{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:25:22Z","timestamp":1777868722170,"version":"3.51.4"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Portal hypertension is a major cause of esophagogastric variceal bleeding in children. Endoscopic therapy is widely used for acute hemostasis; however, it primarily controls the bleeding episode rather than the underlying portal hypertensive physiology, and definitive management often requires surgical portal decompression. Evidence regarding the outcomes of a staged endoscopic\u2013surgical management strategy in pediatric patients remains limited. This study aimed to evaluate the clinical outcomes of children with portal hypertensive bleeding managed with endoscopic hemostasis as a bridging therapy followed by definitive portal decompression surgery. Methods: We conducted a retrospective consecutive cohort study including 12 children presenting with portal hypertension-related variceal bleeding at our tertiary pediatric center between January 2021 and December 2024. All patients underwent endoscopic hemostasis, followed by evaluation for portal decompression surgery when anatomically feasible. Clinical outcomes including hemostasis success, rebleeding, shunt patency, and survival were analyzed. An age-stratified exploratory analysis was performed to examine the association with early dysfunction after Rex shunt reconstruction. Results: Endoscopic hemostasis was successfully achieved in all patients, with no early rebleeding prior to surgery. Ten patients underwent portal decompression surgery within 7 days (Rex shunt, n = 8; splenorenal shunt, n = 2). During a median follow-up of 18 months, early Rex shunt dysfunction (&lt;3 months) was observed in 2 of 8 patients (25%), both of whom were younger than 3 years, whereas no dysfunction was observed in older children. Given the small sample size, this observation should be interpreted descriptively. Rebleeding and mortality occurred exclusively in association with shunt dysfunction. Conclusions: A staged endoscopic\u2013surgical strategy appears feasible for stabilizing children with acute portal hypertensive bleeding and enabling timely definitive portal decompression. In this small cohort (n = 12), an age-related signal in early Rex shunt dysfunction was observed in very young children; however, this finding should be interpreted cautiously and requires further validation in larger studies.<\/jats:p>","DOI":"10.3390\/children13050624","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:20:25Z","timestamp":1777551625000},"page":"624","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Hemostasis as a Bridge to Surgical Portal Decompression in Children with Portal Hypertensive Bleeding: A Staged Endoscopic\u2013Surgical Strategy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6827-4628","authenticated-orcid":false,"given":"Jianji","family":"Xu","sequence":"first","affiliation":[{"name":"Department of General Surgery, Capital Institute of Pediatrics, Capital Medical University, Beijing 100020, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0796-7161","authenticated-orcid":false,"given":"Jinshan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Capital Institute of Pediatrics, Capital Medical University, Beijing 100020, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chihuan","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Capital Institute of Pediatrics, Capital Medical University, Beijing 100020, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1111\/j.1399-3046.2012.01652.x","article-title":"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","volume":"16","author":"Shneider","year":"2012","journal-title":"Pediatr. Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.jhep.2021.12.022","article-title":"Baveno VII Faculty Baveno VII\u2014Renewing Consensus in Portal Hypertension","volume":"76","author":"Bosch","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s12072-019-09979-8","article-title":"Pediatric Non-Cirrhotic Portal Fibrosis: Role of Endoscopic Management in Determining Long-Term Outcome","volume":"14","author":"Prasad","year":"2020","journal-title":"Hepatol. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1111\/j.1399-3046.2006.00598.x","article-title":"Surgical Guidelines for the Management of Extra-Hepatic Portal Vein Obstruction","volume":"10","author":"Superina","year":"2006","journal-title":"Pediatr. Transplant."