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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Consensus on extra-hepatic portal vein obstruction.
Endoscopic band ligation followed by sclerotherapy. In a follow up study from our institute we have shown that factor V Leiden and prothrombin gene mutations were uncommon in children with EHPVO. Variceal bleeding in EHPVO can be successfully managed by endoscopic obliteration of varices, which has low morbidity but requires repeated visits, or by portosystemic shunt surgery, which provides good control of bleeding, possibly helps growth retardation, hypersplenism, and protects against future development of portal biliopathy but is associated with surgical mortality and is sometimes not feasible due to nonavailability of a satisfactory vessel.
As of now, we do not have sufficient data to say what proportions of EHPVO cases are suitable for this new shunt.
There are two main approaches to prevent further bleed: Long term outcome after injection sclerotherapy for esophageal varices in children with extra hepatic portal hypertension. This observation again supports the compression theory in most cases of portal biliopathy. The risk of bleeding is more with secondary gastric varices varices appearing after eradication of esophageal varicesisolated gastric varices IGV1 and gastroesophageal varices along the greater curvature of stomach GOV2.
Idiopathic portal hypertension and extrahepatic portal venous obstruction.
Colonic changes ejpvo patients with cirrhosis and in patients with extrahepatic portal vein obstruction. Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass.
These findings suggest diminished anabolic action of growth hormone on muscle growth affecting the lean muscle mass, and its lipolytic effect resulting in decreased adiposity.
Primary biliary tract surgery has significant morbidity and mortality due to extensive collaterals around the bile ducts. Ssrin, EST cannot be totally ruled out as a therapeutic modality, especially in children. However, since most of the patients are asymptomatic, this approach is recommended only if a therapeutic intervention is contemplated.
Extrahepatic portal vein obstruction.
Prophylactic sclerotherapy in children with esophageal sarib The natural history of portal hypertensive gastropathy: Consequently recurrence of ehhpvo has been shown to be higher with EVL.
Aetiology and management of extrahepatic portal vein obstruction in children: Some people believe that shunt surgery should be done first in all cases with symptomatic biliopathy and if it fails to resolve biliary obstruction then second stage biliary surgery is recommended. Frequency of gastropathy and gastric varices in children with extrahepatic portal venous obstruction treated with sclerotherapy. Besides variceal bleeding, which is the commonest presentation, patients may have symptomatic portal biliopathy, hypersplenism, and growth retardation.
Poddar U Borkar V.
In another study Chaudhary et al  documented relief of jaundice in five of seven patients within weeks of shunt surgery and the remaining two patients required second stage hepaticojejunostomy. The postulated mechanisms ehpbo biliary changes in EHPVO are extrinsic compression by portal collaterals,[ 44] ischemic stricture of bile duct due to injury at the time of portal venous thrombosis[ 45 ] or a combination of both. Whether these patients should have shunt surgery after control of acute bleeding by endotherapy EST or EVL or should undergo further endotherapy for variceal eradication and surveillance is a long-standing debate.
Extrahepatic portal vein obstruction.
Biliary shpvo in extrahepatic portal venous obstruction: Incidence of haemorrhoids and anorectal varices in children with portal hypertension. On the other hand, EVL has the advantages of rapid eradication of varices requiring fewer sessions and portending fewer complications.
Endoscopic band ligation followed by sclerotherapy: Mesoportal bypass for extrahepatic portal vein obstruction in children: Unfortunately, the experience of EVL in children is limited. EHPVO is the commonest cause of portal hypertension and variceal bleeding in children. Pseudosclerosing cholangitis in extrahepatic portal venous ehpco. Conventionally, medical and endoscopic management is usually recommended for EHPVO, and various surgical ssrin are used for refractory or complicated cases.
Significantly increased levels of growth hormone and decreased levels of insulin-like growth factor-1 IGF-1 and insulin-like growth factor binding protein-3 IGFBP-3 have been noted in EHPVO patients, suggesting growth hormone resistance. Extrahepatic portal vein obstruction in children: Portal-vein obstruction in children leads to growth retardation.
Treatment of bleeding esophagogastric varices due to extrahepatic portal hypertension: Most of these bleeding episodes occurred within the first 4 years of variceal eradication. With the availability of effective endotherapy, the mortality due to variceal bleeding has become a rarity but the morbidity due to late sequelae like growth failure, portal bilipathy, gastric varices, rectal sarih etc.
The prevalence and spectrum of colonic lesions in patients with cirrhosis and noncirrhotic portal hypertension.
The exact mechanism of the growth failure is not known. After a follow up of 4.