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Assessment of Risk of Bleeding From Esophageal Varices During Management of Biliary Atresia In Children.
MedLine Citation:
PMID:  23263589     Owner:  NLM     Status:  Publisher    
OBJECTIVES:: The management of esophageal varices (EV) in children suffering from biliary atresia (BA) remains controversial. Recent studies in children proposed initiating a prophylactic treatment in patients with severe (Grade III) EV and/or EV associated with red color signs. Our study was aimed at assessing the risk of bleeding from EV in a series of BA patients, identifying risk factors for bleeding in order to develop a predictive model of bleeding. METHODS:: This was a retrospective study including 83 eligible BA patients. Clinical, ultrasonographic, endoscopic, and laboratory parameters were studied from the beginning of medical management up to the occurrence of upper gastrointestinal bleeding. In patients not presenting any bleeding, data were analyzed until liver transplantation, endoscopic treatment of EV was performed or last follow up. Risk factors were investigated using univariate and multivariate statistical analyses. RESULTS:: Seventeen out of 83 patients (20%) presented gastrointestinal bleeding, with a median age of 9.5 months (6-50 months). In univariate and multivariate analyses, high-grade EV, red color signs on endoscopic examination, and low fibrinogen levels, at first endoscopy, were identified as risk factors for bleeding. When tested in more than 10,000 different models, these three variables appeared to play the most significant role in predicting bleeding. CONCLUSIONS:: Our study confirmed that grade III EV and red color signs are risk factors for bleeding in patients followed up for BA. We identified low fibrinogen levels as an additional risk factor. The relevance of these three factors to predict bleeding from EV requires validation in a prospective study.
Catherine Wanty; Thibault Helleputte; Françoise Smets; Etienne M Sokal; Xavier Stephenne
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-20
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  -     ISSN:  1536-4801     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Service de Gastroentérologie et Hépatologie Pédiatrique, Bruxelles, Belgium †Université Catholique de Louvain, Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), Computing Science Engineering Division (INGI), Louvain-la-Neuve, Belgium.
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