},{"key":"ref_5","first-page":"83","article-title":"Pediatric Gastrointestinal Endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive Summary","volume":"49","author":"Tringali","year":"2017","journal-title":"Endoscopy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.jhep.2013.08.013","article-title":"Non-Cirrhotic Portal Hypertension\u2014Diagnosis and Management","volume":"60","author":"Khanna","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E1063","DOI":"10.1055\/s-0042-114981","article-title":"Endoscopic Management of Bleeding Gastric Varices with N-Butyl, 2-Cyanoacrylate Glue Injection in Children with Non-Cirrhotic Portal Hypertension","volume":"4","author":"Poddar","year":"2016","journal-title":"Endosc. Int. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.3748\/wjg.v21.i9.2719","article-title":"Endoscopic Cyanoacrylate Injection for the Treatment of Gastric Varices in Children","volume":"21","author":"Oh","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sansotta, N., De Angelis, P., Alberti, D., Di Dato, F., Arrigo, S., Bramuzzo, M., Calcaterra, B., Cananzi, M., Cheli, M., and Chiaro, A. (2025). Primary and Secondary Prophylaxis of Gastrointestinal Bleeding in Children with Portal Hypertension: A Multicenter National Study by SIGENP. Children, 12.","DOI":"10.3390\/children12070940"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhang, J., and Li, L. (2022). Rex Shunt for Extra-Hepatic Portal Venous Obstruction in Children. Children, 9.","DOI":"10.3390\/children9020297"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"37095","DOI":"10.1038\/s41598-025-20981-z","article-title":"Comparative Study of Classic Rex Shunt and Modified Rex Shunt in Treating Portal Cavernoma in Children","volume":"15","author":"Zhang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s00383-018-4246-0","article-title":"Surgical Treatment for Rebleeding Caused by Bypass Failure after Rex Shunt: Re-Rex Shunt or Warren Shunt?","volume":"34","author":"Zhang","year":"2018","journal-title":"Pediatr. Surg. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.4254\/wjh.v13.i10.1269","article-title":"Pediatric Non-Cirrhotic Portal Hypertension: Endoscopic Outcome and Perspectives from Developing Nations","volume":"13","author":"Sarma","year":"2021","journal-title":"World J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.gie.2013.07.023","article-title":"The Role of Endoscopy in the Management of Variceal Hemorrhage","volume":"80","author":"Hwang","year":"2014","journal-title":"Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"57","DOI":"10.5114\/ceh.2023.126077","article-title":"Comparison of Efficacy and Safety of Endoscopic and Radiological Interventions for Gastric Varices: A Systematic Review and Network Meta-Analysis","volume":"9","author":"Giri","year":"2023","journal-title":"Clin. Exp. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1002\/jgh3.12629","article-title":"Safety and Efficacy of Endoscopic Cyanoacrylate Injection in the Management of Gastric Varices: A Systematic Review and Meta-Analysis","volume":"5","author":"Chirapongsathorn","year":"2021","journal-title":"JGH Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1111\/j.1399-3046.2006.00597.x","article-title":"Expert Pediatric Opinion on the Report of the Baveno IV Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension","volume":"10","author":"Shneider","year":"2006","journal-title":"Pediatr. Transplant."},{"key":"ref_18","first-page":"22","article-title":"Results of the mesoportal bypass (Rex shunt) in the treatment of idiopathic extrahepatic portal vein obstruction in children","volume":"30","year":"2017","journal-title":"Cir. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.giec.2022.11.003","article-title":"Gastrointestinal Bleeding in Children: Current Management, Controversies, and Advances","volume":"33","author":"Novak","year":"2023","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"161930","DOI":"10.1016\/j.jpedsurg.2024.161930","article-title":"Medium-to Long-Term Outcomes of Rex Shunt in 105 Children With Extrahepatic Portal Vein Obstruction in China","volume":"60","author":"Wang","year":"2025","journal-title":"J. Pediatr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chen, Z., Liu, H., Li, W., Maimaiti, G., Maimaijiang, A., Jiayilawu, Y., Habuding, A., Xi, R., Wang, H., and Huxitaer, H. (2025). Management of Pediatric Portal Vein Cavernous Transformation: A Seven-Case Single-Center Study. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1627388"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Suthantirakumar, R.L., and Gupte, G.L. (2025). Timing and Indications for Liver Transplantation for Children with Chronic Liver Disease. Children, 12.","DOI":"10.3390\/children12040449"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/624\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:30:16Z","timestamp":1777552216000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/5\/624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["children13050624"],"URL":"https:\/\/doi.org\/10.3390\/children13050624","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}