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Ultrasonographic Predictors of Esophageal Varices

de Alcantara, Roberta V.*; Yamada, Roberto M.; Cardoso, Sílvia R.*; de Fátima, Maria; Servidoni, C.P.*; Hessel, Gabriel*

Journal of Pediatric Gastroenterology and Nutrition: December 2013 - Volume 57 - Issue 6 - p 700–703
doi: 10.1097/MPG.0b013e3182a7bc2e
Original Articles: Hepatology and Nutrition

Objective: The aim of this study was to identify ultrasonographic predictors of esophageal varices (EVs) in children and adolescents with chronic liver disease (CLD) and extrahepatic portal venous obstruction (EHPVO).

Methods: This study evaluates 53 patients younger than 20 years with CLD or EHPVO and no history of bleeding or prophylactic EVs treatment. They were divided into 2 groups: group I (35 with CLD) and group II (18 with EHPVO). Splenorenal shunt (SS), gallbladder wall varices, gallbladder wall thickening (GT), and lesser omental thickness (LOT) were compared with the presence of EVs, gastric varices, and portal hypertensive gastropathy (PHG). Univariate (χ 2 test, Fisher exact test, and Wilcoxon signed rank test) and multivariate (logistic regression) analyses were performed. The area under the receiver operating curve was calculated.

Results: EVs were observed in 48.5% of patients with CLD and in 83.3% of patients with EHPVO. SS (P = 0.0329) and LOT (P = 0.0151) predicted EV among patients with CLD. A median of 5.3 mm of LOT was considered a predictor of EVs among these patients. Multivariate analysis showed SS as an independent predictor of EVs in patients with EHPVO (odds ratio 15). Gallbladder varices (P = 0.0245) and GT (P = 0.0289) predicted EVs among patients with EHPVO. PHG occurred more often among patients with CLD who had SS (P = 0.0384) and greater LOT (P = 0.0226).

Conclusions: SS and a greater LOT were indicative of EV among children and adolescents with CLD. Gallbladder varices and GT were indicative of EVs among patients with EHPVO. SS and a greater LOT were indicative of PHG among patients with CLD.

*Department of Pediatrics, Hospital de Clínicas, UNICAMP, Campinas

Department of Medicine, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.

Address correspondence and reprint requests to Roberta V. de Alcantara, Departamento de Pediatria/FCM/UNICAMP, Rua Tessália Vieira de Camargo, 126 Barão Geraldo, Campinas, Sao Paulo 13083-887, Brazil (e-mail:

Received 6 March, 2013

Accepted 29 July, 2013

The authors report no conflict of interest.

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