Sarin SK(1), Agarwal SR. Extrahepatic portal vein obstruction (EHPVO) is an important cause of noncirrhotic portal hypertension, especially in Third World. Endoscopic Management. S. K. Sarin, Cyriac Abby Philips, Rajeev Khanna tal vein obstruction (EHPVO), noncirrhotic portal fibrosis. (NCPF; or idiopathic PHT. Extrahepatic Portal Vein Obstruction (EHPVO). Non‐Cirrhotic Shiv Kumar Sarin MD, DM. Director Treatment of chronic EHPVO in children.
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Management of esophageal varices. On the other hand, EVL has the advantages of rapid eradication of varices requiring fewer sessions and portending fewer complications.
Consensus on extra-hepatic portal vein obstruction.
In a study of 36 children Stringer et al36 noted sain a mean follow up of 8. It is expected that the incidence of rectal varices with and without rectal bleeding will rise in children as they approach adolescence and adulthood. The latter mechanism has been further substantiated by the fact that after conventional shunt surgery the levels of anticoagulant proteins tend to further go down. Improvement of growth after restoration of hepatic blood flow with mesenteric-left-portal bypass or Rex shunt, has been documented.
There is a paradigm shift in EHPVO management towards shunt surgery after the introduction of mesenteric-left-portal vein bypass or Rex shunt as it provides complete cure of the condition. Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass.
Mesoportal bypass for extrahepatic portal vein obstruction in children: Abstract Extrahepatic portal venous obstruction Saron is the commonest cause of portal hypertension and variceal bleeding in children. Variceal recurrence was low in both the groups 6.
Extrahepatic portal vein obstruction EHPVO is an important cause of noncirrhotic portal hypertension, especially in Third World countries.
Non-cirrhotic portal hypertension – diagnosis and management.
Management of colorectal saron. Endoscopic sclerotherapy in children. Correction of extrahepatic portal vein thrombosis by the meserteric to left portal vein bypass. Primary biliary tract surgery has significant morbidity and mortality due to extensive collaterals around the bile ducts.
This suggests that children with EHPVO have growth failure and decreased growth velocity despite adequate nutrition. Further research is needed to understand the pathogenesis and natural history of these disorders. In this article we will discuss the management of EHPVO under the headings of etiology, management of variceal bleeding, ectopic varices, portal biliopathy, growth zarin and the role of shunt surgery.
Longterm studies after endotherapy have shown almost no mortality.
Management of extra hepatic portal venous obstruction (EHPVO): current strategies
Relation of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels to growth retardation in extrahepatic portal vein obstruction. Nevertheless, EST cannot be sxrin ruled out as a therapeutic modality, especially in children. Surgical guidelines for the management of extra-hepatic portal vein obstruction. The debate is whether to send a child for shunt surgery preferably Rex shunt immediately after controlling acute variceal bleeding ehovo endotherapy or to continue endotherapy to prevent further bleed and xarin offer shunt surgery as and when the child needs it.
Bleeding in extrahepatic portal vein obstruction. Biliary changes in extrahepatic portal venous obstruction: The definitive method of diagnosis of portal biliopathy is ERCP.
Endoscopic band ligation followed by sclerotherapy. The low prevalence in pediatric studies clearly suggests that the duration of portal hypertension plays an important role in the development of rectal varices.
Extrahepatic portal vein obstruction.
Shunt surgery should be considered for asymptomatic portal biliopathy in presence of another indication like growth failure, symptomatic hypersplenism or ectopic varices. Eur J Pediatr Surg. Patients with choledocholithiasis and stricture will require multiple sessions of endoscopic therapy with balloon dilatation and stent placement.
Nevertheless, a combination of band ligation followed by sclerotherapy has shown to be superior to either modality in children with EHPVO. Chawla Y, Dilawari JB.
Extrahepatic portal venous obstruction EHPVO is the commonest cause of portal hypertension and variceal bleeding in children. Though mortality related to variceal bleeding is uncommon, morbidity due to massive splenomegaly with hypersplenism, growth failure, ectopic varices like rectal varices and portal biliopathy is significant.
Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Infections, autoimmunity, drugs, immunodeficiency and prothrombotic states are possible etiological agents in IPH. Portal hypertensive gastropathy in children. Cholestasis in children with portal vein obstruction. This is the most physiological shunt as it restores the hepatic blood flow.
In adults, overt or occult primary myeloproliferative disorders MPD are the commonest cause of portal vein thrombosis. Growth failure, portal biliopathy and minimal hepatic encephalopathy are additional concerns in EHPVO.
Another study from Lucknow  documented growth retardation height less than 5th percentile for age sqrin