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Murillo Pineda MI, Siu Xiao T, Sanabria Herrera EJ, Ayala Aguilar A, Arriaga Escamilla D, Aleman Reyes AM, Rojas Marron AD, Fabila Lievano RR, de Jesús Correa Gomez JJ, Martinez Ramirez M. The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review. Cureus 2024; 16:e55786. [PMID: 38586705 PMCID: PMC10999134 DOI: 10.7759/cureus.55786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Esophageal varices (EVs), a significant complication of cirrhosis, present a considerable challenge in clinical practice due to their high risk of bleeding and associated morbidity and mortality. This manuscript explores the transformative role of artificial intelligence (AI) in the management of EV, particularly in enhancing diagnostic accuracy and predicting bleeding risks. It underscores the potential of AI in offering noninvasive, efficient alternatives to traditional diagnostic methods such as esophagogastroduodenoscopy (EGD). The complexity of EV management is highlighted, necessitating a multidisciplinary approach that includes pharmacological therapy, endoscopic interventions, and, in some cases, surgical options tailored to individual patient profiles. Additionally, the paper emphasizes the importance of integrating AI into medical education and practice, preparing healthcare professionals for the evolving landscape of medical technology. It projects a future where AI significantly influences the management of gastrointestinal bleeding, improving clinical decision-making, patient outcomes, and overall healthcare efficiency. The study advocates for a patient-centered approach in healthcare, balancing the incorporation of innovative technologies with ethical principles and the diverse needs of patients to optimize treatment efficacy and enhance healthcare accessibility.
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Affiliation(s)
| | - Tania Siu Xiao
- Radiology, Thomas Jefferson University Hospital, Philadelphia, USA
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2
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Baldisseri F, Wrona A, Menegatti D, Pietrabissa A, Battilotti S, Califano C, Cristofaro A, Di Giamberardino P, Facchinei F, Palagi L, Giuseppi A, Delli Priscoli F. Deep Neural Network Regression to Assist Non-Invasive Diagnosis of Portal Hypertension. Healthcare (Basel) 2023; 11:2603. [PMID: 37761800 PMCID: PMC10530845 DOI: 10.3390/healthcare11182603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Portal hypertension is a complex medical condition characterized by elevated blood pressure in the portal venous system. The conventional diagnosis of such disease often involves invasive procedures such as liver biopsy, endoscopy, or imaging techniques with contrast agents, which can be uncomfortable for patients and carry inherent risks. This study presents a deep neural network method in support of the non-invasive diagnosis of portal hypertension in patients with chronic liver diseases. The proposed method utilizes readily available clinical data, thus eliminating the need for invasive procedures. A dataset composed of standard laboratory parameters is used to train and validate the deep neural network regressor. The experimental results exhibit reasonable performance in distinguishing patients with portal hypertension from healthy individuals. Such performances may be improved by using larger datasets of high quality. These findings suggest that deep neural networks can serve as useful auxiliary diagnostic tools, aiding healthcare professionals in making timely and accurate decisions for patients suspected of having portal hypertension.
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Affiliation(s)
- Federico Baldisseri
- Department of Computer, Control and Management Engineering (DIAG), University of Rome “La Sapienza”, Via Ariosto 25, 00185 Rome, Italy; (A.W.); (D.M.); (A.P.); (S.B.); (C.C.); (A.C.); (P.D.G.); (F.F.); (L.P.); (A.G.); (F.D.P.)
