastava, A, Ling, SC, Duché, M, Mckiernan, P, Superina, RA, Squires, RH, Bosch, J, Groszmann, R, Sarin, SK, de Franchis, R & Mazariegos, GV 2016, 'Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass: Summary of the Baveno VI Pediatric Satellite Symposium', Hepatology, vol. 63, no. 4, pp. 1368-1380. https://doi.org/10.1002/hep.28153

Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass : Summary of the Baveno VI Pediatric Satellite Symposium. / Shneider, Benjamin L.; de Ville de Goyet, Jean; Leung, Daniel H.; Srivastava, Anshu; Ling, Simon C.; Duché, Mathieu; Mckiernan, Patrick; Superina, Riccardo A; Squires, Robert H.; Bosch, Jaime; Groszmann, Roberto; Sarin, Shiv K.; de Franchis, Roberto; Mazariegos, George V.

In: Hepatology, Vol. 63, No. 4, 01.04.2016, p. 1368-1380.

Research output: Contribution to journalArticle

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T1 - Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass

T2 - Summary of the Baveno VI Pediatric Satellite Symposium

AU - Shneider, Benjamin L.

AU - de Ville de Goyet, Jean

AU - Leung, Daniel H.

AU - Srivastava, Anshu

AU - Ling, Simon C.

AU - Duché, Mathieu

AU - Mckiernan, Patrick

AU - Superina, Riccardo A

AU - Squires, Robert H.

AU - Bosch, Jaime

AU - Groszmann, Roberto

AU - Sarin, Shiv K.

AU - de Franchis, Roberto

AU - Mazariegos, George V.

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N2 - 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.

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