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Assessment of Risk of Bleeding From Esophageal Varices During Management of Biliary Atresia in Children

Wanty, Catherine*; Helleputte, Thibault; Smets, Françoise*; Sokal, Etienne M.*; Stephenne, Xavier*

Journal of Pediatric Gastroenterology and Nutrition: May 2013 - Volume 56 - Issue 5 - p 537–543
doi: 10.1097/MPG.0b013e318282a22c
Original Articles: Hepatology and Nutrition

Objectives: The management of esophageal varices (EV) in children experiencing biliary atresia (BA) remains controversial. Recent studies in children proposed initiating a prophylactic treatment in patients with severe (grade III) EV and/or EV associated with red color signs. Our study was aimed at assessing the risk of bleeding from EV in a series of patients with BA, identifying risk factors for bleeding to develop a predictive model of bleeding.

Methods: This was a retrospective study including 83 eligible patients with BA. Clinical, ultrasonographic, endoscopic, and laboratory parameters were studied from the beginning of medical management up to the occurrence of upper gastrointestinal bleeding. In patients not presenting any bleeding, data were analyzed until liver transplantation, endoscopic treatment of EV was performed, or last follow-up. Risk factors were investigated using univariate and multivariate statistical analyses.

Results: Seventeen of 83 patients (20%) presented gastrointestinal bleeding, with a median age of 9.5 months (6–50 months). In univariate and multivariate analyses, high-grade EV, red color signs on endoscopic examination, and low fibrinogen levels, at first endoscopy, were identified as risk factors for bleeding. When tested in >10,000 different models, these 3 variables appeared to play the most significant role in predicting bleeding.

Conclusions: Our study confirmed that grade III EV and red color signs are risk factors for bleeding in patients followed up for BA. We identified low fibrinogen levels as an additional risk factor. The relevance of these 3 factors to predict bleeding from EV requires validation in a prospective study.

*Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Service de Gastroentérologie et Hépatologie Pédiatrique, Bruxelles, Belgium

Université Catholique de Louvain, Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), Computing Science Engineering Division (INGI), Louvain-la-Neuve, Belgium.

Address correspondence and reprint requests to Xavier Stephenne, Service de Gastro-Entérologie Pédiatrique, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, B-1200 Bruxelles, Belgium (e-mail:

Received 25 September, 2012

Accepted 11 December, 2012

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,