Noninvasive Methods of Predicting Large Esophageal Varices in Children With Intrahepatic Portal Hypertension

ABSTRACT Objective: Esophageal variceal bleeding is a severe complication of portal hypertension. The standard diagnostic screening test and therapeutic procedure for esophageal varices is endoscopy, which is invasive in pediatric patients. This study aimed to evaluate the role of noninvasive parameters as predictors of large varices in children with intrahepatic portal hypertension. Methods: Participants included in this cross-sectional study underwent a screening endoscopy. Variceal size, red marks, and portal gastropathy were assessed and rated. Patients were classified into two groups: G1, with small or no varices; and G2, with large varices. The population consisted of 98 children with no history of gastrointestinal bleeding, with a mean age of 8.9 ± 4.7 years. The main outcome evaluated was the presence of large varices. Results: The first endoscopy session revealed the presence of large varices in 32 children. The best noninvasive predictors for large varices were platelets (AUROC 0.67; 95%CI, 0.57–0.78), the Clinical Prediction Rule (AUROC 0.65; 95%CI, 0.54–0.76), and risk score (AUROC 0.66; 95%CI: 0.56–0.76). The logistic regression model showed that children with a Clinical Prediction Rule value under 114 were 8.59 times more likely to have large varices. Risk scores higher than −1.2 also increased the likelihood of large varices (OR6.09; P = 0.014), as did a platelet count/spleen size z-score lower than 25 (OR 3.99; P = 0.043). The combination of these three tests showed a high negative predictive value. Conclusion: The Clinical Prediction Rule, the risk score, and the platelet count/spleen size z-score could be helpful in identifying cirrhotic children who may be eligible for endoscopy. Address correspondence and reprint requests to Marina R. Adami, MD, Rua Jari 671/812; Zip Code: 91350-170, Porto Alegre, Rio Grande do Sul, Brazil (e-mail: marinaadami2008@gmail.com). Received 29 May, 2015 Accepted 13 September, 2017 This article has been developed as a Journal CME Activity by NASPGHAN. Visit http://ift.tt/2ioSD8w to view instructions, documentation, and the complete necessary steps to receive CME credit for reading this article. The other authors report no conflicts of interest. Source of Support: Fundação de Incentivo a Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre: FIPE-HCPA. Non-Financial Disclosure. © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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