Predicting variceal bleeding in patients with biliary atresia

• Published in: Scandinavian journal of gastroenterology Vol. 54; no. 11; pp. 1385 - 1390
• Main Authors: Sohn, Hanbyul, Park, Sowon, Kang, Yunkoo, Koh, Hong, Han, Seok Joo, Kim, Seung
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02-11-2019
• Subjects: Children; endoscopy; Kasai portoenterostomy; transient elastrography; Kasai portoenterostomy; endoscopy; Children; transient elastrography
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/00365521.2019.1683225

Background/aims: Variceal bleeding is the main cause of morbidity and mortality in children with portal hypertension and biliary atresia. The aim of this study is to predict high-risk varices by analyzing various clinical factors, thus improve prognosis of patients with biliary atresia.
Methods: A total of 157 patients with biliary atresia who underwent Kasai portoentrostomy were enrolled in a single center. Clinical data including laboratory values, endoscopic findings and values of transient elastography (FibroScan
®
) were analyzed retrospectively.
Results: The bleeding group and the non-bleeding group showed statistically significant differences in several variables; The FibroScan
®
value (HR 1.05, 95% CI (1.03-1.07), p  <  .01) was higher in the bleeding group. The bleeding group had values of lower albumin after 3 months of operation (HR 0.28, 95% CI (0.11-0.73), p  =  .01), higher bilirubin after 3 months of operation (total bilirubin: HR 1.18, 95% CI (1.04-1.33), p  =  .01), (direct bilirubin: HR 1.21, 95% CI (1.05-1.41), p  =  .01). Gastric varix (HR 4.10, 95% CI (1.62-10.36), p  <  .01) was more frequent in the bleeding group. And the presence of red sign was also predictive of bleeding. The FibroScan
®
cut-off value with the predictive power of bleeding was 31.5 kPa (HR 7.7, 95% CI (3.36-17.73), p  <  .01).
Conclusions: Several clinical factors including high value of transient elastography (FibroScan
®
), gastric varix or red sign of endoscopy, and low albumin or high bilirubin values after 3 months of Kasai operation can be useful in predicting variceal bleeding in patients with biliary atresia.