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3
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Huang YF, Hu SJ, Bu Y, Li YL, Deng YH, Hu JP, Yang SQ, Shen Q, McAlindon M, Shi RC, Li XQ, Song TY, Qi HL, Jiao TW, Liu MY, He F, Zhu J, Ma B, Yu XB, Guo JY, Yu YH, Yong HJ, Yao WT, Ye T, Wang H, Dong WF, Liu JG, Wei Q, Tian J, Li XG, Dray X, Qi XL. Endoscopic Ruler for varix size measurement: A multicenter pilot study. World J Gastrointest Endosc 2023; 15:564-573. [PMID: 37744321 PMCID: PMC10514704 DOI: 10.4253/wjge.v15.i9.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND We invented Endoscopic Ruler, a new endoscopic device to measure the size of varices in patients with cirrhosis and portal hypertension. AIM To assess the feasibility and safety of Endoscopic Ruler, and evaluate the agreement on identifying large oesophageal varices (OV) between Endoscopic Ruler and the endoscopists, as well as the interobserver agreement on diagnosing large OV using Endoscopic Ruler. METHODS We prospectively and consecutively enrolled patients with cirrhosis from 11 hospitals, all of whom got esophagogastroduodenoscopy (EGD) with Endoscopic Ruler. The primary study outcome was a successful measurement of the size of varices using Endoscopic Ruler. The secondary outcomes included adverse events, operation time, the agreement of identifying large OV between the objective measurement of Endoscopic Ruler and the empirical reading of endoscopists, together with the interobserver agreement on diagnosing large OV by Endoscopic Ruler. RESULTS From November 2020 to April 2022, a total of 120 eligible patients with cirrhosis were recruited and all of them underwent EGD examinations with Endoscopic Ruler successfully without any adverse event. The median operation time of Endoscopic Ruler was 3.00 min [interquartile range (IQR): 3.00 min]. The kappa value between Endoscopic Ruler and the endoscopists while detecting large OV was 0.52, demonstrating a moderate agreement. The kappa value for diagnosing large OV using Endoscopic Ruler among the six independent observers was 0.77, demonstrating a substantial agreement. CONCLUSION The data demonstrates that Endoscopic Ruler is feasible and safe for measuring the size of varices in patients with cirrhosis and portal hypertension. Endoscopic Ruler is potential to promote the clinical practice of the two-grade classification system of OV.
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Affiliation(s)
- Yi-Fei Huang
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Sheng-Juan Hu
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Yang Bu
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Yi-Ling Li
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Yan-Hong Deng
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Jian-Ping Hu
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Shao-Qi Yang
- Department of Gastroenterology, Ningxia Medical University General Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Qian Shen
- Department of Gastroenterology, Yinchuan Second People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Mark McAlindon
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, AL 35660, Sheffield, United Kingdom
| | - Rui-Chun Shi
- Department of Gastroenterology, Wuzhong People's Hospital, Wuzhong 751100, Ningxia Hui Autonomous Region, China
| | - Xiao-Qin Li
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Tie-Ying Song
- Department of Second Gastroenterology, The Sixth People’s Hospital of Shenyang, Shenyang 110000, Liaoning Province, China
| | - Hai-Long Qi
- Department of Gastroenterology, Shizuishan Second People's Hospital, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Tai-Wei Jiao
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Meng-Yuan Liu
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Fang He
- Department of Gastroenterology, Ningxia Medical University General Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Jun Zhu
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Bin Ma
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Xiao-Bin Yu
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Jian-Yang Guo
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Yue-Hua Yu
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Hai-Jiang Yong
- Department of Gastroenterology, Wuzhong People's Hospital, Wuzhong 751100, Ningxia Hui Autonomous Region, China
| | - Wen-Tun Yao
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Ting Ye
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Hua Wang
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Wen-Fu Dong
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Jian-Guo Liu
- Department of Gastroenterology, Zhongwei People's Hospital, Zhongwei 755000, Ningxia Hui Autonomous Region, China
| | - Qiang Wei
- Department of Gastroenterology, Zhongwei People's Hospital, Zhongwei 755000, Ningxia Hui Autonomous Region, China
| | - Jing Tian
- Department of Gastroenterology, Zhongwei People's Hospital, Zhongwei 755000, Ningxia Hui Autonomous Region, China
| | - Xiao-Guo Li
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xavier Dray
