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Authors’ Response

Alberti, Daniele*; D’Antiga, Lorenzo

Journal of Pediatric Gastroenterology & Nutrition: April 2014 - Volume 58 - Issue 4 - p e41
doi: 10.1097/MPG.0000000000000287
Letters to the Editor

*Paediatric Surgery, University of Brescia, Presidio Ospedale dei Bambini, Brescia

Paediatric Hepatology, Gastroenterology, and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy

To the Editor:

Our study reports the outcome of children with extrahepatic portal vein obstruction managed prospectively with the same protocol for 15 years, without any selection. In this protocol, surgery (with priority to meso-portal bypass [MPB]) was indicated only after the failure of medical and endoscopic treatments. Accurate methodology suggested considering our latest cases, which had a preemptive MPB, as violations. With these data, we could certainly not argue in favor of or against different approaches, although the violations tell that we probably agree with the comment made.

We hope that Drs Superina and de Ville will have the chance to produce similar data on a large, unselected population of children presenting with extrahepatic portal vein obstruction and managed prospectively with a protocol considering preemptive MPB as the first step. We look forward to reading such a study that could prove that preemptive MPB is superior to MPB carried out as a second-line treatment (1). Meanwhile, we appreciate the comment and we agree with what, at the moment, is an expert opinion (2).

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1. Alberti D, Colusso M, Cheli M, et al. Results of a stepwise approach to extra-hepatic portal vein obstruction in children. J Pediatr Gastroenterol Nutr 2013; 57:619–626.
2. Shneider BL, Bosch J, de Franchis R, et al. Portal hypertension in children: expert pediatric opinion on the report of the Baveno v Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension. Pediatr Transplant 2012; 16:426–437.
© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,