title: Primary prophylaxis of variceal bleeding in children and the role of MesoRex Bypass: Summary of the Baveno VI Pediatric Satellite Symposium.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Shneider
authors.affiliation: Bambino Gesu Children's Hospital and Tor Vergata Roma University, Rome, Italy.
authors.forename: Jean
authors.initials: J
authors.lastname: de Ville de Goyet
authors.affiliation: Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Leung
authors.affiliation: Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Anshu
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Hospital for Sick Children and the Department of Paediatrics, University of Toronto, Toronto, Canada.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Ling
authors.affiliation: Hépatologie Pédiatrique and Centre de Référence National de l'Atrésie des Voies Biliaires, Radiologie Pédiatrique, Université Paris-Sud 11, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Duché
authors.affiliation: Birmingham Children's Hospital, Birmingham, United Kingdom.
authors.forename: Patrick
authors.initials: P
authors.lastname: McKiernan
authors.affiliation: Lurie Children's Hospital, Chicago, IL.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Superina
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Squires
authors.affiliation: Hospital Clinic-IDIBAPS and CIBEREHD, Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Yale University School of Medicine, New Haven, CT.
authors.forename: Roberto
authors.initials: R
authors.lastname: Groszmann
authors.affiliation: Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Sarin
authors.affiliation: University of Milan, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: de Franchis
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
authors.forename: George V
authors.initials: GV
authors.lastname: Mazariegos
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003226:Congresses as Topic; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000000981:diagnostic imaging; D008026:Ligation / Q000379:methods; D008297:Male; D010372:Pediatrics; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D015911:Sclerotherapy / Q000379:methods; D015996:Survival Rate; D013685:Telecommunications; D016896:Treatment Outcome; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000379:methods