Background and Aims
The medical literature on colonic changes in children with extrahepatic portal venous
obstruction (EHPVO) is limited. We evaluated EHPVO children for prevalence, nature,
and relation of colonic changes with disease duration, extent of splenoportal axis
(SPA) thrombosis, portal hypertensive gastropathy (PHG), and esophageal varices (EVs).
The correlation between histologic and endoscopic changes was studied.
Methods
Subjects were evaluated by colonoscopy with ileoscopy and biopsy sampling, clinico-laboratory
profiles, and SPA imaging. Colonic changes were classified as varices (rectal/colonic)
and portal hypertensive colopathy (PHC; colitis-like or vascular lesions). Morphometric
analysis of colonic biopsy specimens was performed.
Results
Fifty-four children (median age, 12 years [range, 8-15]; hematochezia in 9 [16.6%])
were evaluated. Rectal and colonic varices were seen in 51 (94%) and 2 (3.7%) cases,
respectively. Seventy-five percent of patients had PHC, and colitis-like lesions were
more common than vascular lesions (36/40 vs 23/40; P = .001). Colopathy changes were pancolonic in 52.5%, left-sided in 42.5%, and right-sided
in 5% of cases. Sixteen percent of patients (8/49) had ileal changes. Children with
PHC had PHG more often (90% vs 57%; P = .01), more endotherapy sessions (mean 6 [range, 4-8] vs 2 [range, 1-4]; P = .03), and large EVs less often (12.5% vs 43%; P = .02) than those without colopathy. The extent of SPA thrombosis was similar in
patients with and without PHC. The number of capillaries per crypt was higher in EHPVO
than in control subjects. Morphometric changes had no correlation with endoscopy.
Conclusions
Most EHPVO children had colonic changes, and 16% had ileopathy. “Colitis-like” changes
and left-side involvement were more common. Patients with PHG and eradicated EVs had
a higher risk of PHC.
Graphical abstract
Graphical Abstract
Abbreviations:
EHPVO (extrahepatic portal vein obstruction), EST (endoscopic sclerotherapy), EV (esophageal varix), EVL (endoscopic variceal ligation), IMV (inferior mesenteric vein), PHC (portal hypertensive colopathy), PHG (portal hypertensive gastropathy), PHT (portal hypertension), PV (portal vein), RV (rectal varix), SMV (superior mesenteric vein), SPA (splenoportal axis), SV (splenic vein)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 06, 2019
Accepted:
November 20,
2019
Received:
August 10,
2019
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
