Browsing by Author "Ling, Simon C."

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    A Clinical Prediction Rule and Platelet Count Predict Esophageal Varices in Children
    (W B SAUNDERS CO-ELSEVIER INC, 2011) Cristobal Gana, Juan; Turner, Dan; Mieli Vergani, Giorgina; Davenport, Mark; Miloh, Tamir; Avitzur, Yaron; Yap, Jason; Morinville, Veronique; Brill, Herbert; Ling, Simon C.
    BACKGROUND & AIMS: The validation of noninvasive tests to diagnose esophageal varices is a priority in children because repeated endoscopic evaluations are too invasive. We measured the ability of a previously developed noninvasive clinical prediction rule (CPR) to predict the presence of esophageal varices in children. METHODS: We analyzed data from 108 children, younger than age 18, who received endoscopies at 8 centers, to assess portal hypertension from chronic liver disease or portal vein obstruction. Blood test and abdominal ultrasound scan results were obtained within 4 months of endoscopy. Grading of varices identified by endoscopy was confirmed by independent blinded review. Spleen size, based on data from the ultrasound scan, was expressed as a standard deviation score relative to normal values for age. RESULTS: Of the children studied, 74 had esophageal varices (69%), including 35 with large varices (32%). The best noninvasive predictors of esophageal varices of any size were as follows: platelet: spleen size z-score ratio (area under the receiver operating characteristic curve [AUROC], 0.84; 95% confidence interval [CI] 0.75-0.93), CPR (AUROC, 0.80; 95% CI, 0.70-0.91), and platelet count (AUROC, 0.79; 95% CI, 0.69-0.90). The positive predictive values for the CPR and platelet count were 0.87 and 0.86, the negative predictive values were 0.64 and 0.63, the positive likelihood ratios were 3.06 and 2.76, and the negative likelihood ratios were 0.64 and 0.63, respectively. Based on positive and negative predictive values, the most accurate noninvasive tests were the CPR and platelet counts. CONCLUSIONS: Noninvasive tests such as CPR and platelet count can assist in triaging children for endoscopy to identify esophageal varices.
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    Congenital Portosystemic Shunt : Characterization of A Multisystem Disease
    (2013) Sokollik, Christiane; Bandsma, Robert H. J.; Gana Ansaldo, Juan Cristóbal; Van Den Heuvel, Meta; Ling, Simon C.
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    Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis
    (2017) Colli, Agostino; Gana Ansaldo, Juan Cristóbal; Yap, Jason; Adams-Webber, Thomasin; Rashkovan, Natalie; Ling, Simon C.; Casazza, Giovanni
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    Variation in Care for Children With Esophageal Varices: A Study of Physicians', Patients', and Families' Approaches and Attitudes
    (LIPPINCOTT WILLIAMS & WILKINS, 2011) Cristobal Gana, Juan; Valentino, Pamela L.; Morinville, Veronique; O'Connor, Constance; Ling, Simon C.
    Background and Aims: Inadequate evidence to guide the management of children with esophageal varices may lead to variation in care and the provision of poor-quality care to some children. The aims of the study were to describe approaches taken by pediatric gastroenterologists for the management of esophageal varices in children, and to determine the attitudes of children, parents, and physicians toward screening endoscopy for identification of varices.