DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194747

Evaluate the role of endoscopy and ultrasonography in patients of portal hypertension

Ghanshyam Das, Shweta Gautam, Vijay Pal

Abstract


Background: Aim of the study was to evaluate the role of endoscopy and ultrasonography in pediatric patients suffering from portal hypertension .subjects: children under 12 years of age hospitalized with any symptom or sign suggestive of portal hypertension.

Methods: The study was conducted in 30 children with portal hypertension. They were divided into two groups on the basis of site of lesion: extrahepatic (extra hepatic portal vein obstruction) and intrahepatic (chronic liver diseases).

Results: Mean age of children with EHPVO (extra hepatic portal vein obstruction) was 4 years and 4 months while that of children with CLD (chronic liver diseases) mean age was 8 years and 4 months. Endoscopic findings in patients with EHPVO have severe grade of varices as compared to those with CLD. In patients with EHPVO, the most common USG finding was nonvisualisation of the main portal vein or either branch (75-85%). Portal vein cavernoma was seen in 75% of these patients. Portosystemic collaterals were visualized in 23 patients  in which the left gastric collateral (60%) was the most common followed by short gastric collaterals in 11 children (55%).

Conclusions: Endoscopy and ultrasonography are new and better modalities to assess the diagnosis and severity of portal hypertension. Extra hepatic portal vein obstruction is the commonest cause followed by intrahepatic obstruction (Chronic liver diseases).


Keywords


Collaterals, Endoscopy, Liver, Portal hypertension, Ultrasonography, Varices

Full Text:

PDF

References


Alvarez F, Bernard O, Brunelle F, Hadchouel M, Leblanc A, Odievre M, Alagille D. Congenital hepatic fibrosis in children. J Pediatr. 1981 Sep 1;99(3):370-5.

Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odievre M, Alagille D. Portal obstruction in children. I. Clinical investigation and hemorrhage risk. J Pediatr. 1983 Nov 1;103(5):696-702.

Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odievre M, Alagille D. Portal obstruction in children. II. Results of surgical portosystemic shunts. J Pediatr. 1983 Nov 1;103(5):703-7.

Bernard O, Alvarez F, Brunelle f, Hadchouel P, Alagille D. Portal hypertension in children. Clin Gastroentrol. 1985;14:33-55.

Wilson KW, Robinson DC. Portal hypertension in childhood. Br J Surg. 1969;56:13-22.

Bismuth HE, Franco DO, Alagille DA. Portal diversion for portal hypertension in children. The first ninety patients. Ann surg. 1980 Jul;192(1):18.

Clark AW Mac Dougal BRD, Westaby D. Prospective clinical trials of injection sclerotherapy in cirrhotic patients with recent variceal hemorrhage. Lancet. 1980;2:552-4.

Bhave SA, Pradhan AM, Sidhaja DG, Pandit AN, Tanner MS: Liver disease in India. Arch Dis Child. 1982;57:922-8.

Westaby D, Melia WM, Macdougall BR, Hegarty JE, Williams R. Injection sclerotherapy for oesophageal varices: a prospective randomised trial of different treatment schedules. Gut. 1984 Feb 1;25(2):129-32.

Dokmeci AK, Kimura K, Matsutani S, Ohto M, Ono T, Tsuchiya Y, et al. Collateral veins in portal hypertension: demonstration by sonography. Am J Roentgenol. 1981 Dec 1;137(6):1173-7.

Kumar A, Sharma N, Bajpai M, Panda SS. Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children with extra hepatic portal venous obstruction: Our experience. Afri J Paediatr Surg. 2014 Jan 1;11(1):48.

Mitra SK, Mukherjee B, Prasad G: Extraheaptic portal obstruction in children. Expereince with side-to-side lienorenal shunt without splenectomy. Ind J Pediatr. 1983;50:50-60.

Hsia DY and Gellis SS. Portal hypertension in infants and children. Am J Dis Child. 1965;90:290.

William R, Westaby D. Endoscopic sclerotherapy for esophageal varices. Dig Dis Sci. 1986;31:108-21.