- Department of Hepato-Gastroenterology, ETIS, ENSEA, CNRS, Sorbonne Université & APHP, Hôpital Saint Antoine, Université Paris-Seine, Université de Cergy-Pontoise, Paris 75012, Sélectionner, France
| | - Xiao-Long Qi
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210000, Jiangsu Province, China
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Manga S, Muthavarapu N, Redij R, Baraskar B, Kaur A, Gaddam S, Gopalakrishnan K, Shinde R, Rajagopal A, Samaddar P, Damani DN, Shivaram S, Dey S, Mitra D, Roy S, Kulkarni K, Arunachalam SP. Estimation of Physiologic Pressures: Invasive and Non-Invasive Techniques, AI Models, and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2023; 23:5744. [PMID: 37420919 DOI: 10.3390/s23125744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/25/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
The measurement of physiologic pressure helps diagnose and prevent associated health complications. From typical conventional methods to more complicated modalities, such as the estimation of intracranial pressures, numerous invasive and noninvasive tools that provide us with insight into daily physiology and aid in understanding pathology are within our grasp. Currently, our standards for estimating vital pressures, including continuous BP measurements, pulmonary capillary wedge pressures, and hepatic portal gradients, involve the use of invasive modalities. As an emerging field in medical technology, artificial intelligence (AI) has been incorporated into analyzing and predicting patterns of physiologic pressures. AI has been used to construct models that have clinical applicability both in hospital settings and at-home settings for ease of use for patients. Studies applying AI to each of these compartmental pressures were searched and shortlisted for thorough assessment and review. There are several AI-based innovations in noninvasive blood pressure estimation based on imaging, auscultation, oscillometry and wearable technology employing biosignals. The purpose of this review is to provide an in-depth assessment of the involved physiologies, prevailing methodologies and emerging technologies incorporating AI in clinical practice for each type of compartmental pressure measurement. We also bring to the forefront AI-based noninvasive estimation techniques for physiologic pressure based on microwave systems that have promising potential for clinical practice.
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Affiliation(s)
- Sharanya Manga
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Neha Muthavarapu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Renisha Redij
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Avneet Kaur
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sunil Gaddam
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Keerthy Gopalakrishnan
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Rutuja Shinde
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Poulami Samaddar
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Devanshi N Damani
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79995, USA
| | - Suganti Shivaram
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Shuvashis Dey
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical and Computer Engineering, North Dakota State University, Fargo, ND 58105, USA
| | - Dipankar Mitra
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Computer Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Sayan Roy
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical Engineering and Computer Science, South Dakota Mines, Rapid City, SD 57701, USA
| | - Kanchan Kulkarni
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, U1045, 33000 Bordeaux, France
- IHU Liryc, Heart Rhythm Disease Institute, Fondation Bordeaux Université, Bordeaux, 33600 Pessac, France
| | - Shivaram P Arunachalam
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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5
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Huang Y, Li J, Zheng T, Ji D, Wong YJ, You H, Gu Y, Li M, Zhao L, Li S, Geng S, Yang N, Chen G, Wang Y, Kumar M, Jindal A, Qin W, Chen Z, Xin Y, Jiang Z, Chi X, Cheng J, Zhang M, Liu H, Lu M, Li L, Zhang Y, Pu C, Ma D, He Q, Tang S, Wang C, Liu S, Wang J, Liu Y, Liu C, Liu H, Sarin SK, Xiaolong Qi. Development and validation of a machine learning-based model for varices screening in compensated cirrhosis (CHESS2001): an international multicenter study. Gastrointest Endosc 2023; 97:435-444.e2. [PMID: 36252870 DOI: 10.1016/j.gie.