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). Nonā€Cirrhotic Shiv Kumar Sarin MD, DM. Director Treatment of chronic EHPVO in children.

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Introduction Extrahepatic portal venous obstruction EHPVO is the commonest cause of portal hypertension in children [12] and one of the common causes in adults in India. Conventionally, medical and endoscopic management is usually recommended for EHPVO, and various surgical shunts are used for refractory or complicated cases.

Liver function tests took 2 to 2. Pant Hospital, New Delhi, India. Extrahepatic portal venous obstruction EHPVO is the commonest cause of portal hypertension and variceal bleeding in children. This observation again supports the compression theory in most cases of portal biliopathy. Results of surgical portosystemic shunts. After hemodynamic resuscitation all such patients should undergo endotherapy [either sclerotherapy EST or band ligation EVL ].

A prospective study of endoscopic esophageal variceal ligation using multiband ligator. Portal hypertension, children, biliopathy, growth, sclerotherapy. On the other hand, the alternate hypothesis suggests that shunting of blood away from the liver results in impaired synthesis of factors needed for normal growth.

The only pediatric study by Gauthier-Villars et al [53] in 8 children with symptomatic biliopathy in EHPVO showed regression of cholestasis in all cases after shunt surgery mesocaval shunt in 6 and Rex in 2. The natural history of portal hypertensive gastropathy: J Pediatr Gastroenterol Nutr. Aetiology and management of extrahepatic portal vein obstruction in children: Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children.


Thapa BR, Mehta S. J Pediatri Gastroenterol Nutr. Primary biliary tract surgery has significant morbidity and mortality due to extensive collaterals around the bile ducts. Low hepatic blood flow due to portal vein thrombosis low synthesis and portosystemic shunt increased clearance or consumption are supposed to be responsible for low anticoagulant proteins in blood in EHPVO.

Non-cirrhotic portal fibrosis in children. Management of esophageal varices. Hence, more attention is now being paid to the other effects of portal hypertension on the gastrointestinal tract, namely gastric varices and portal hypertensive gastropathy PHG.

Nevertheless, EST cannot be totally ruled out as a therapeutic modality, especially in children. PHG classically described in cirrhosis.

Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction. Biliary changes in extrahepatic portal venous obstruction: This suggests that children with EHPVO have growth failure and decreased growth velocity despite adequate nutrition. Symptomatic portal biliopathy is a definite indication for intervention.

Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a year follow-up. Though mortality related to variceal bleeding is uncommon, morbidity due to massive splenomegaly with hypersplenism, growth failure, ectopic varices like rectal varices and portal biliopathy is significant.


Patients with choledocholithiasis and stricture will require multiple sessions of endoscopic therapy with balloon dilatation and stent placement.

Non-cirrhotic portal hypertension – diagnosis and management.

Management of gastric varices and portal hypertensive gastropathy. Extrahepatic portal venous obstruction and obstructive jaundice: Endoscopic sclerotherapy in children: 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 varices etc.

Portal diversion for portal hypertension in children. However, controversy exists regarding prevention of further bleed. Despite the clear cut ehlvo of EVL when used alone, there is a higher risk of recurrence of varices as it is difficult to ligate smaller varices, and because perforators and paraesophageal collaterals remain patent after EVL.

Non-cirrhotic portal hypertension – diagnosis and management.

A longer interval up to 1 year and documentation of a patent shunt with decompressed collaterals on color Doppler or MR angiography may help in determining the optimum time for surgery. This is the most physiological shunt as it restores the hepatic blood flow. The definitive method of diagnosis of portal biliopathy is ERCP. Portal obstruction in children. The prevalence and spectrum of colonic lesions in patients with cirrhosis and noncirrhotic portal hypertension.