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Splenic stiffness and platelet count to predict varices needing treatment in pediatric extrahepatic portal vein obstruction

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Abstract

Background

Surveillance endoscopy to detect varices needing treatment (VNT) is important to prevent bleeding and morbidity in portal hypertension. In adult and pediatric cirrhosis, platelet count and liver stiffness measurement (LSM) are useful in selecting patients for endoscopy. Such recommendations do not exist for extrahepatic portal vein obstruction (EHPVO). Splenic stiffness measurement (SSM) has been studied in adult and pediatric EHPVO with conflicting results and methodological errors. This study evaluates the role of platelet counts and SSM to predict VNT and bleeding in pediatric EHPVO while comparing LSM and SSM between pediatric EHPVO and controls.

Methods

One hundred and seven children (55 with EHPVO and 52 controls) were recruited. Clinical, biochemical, hematological, and radiographic parameters of all children were noted. All children with EHPVO underwent endoscopy.

Results

Of the 55 children with EHPVO, 48 (87.3%) had VNT. There was no difference in the platelet counts (85,000/mm3 vs. 120,000/mm3, p = 0.58) and SSM (3.62 vs. 3.19, p = 0.05) between EHPVO children with VNT and those without. They had poor sensitivity and specificity to predict VNT. EHPVO children with bleeding had higher SSM that those without. LSM was higher among EHPVO than among controls (1.19 vs. 1.10, p = 0.003). Those with LSM higher than controls had normal liver histology.

Conclusion

SSM is higher in EHPVO bleeders but SSM and platelet counts are unreliable to predict VNT in pediatric EHPVO. Surveillance endoscopies may be needed in all pediatric EHPVO until better screening strategies are available.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605 006, India

    Srinivas Srinidhi Vadlapudi

  2. Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India

    Barath Jagadisan

  3. Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India

    Ramesh Ananthkrishnan & Sunil Narayanaswamy

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  1. Srinivas Srinidhi Vadlapudi
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  2. Barath Jagadisan
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  3. Ramesh Ananthkrishnan
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  4. Sunil Narayanaswamy
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Contributions

Srinivas Srinidhi Vadlapudi: collected the data, analyzed and interpreted the data. Barath Jagadisan: conceptualized and designed the study, interpreted the data, prepared the manuscript, performed endoscopies. Ramesh Ananthkrishnan: performed ultrasonography and ARFI. Sunil Narayanaswamy: performed ultrasonography and ARFI. All authors contributed to the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Barath Jagadisan.

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Conflict of interest

SSV, BJ, RA and SN declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

The study had been approved by the institute ethics committee that complies with international standards and is registered with the government of India (JIP/IEC/2016/1082).

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Supplementary Information

Supplemental Fig 1

AUROC for SSM and platelet count to predict variceal bleeding in EHPVO (PNG 160 kb)

High Resolution image (TIFF 226 kb)

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Vadlapudi, S.S., Jagadisan, B., Ananthkrishnan, R. et al. Splenic stiffness and platelet count to predict varices needing treatment in pediatric extrahepatic portal vein obstruction. Indian J Gastroenterol 39, 576–583 (2020). https://doi.org/10.1007/s12664-020-01099-8

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  • DOI: https://doi.org/10.1007/s12664-020-01099-8

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