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS The prevalence of high-risk varices (HRV) is low among compensated cirrhotic patients undergoing EGD. Our study aimed to identify a novel machine learning (ML)-based model, named ML EGD, for ruling out HRV and avoiding unnecessary EGDs in patients with compensated cirrhosis. METHODS An international cohort from 17 institutions from China, Singapore, and India were enrolled (CHESS2001). The variables with the top 3 importance scores (liver stiffness, platelet count, and total bilirubin) were selected by the Shapley additive explanation and input into a light gradient-boosting machine algorithm to develop ML EGD for identification of HRV. Furthermore, we built a web-based calculator for ML EGD, which is free with open access (http://www.pan-chess.cn/calculator/MLEGD_score). Unnecessary EGDs that were not performed and the rates of missed HRV were used to assess the efficacy and safety for varices screening. RESULTS Of 2794 enrolled patients, 1283 patients formed a real-world cohort from 1 university hospital in China used to develop and internally validate the performance of ML EGD for varices screening. They were randomly assigned into the training (n = 1154) and validation (n = 129) cohorts with a ratio of 9:1. In the training cohort, ML EGD spared 607 (52.6%) unnecessary EGDs with a missed HRV rate of 3.6%. In the validation cohort, ML EGD spared 75 (58.1%) EGDs with a missed HRV rate of 1.4%. To externally test the performance of ML EGD, 966 patients from 14 university hospitals in China (test cohort 1) and 545 from 2 hospitals in Singapore and India (test cohort 2) comprised the 2 test cohorts. In test cohort 1, ML EGD spared 506 (52.4%) EGDs with a missed HRV rate of 2.8%. In test cohort 2, ML EGD spared 224 (41.1%) EGDs with a missed HRV rate of 3.1%. When compared with the Baveno VI criteria, ML EGD spared more screening EGDs in all cohorts (training cohort, 52.6% vs 29.4%; validation cohort, 58.1% vs 44.2%; test cohort 1, 52.4% vs 26.5%; test cohort 2, 41.1% vs 21.1%, respectively; P < .001). CONCLUSIONS We identified a novel model based on liver stiffness, platelet count, and total bilirubin, named ML EGD, as a free web-based calculator. ML EGD could efficiently help rule out HRV and avoid unnecessary EGDs in patients with compensated cirrhosis. (Clinical trial registration number: NCT04307264.).
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Affiliation(s)
- Yifei Huang
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jia Li
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Tianlei Zheng
- Artificial Intelligence Unit, Department of Medical Equipment, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dong Ji
- Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Jun Wong
- Department of Gastroenterology & Hepatology, Changi General Hospital, Duke-NUS Medical School, Singapore
| | - Hong You
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ye Gu
- Portal Hypertension Center, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Musong Li
- Department of Gastroenterology, Baoding People's Hospital, Baoding, China
| | - Lili Zhao
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Shuang Li
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Shi Geng
- Artificial Intelligence Unit, Department of Medical Equipment, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Na Yang
- Artificial Intelligence Unit, Department of Medical Equipment, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Guofeng Chen
- Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Wang
- Portal Hypertension Center, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| | - Wei Qin
- Department of Gastroenterology, Baoding People's Hospital, Baoding, China
| | - Zhenhuai Chen
- Department of Gastroenterology, Baoding People's Hospital, Baoding, China
| | - Yongning Xin
- Department of Infectious Disease, Qingdao Municipal Hospital, Qingdao University, Qindao, China
| | - Zicheng Jiang
- Department of Infectious Diseases, Ankang Central Hospital, Ankang, China
| | - Xiaoling Chi
- Department of Hepatology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jilin Cheng
- Department of Gastroenterology and Hepatology, Shanghai Public Health Clinical Center affiliated with Fudan University, Shanghai, China
| | - Mingxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Huan Liu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Ming Lu
- Department of Gastroenterology, Mengzi People's Hospital, Yunnan, China
| | - Li Li
- Department of Gastroenterology, Mengzi People's Hospital, Yunnan, China
| | - Yong Zhang
- Dalian Public Health Clinical Center, Dalian, China
| | - Chunwen Pu
- Dalian Public Health Clinical Center, Dalian, China
| | - Deqiang Ma
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qibin He
- Department of Gastroenterology, Second Hospital of Nanjing, Nanjing Hospital of Chinese Medicine, Nanjing, China
| | - Shanhong Tang
- Department of Gastroenterology, General Hospital of Western Theater Command PLA, Chengdu, China
| | - Chunyan Wang
- Department of Gastroenterology, General Hospital of Western Theater Command PLA, Chengdu, China
| | - Shanghao Liu
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jitao Wang
- Xingtai Key Laboratory of Precision Medicine for Liver Cirrhosis and Portal Hypertension, Xingtai People's Hospital, Xingtai, China
| | - Yanna Liu
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Chuan Liu
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Hao Liu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| | - Xiaolong Qi
