Use and safety of prophylactic endoscopy from a single center serving urban and rural children with portal hypertension

Abstract

Prophylactic endoscopy is routine in adults with portal hypertension (PHTN), but there is limited data in pediatrics. We sought to describe our experience with prophylactic endoscopy in pediatric PHTN. This is a retrospective study of 87 children who began surveillance endoscopy prior to gastrointestinal bleeding (primary prophylaxis) and 52 who began after an episode of bleeding (secondary prophylaxis) from 01/01/1994 to 07/01/2019. Patients who underwent primary prophylaxis had a lower mean number of endoscopies (3.897 vs 6.269, p = 0.001). The primary prophylaxis group was less likely to require a portosystemic shunt (6% vs 15%, p < 0.001) with no difference in immediate complications (1% vs 2%, p = 0.173) or 2-week complications (1% vs 2%, p = 0.097). No deaths were related to variceal bleeding or endoscopy. Kaplan-Meier Survival Curve suggests improved transplant and shunt free survival in the primary prophylaxis group (log-rank p < 0.001). Primary and secondary endoscopic prophylaxis should be considered safe for the prevention of variceal hemorrhage in pediatric portal hypertension. There are differences in outcomes in primary and secondary prophylaxis, but unclear if this is due to patient characteristics versus treatment strategy. Further study is needed to compare safety and efficacy to watchful waiting.

Figure 1

(A) Kaplan–Meier Overall Survival Curve for Primary and Secondary Endoscopic Prophylaxis (log-rank p = 0.023). (B) Kaplan–Meier Survival Curve without portosystemic shunt or liver transplant for Primary and Secondary Endoscopic Prophylaxis (log-rank p < 0.001).

Figure 2

(a) Kaplan–Meier Overall Survival Curve for Primary and Secondary Endoscopic Prophylaxis excluding CTPV/PTV (log-rank p = 0.017). (b) Kaplan–Meier Survival Curve without portosystemic shunt or liver transplant for Primary and Secondary Endoscopic Prophylaxis excluding CTPV/PTV (log-rank p = 0.008).