{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:08:08Z","timestamp":1787501288302,"version":"build-2736575974"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,11,1]],"date-time":"2013-11-01T00:00:00Z","timestamp":1383264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The management of extrahepatic portal vein obstruction (EHPVO) in children is controversial. We report our experience with a prospective evaluation of a stepwise protocol based on severity of portal hypertension and feasibility of mesoportal bypass (MPB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>After diagnosis, children with EHPVO underwent surveillance endoscopies and received nonselective \u03b2\u2010blockers (NSBBs) or endoscopic variceal obliteration (EVO) when large varices were detected. In patients who failed NSBBs and EVO, we considered MPB as first\u2010line and shunts or transjugular intrahepatic portosystemic shunt (TIPS) as second\u2010line options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010five children, median age 12.5 (range 1.6\u201325.8), whose age at diagnosis was 3.5 (0.2\u201317.5) years, were referred to our unit. Forty\u2010three (66%) had a neonatal illness, 36 (55%) an umbilical vein catheterisation. Thirty\u2010two (49%) presented with bleeding at a median age of 3.8 years (0.5\u201315.5); during an 8.4\u2010year follow\u2010up period (1\u201316), 43 (66%) had a bleeding episode, 52 (80%) were started on NSBBs, 55 (85%) required EVO, and 33 (51%) required surgery or TIPS. The Rex recessus was patent in 24 of 54 (44%), negatively affected by a history of umbilical catheterisation (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.01). Thirty\u2010four (53%) patients underwent a major procedure: MPB (13), proximal splenorenal (13), distal splenorenal (2), mesocaval shunt (3), TIPS (2), and OLT (1). At the last follow\u2010up, 2 patients died, 53 of 57 (93%) are alive with bleeding control, 27 of 33 (82%) have a patent conduit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Children with EHPVO have a high rate of bleeding episodes early in life. A stepwise approach comprising of medical, endoscopic, and surgical options provided excellent survival and bleeding control in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/mpg.0b013e31829fad46","type":"journal-article","created":{"date-parts":[[2013,6,19]],"date-time":"2013-06-19T08:25:55Z","timestamp":1371630355000},"page":"619-626","source":"Crossref","is-referenced-by-count":42,"title":["Results of a Stepwise Approach to Extrahepatic Portal Vein Obstruction in Children"],"prefix":"10.1002","volume":"57","author":[{"given":"Daniele","family":"Alberti","sequence":"first","affiliation":[{"name":"Paediatric Surgery Hospital Papa Giovanni XXIII Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Colusso","sequence":"additional","affiliation":[{"name":"Paediatric Surgery Hospital Papa Giovanni XXIII Bergamo 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