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Huang Y, Zhao L, He R, Li S, Liu C, Qi X, Li J. A strategy for varices screening based on acoustic radiation force impulse combined with platelet (CHESS2001): An alternative of Baveno VI criteria. Hepatol Commun 2022; 6:3154-3162. [PMID: 36121707 PMCID: PMC9592788 DOI: 10.1002/hep4.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/07/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022] Open
Abstract
Few studies have reported on acoustic radiation force impulse (ARFI) for varices screening. Our study aimed to identify a strategy based on liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) by ARFI combined with platelet count (PLT), named the ARP strategy, for ruling out high-risk varices (HRV) and avoiding unnecessary esophagogastroduodenoscopy (EGD) in patients with compensated cirrhosis. We retrospectively reviewed patients who underwent ARFI from a previous cohort (NCT04307264). Of them, patients between 2017 and 2019 composed the training cohort to develop the ARP strategy. The validation cohort consisted of others between 2015 and 2016 to validate and compare it with Baveno VI criteria about the performance for varices screening. Primary outcomes were the rates of spared EGDs and HRV missed. A total of 741 consecutive patients were included in the final analysis. Of them, 576 patients were included in the training cohort and 165 patients in the validation cohort. In the training cohort, ARP strategy was defined as LSM < 1.805 m/s or SSM < 2.445 m/s and PLT > 110 × 109 /L. ARP strategy could spare 234 (40.6%) EGDs with a missed HRV rate of 3.4% (8 of 234). In the validation cohort, compared with Baveno VI criteria, the ARP strategy improved the proportion of avoided EGDs (49.7% vs. 34.5%; p < 0.001) and lowered the rate of misclassified HRV (1.2% vs. 3.5%; p < 0.001). Conclusion: The ARP strategy was an efficient and safe tool for varices screening in compensated cirrhosis, and it might be an auxiliary or even alternative to Baveno VI criteria.
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Affiliation(s)
| | - Lili Zhao
- Department of Gastroenterology and HepatologyTianjin Second People's HospitalTianjinChina
| | - Ruiling He
- Institute of Portal HypertensionThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Shuang Li
- Department of Gastroenterology and HepatologyTianjin Second People's HospitalTianjinChina
| | - Chuan Liu
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical SchoolSoutheast UniversityNanjingChina
| | - Xiaolong Qi
- Institute of Portal HypertensionThe First Hospital of Lanzhou UniversityLanzhouChina,Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical SchoolSoutheast UniversityNanjingChina
| | - Jia Li
- Department of Gastroenterology and HepatologyTianjin Second People's HospitalTianjinChina
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7
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Huang Y, Zhang W, Xiang H, Liu Y, Yuan L, Zhang L, Hu S, Xia D, Li J, Gao M, Wang X, Qi X, Peng L, Song Y, Zhou X, Zeng J, Tan X, Deng M, Fang H, Qi S, He S, He Y, Ye B, Wu W, Dang T, Shao J, Wei W, Hu J, Yong X, He C, Bao J, Zhang Y, Zhang G, Ji R, Bo Y, Yan W, Li H, Wang Y, Li M, Wang F, Lian J, Liu C, Cao P, Liu Z, Liu A, Zhao L, Li S, Wu Y, Gu Y, Wang Y, Fang Y, Jiang P, Wu B, Liu C, Qi X. Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study. Front Med (Lausanne) 2022; 9:872881. [PMID: 35572990 PMCID: PMC9092278 DOI: 10.3389/fmed.2022.872881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/16/2022] [Indexed: 12/16/2022] Open
Abstract
Background and Aims Emergency endoscopy is recommended for patients with acute esophageal variceal bleeding (EVB) and their prognosis has improved markedly over past decades due to the increased specialization of endoscopic practice. The study aimed to compare outcomes following emergency endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) in cirrhotic patients with acute EVB. Methods Cirrhotic patients with acute EVB who underwent emergency endoscopy were retrospectively enrolled from 2013 to 2020 across 34 university hospitals from 30 cities. The primary outcome was the incidence of 5-day rebleeding after emergency endoscopy. Subgroup analysis was stratified by Child-Pugh class and bleeding history. A 1:1 propensity score matching (PSM) analysis was performed. Results A total of 1,017 and 382 patients were included in EIS group and EVL group, respectively. The 5-day rebleeding incidence was similar between EIS group and EVL group (4% vs. 5%, P = 0.45). The result remained the same after PSM (P = 1.00). Among Child-Pugh class A, B and C patients, there were no differences in the 5-day rebleeding incidence between the two groups after PSM (P = 0.25, 0.82, and 0.21, respectively). As for the patients with or without bleeding history, the differences between EIS group and EVL group were not significant after PSM (P = 1.00 and 0.26, respectively). Conclusion The nationwide cohort study indicates that EIS and EVL are both efficient emergency endoscopic treatment strategies for acute EVB. EIS should not be dismissed as an economical and effective emergency endoscopic treatment strategy of acute EVB. ClincialTrials.gov number NCT04307264.
