title: Endoscopic surveillance and primary prophylaxis sclerotherapy of esophageal varices in biliary atresia.
abstract: OBJECTIVE
  Evidence-based recommendations on endoscopic screening and prophylactic treatment of esophageal varices in patients with biliary atresia (BA) are scarce. We assessed the efficiency of endoscopic surveillance and risk factors of esophageal varices and associated upper gastrointestinal bleeding.
  
  
  METHODS
  A total of 47 consecutive children with BA and portoenterostomy underwent yearly endoscopies and prophylactic injection sclerotherapy of esophageal varices between 1987 and 2009. The median follow-up was 1.7 years (range 0.5-18.9) and overall 2-year survival 71%. Disease characteristics, clearance of jaundice, laboratory tests reflecting liver function and hypersplenism, as well as sonographic signs of portal hypertension were related to endoscopic findings and bleeding episodes.
  
  
  RESULTS
  Grade 2 to 3 varices developed with similar frequency after failed (18/28, 64%) and successful portoenterostomy (10/19, 53%) in 28 patients. Following failed portoenterostomy, esophageal varices were encountered significantly earlier (8 [4-23] vs. 19 [4-165] months, P = 0.004), and they reappeared after eradication more often (16/16 vs. 4/10, P = 0.001). Varices bled only after failed portoenterostomy (13/28 vs. 0/19, P < 0.001). Increased serum bilirubin concentration >40 μmol/L at 3 months after portoenterostomy was a risk factor of upper gastrointestinal bleeding (odds ratio [OR] 17, 95% confidence interval [CI] 1.7-175, P = 0.017).
  
  
  CONCLUSIONS
  In future studies as well as clinical surveillance of BA patients' varices, successful and failed portoenterostomy patients should be approached as separate groups with divergent prognoses. After failed portoenterostomy, surveillance should start early, for example, at 6 months.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. hanna.lampela@hus.fi
authors.forename: Hanna
authors.initials: H
authors.lastname: Lampela
authors.forename: Silja
authors.initials: S
authors.lastname: Kosola
authors.forename: Antti
authors.initials: A
authors.lastname: Koivusalo
authors.forename: Jouni
authors.initials: J
authors.lastname: Lauronen
authors.forename: Hannu
authors.initials: H
authors.lastname: Jalanko
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
mesh_terms: D000293:Adolescent; D001656:Biliary Atresia / Q000150:complications*; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy / Q000379:methods; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006971:Hypersplenism / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D007565:Jaundice / Q000209:etiology / Q000628:therapy; D011171:Portoenterostomy, Hepatic / Q000379:methods; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D015911:Sclerotherapy; D017211:Treatment Failure
chemical_list: D001663:Bilirubin