Use of non-invasive scales for detecting esophageal varices in paediatric patients with portal vein thrombosis

Abstract

IntroductionPortal vein thrombosis (PVT) is the most frequent cause of portal hypertension in paediatric population. Baveno VI Consensus considers endoscopic variceal ligation (EVL) as the second therapeutic option after Meso-Rex bypass (surgical shunt). AimAnalyse the diagnostic profitability of non-invasive scales in order to predict the risk of esophageal varices (OV) in children with PVT. Materials and methodsDescriptive retrospective study where every upper gastrointestinal endoscopy (UGE) carried on patients <15 years old with non-cirrhotic PVT were included. There were divided according to the presence of OV and sex, cause, age, previous gastrointestinal bleeding or treatments, results of UGE and scales (Clinical Prediction Rule-CPR), Varices Prediction Rule-VPR), King’s Variceal Prediction Score-K-VaPS) and Platelet count / Spleen diameter Ratio-PSR). Qualitative variables were expressed as absolute frequency and percentage, and quantitative variables as median and intercuartilic range. U Mann–Whitney and Hanley–McNeil tests were used for comparisons. Results45 UGE were analysed. 80% (n = 36) presented OV: median of 3(2–3) and 33,3%(n = 12) required EVL. Statistical differences were demonstrated between both groups: CPR (142,39 (132,22–166,53) vs. 122,75 (115,24–133,15); p = 0,003), VPR (9,91 (9,36 – 11,75) vs. 5,6 (3,34–8,39) p = 0,001), K-VaPS (117,86 (99,66–126,58) vs. 99,64 (94,88–110,18) p = 0,019), PSR (2384,62 (1902,22–3201,63) vs. 1252,5 (579,6–2144,42) p = 0,05), with and area under the curve AUROC > 75%, without statistical differences between scales. ConclusionsIn paediatric patients with non-cirrotic PVT non-invasive scales can be used as a tool to predict the presence of OV and raise the indication of UGE.