title: Progression to high-risk gastroesophageal varices in children with biliary atresia with low-risk signs at first endoscopy.
abstract: OBJECTIVE
  Biliary atresia carries a risk of bleeding because of portal hypertension. Our goal was to define the factors associated with the emergence of endoscopic signs carrying a high risk of bleeding in children who did not display these signs at the first upper gastrointestinal endoscopy.
  
  
  METHODS
  From 1989 to 2013, a total of 225 children with low-risk signs at the first endoscopic examination underwent ≥2 upper gastrointestinal endoscopic examinations. The emergence of high-risk gastroesophageal varices was observed in 76 children in the 10 years following the first endoscopic examination. A survival study using the occurrence of high-risk varices as an event was performed to identify factors related to the emergence of these varices and to describe the probability of their emergence in 2 groups of children ages older than 18 months and 18 months or younger at the time of the first endoscopy.
  
  
  RESULTS
  High total serum bilirubin concentration, young age, and high number/grade of esophageal varices at the first endoscopy were significantly related to the emergence of high-risk varices. The probability of the emergence of high-risk signs was higher and these signs appeared faster in infants 12 months of age or younger and/or when the first endoscopic examination displayed >1 grade 1 or grade 2 varices. Progression to high-risk varices was also related to bilirubinemia in children older than 18 months at the first endoscopy.
  
  
  CONCLUSIONS
  The results allow defining a program of repeat endoscopies to detect high-risk varices and to discuss endoscopic primary prophylaxis of bleeding or hasten liver transplantation when these signs are found.
authors.affiliation: *Hépatologie Pédiatrique and Centre de Référence National de l'atrésie des Voies Biliaires, Hôpital Bicêtre, AP-HP †Santé Publique et Epidémiologie, Hôpital Bicêtre, AP-HP, Orsay, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Duché
authors.forename: Béatrice
authors.initials: B
authors.lastname: Ducot
authors.forename: Oanez
authors.initials: O
authors.lastname: Ackermann
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Jacquemin
authors.forename: Olivier
authors.initials: O
authors.lastname: Bernard
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001656:Biliary Atresia / Q000097:blood / Q000150:complications*; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000209:etiology* / Q000473:pathology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007223:Infant; D011159:Population Surveillance; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001663:Bilirubin