The work is devoted to improving the treatment results of portal hypertension in children by developing and improving methods of endoscopic variceal bleeding prevention and surgical tactics optimization.
Esophageal varices are present in 40-60% of patients with hepatic portal hypertension [D’Amico G. et al., 1997] and in 95% of cases with portal vein thrombosis in the prehepatic portal hypertension form [Giouleme O. Et al., 2013]. Rupture of esophageal and stomach varices, as a complication of portal hypertension, is a common cause of bleeding from the upper gastrointestinal tract in children [Attard TM et al., 2017]. Mortality from acute bleeding associated with esophageal and stomach variceal rupture in children remains high 5-19%, despite the involvement of modern surgical and endoscopic hemostatic methods [Reis dos Santos J.M., 2013]. In view of this, the question of choosing a prophylactic method aimed at preventing bleeding becomes extremely important.
Esophagogastroduodenoscopy is a standard diagnostic and treatment procedure in pediatrics for the detection and follow-up of the esophageal and stomach varices, with the possibility of early endoscopic eradication [Cardey J. et al., 2018].
The proposed endoscopic classifications of esophagus and stomach varicose veins in adulthood do not have a single reasonable signs of division by degrees and determination of markers of high bleeding risk from them [Jeanniard-Malet O. et al., 2017; Philips CA et al., 2016; Duche M. et al., 2015; Tajiri T. et al., 2010]. In addition, there is no single endoscopic classification of varicose veins that has been tested or standardized for childhood [D’Antiga L. et al., 2015].
The question of the screening endoscopy appropriateness in children to detect varicose veins with a high bleeding risk remains open [Squires R.H. et al., 2014; Verdaguer D.S. et al., 2016; D’Antiga L. et al., 2012].
The concept of primary variceal bleeding prevention in children with portal hypertension in the modern literature is not fully supported for several reasons: 1) lack of data to clearly define the endoscopic characteristics of esophagus and stomach varicose veins with a high risk of bleeding, which justifies prevention of portal hypertension; 2) efficacy and safety of β-blockers, which are widely used in adults; 3) low mortality from the first episode of bleeding in children [Duche M. et al., 2017; Ling SC Et al., 2011; Shneider BL et al., 2016; Molleston JP, 2013; Duche M. et al., 2017; Pimenta JR et al., 2017; Jeanniard- Malet O. et al., 2017; Verdaguer DS et al., 2016].
According to global guidelines, secondary variceal bleeding prevention in portal hypertension should always be performed in children [Shneider B.L., 2012]. However, research is still underway to determine the most optimal method and stages of secondary prevention in children.
