Predicting variceal bleeding in patients with biliary atresia

Abstract

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.

Keywords:

• Children
• endoscopy
• transient elastrography
• Kasai portoenterostomy

Acknowledgments

The statistical analysis of this study was supported by Sinae Kim and Ju-young Park, Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine.

Author contributions

Hanbyul Sohn primary designed the study, collected the patient data and had responsibility for outcome assessment, literature review and writing the manuscript. Sowon Park, Yunkoo Kang collected the patient data and participated in outcome assessment. Hong Koh, Seok Joo Han and Seung Kim supervised every process of this study.

Disclosure statement

No potential conflict of interest was reported by the authors.