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Affiliation(s)
- Yifei Huang
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wenhui Zhang
- Beijing Shijitan Hospital, Beijing, China.,Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Huiling Xiang
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
| | - Yanna Liu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Lili Yuan
- Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China
| | - Liyao Zhang
- Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Shengjuan Hu
- Department of Gastroenterology, Endoscopic Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Dongli Xia
- Department of Gastroenterology, Chongqing Fuling Central Hospital, Chongqing, China
| | - Jia Li
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Min Gao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xing Wang
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xingsi Qi
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijun Peng
- Department of Gastroenterology, Linyi People's Hospital, Linyi, China
| | - Ying Song
- Department of Gastroenterology, Xi'an GaoXin Hospital, Xi'an, China
| | - Xiqiao Zhou
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Zeng
- Department of Emergency, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Xiaoyan Tan
- Department of Gastroenterology, Maoming People's Hospital, Maoming, China
| | - Mingming Deng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haiming Fang
- Department of Gastroenterology and Hepatology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shenglin Qi
- Department of Hepatology, Dalian Sixth People's Hospital, Dalian, China
| | - Song He
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongfeng He
- Department of Gastroenterology, Endoscopic Center, Ankang Central Hospital, Ankang, China
| | - Bin Ye
- Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Wei Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tong Dang
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Jiangbo Shao
- Department of Liver Disease, The Third People's Hospital of Zhenjiang, Zhenjiang, China
| | - Wei Wei
- Department of Gastroenterology, Jinhua Hospital, Jinhua, China
| | - Jianping Hu
- Department of Gastroenterology, First People's Hospital of Yinchuan City, Yinchuan, China
| | - Xin Yong
- Gastroenterology, General Hospital of Western Theater Command, Chengdu, China
| | - Chaohui He
- Department of Gastroenterology and Endoscopy, The Fifth Affiliated Zhuhai Hospital of Zunyi Medical University, Zhuhai, China
| | - Jinlun Bao
- Department of Gastroenterology, Shannan People's Hospital, Shannan, China
| | - Yuening Zhang
- Center of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Guo Zhang
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Rui Ji
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yang Bo
- Department of Hepatobiliary Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Wei Yan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongjiang Li
- Department of Hepatology, Baoding People's Hospital, Baoding, China
| | - Yanling Wang
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Mengmeng Li
- Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Fengmei Wang
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
| | - Jia Lian
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
| | - Chang'en Liu
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
| | - Ping Cao
- Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China
| | - Zhenbei Liu
- Department of Gastroenterology, Chongqing Fuling Central Hospital, Chongqing, China
| | - Aimin Liu
- Department of Gastroenterology, Chongqing Fuling Central Hospital, Chongqing, China
| | - Lili Zhao
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Shuang Li
- Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Yunhai Wu
- Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Ye Gu
- Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Yan Wang
- Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Yanfei Fang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pan Jiang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bin Wu
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chuan Liu
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaolong Qi
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
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