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Xu L, Zhang J, Liu S, He G, Shu J. Development and internal validation of prediction model for rebleeding within one year after endoscopic treatment of cirrhotic varices: consideration from organ-based CT radiomics signature. BMC Med Imaging 2024; 24:292. [PMID: 39472821 PMCID: PMC11523671 DOI: 10.1186/s12880-024-01461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 10/09/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Rebleeding after endoscopic treatment for esophagogastric varices (EGVs) in cirrhotic patients remains a significant clinical challenge, with high mortality rates and limited predictive tools. Current methods, relying on clinical indicators, often lack precision and fail to provide personalized risk assessments. This study aims to develop and validate a novel, non-invasive prediction model based on CT radiomics to predict rebleeding risk within one year of treatment, integrating radiomic features from key organs and clinical data. METHODS 123 patients were enrolled and divided into rebleeding (n = 44) and non-bleeding group (n = 79) within 1 year after endoscopic treatment of EGVs. The liver, spleen, and the lower part of the esophagus were segmented and the extracted radiomics features were selected to construct liver/spleen/esophagus radiomics signatures based on logistic regression. Clinic-radiomics combined models and multi-organ combined radiomics models were constructed based on independent model scores using logistic regression. The model performance was evaluated by ROC analysis, calibration and decision curves. The continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices were analyzed. RESULTS The clinical-liver combined model had the highest AUC of 0.931 (95% CI: 0.887-0.974), which was followed by the liver-based model with AUC of 0.891 (95% CI: 0.835-0.74). The decision curves also showed that the clinical-liver combined model afforded a greater net benefit compared to other models within the threshold probability of 0.45 to 0.80. Significant improvements in discrimination (IDI, P < 0.05) and reclassification (NRI, P < 0.05) were obtained for clinical-liver combined model compared with the independent ones. CONCLUSION The independent and combined liver-based CT radiomics models performed well in predicting rebleeding within 1 year after endoscopic treatment of EGVs.
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Affiliation(s)
- Lulu Xu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, NO. 25, Taiping Road, Jiangyang District, Luzhou City, Sichuan, China
| | - Jing Zhang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, NO. 25, Taiping Road, Jiangyang District, Luzhou City, Sichuan, China
| | - Siyun Liu
- Pharmaceutical Diagnostics, GE Healthcare, Beijing, China
| | - Guoyun He
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, NO. 25, Taiping Road, Jiangyang District, Luzhou City, Sichuan, China.
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Sun L, Long L, Wang Q, Xiang H. Expert consensus on emergency procedures for portal hypertension bleeding (2022). J Interv Med 2023; 6:1-9. [PMID: 37180370 PMCID: PMC10167519 DOI: 10.1016/j.jimed.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 01/13/2023] Open
Abstract
Expert consensus proposes an emergency treatment protocol for portal hypertension bleeding. Herein, the emergency treatment procedures, which include first aid, medical, interventional, and surgical treatments, are described. In addition, the indications, contraindications, operating norms, precautions, and prevention of complications of portal hypertension are described to optimize the first aid process.
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Affiliation(s)
- Lin Sun
- Chinese Society of Emergency Medicine, Interventional Physician Branch of Chinese Medical Doctor Association, China
- Interventional Group of Radiology Society of Chinese Medical Association, China
- Haemorrhage Professional Committee of Chinese Research Hospital Association, China
- China Haemorrhage Center Alliance, China
- Hunan Provincial People′s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
| | - Lin Long
- Chinese Society of Emergency Medicine, Interventional Physician Branch of Chinese Medical Doctor Association, China
- Interventional Group of Radiology Society of Chinese Medical Association, China
- Haemorrhage Professional Committee of Chinese Research Hospital Association, China
- China Haemorrhage Center Alliance, China
- Hunan Provincial People′s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
| | - Qing Wang
- Chinese Society of Emergency Medicine, Interventional Physician Branch of Chinese Medical Doctor Association, China
- Interventional Group of Radiology Society of Chinese Medical Association, China
- Haemorrhage Professional Committee of Chinese Research Hospital Association, China
- China Haemorrhage Center Alliance, China
- Hunan Provincial People′s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
| | - Hua Xiang
- Chinese Society of Emergency Medicine, Interventional Physician Branch of Chinese Medical Doctor Association, China
- Interventional Group of Radiology Society of Chinese Medical Association, China
- Haemorrhage Professional Committee of Chinese Research Hospital Association, China
- China Haemorrhage Center Alliance, China
- Hunan Provincial People′s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
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Zhang YY, Wang L, Shao XD, Zhang YG, Ma SZ, Peng MY, Xu SX, Yin Y, Guo XZ, Qi XS. Effects of postoperative use of proton pump inhibitors on gastrointestinal bleeding after endoscopic variceal treatment during hospitalization. World J Gastrointest Surg 2023; 15:82-93. [PMID: 36741070 PMCID: PMC9896494 DOI: 10.4240/wjgs.v15.i1.82] [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: 07/25/2022] [Revised: 10/11/2022] [Accepted: 11/07/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Endoscopic variceal treatment (EVT) is recommended as the mainstay choice for the management of high-risk gastroesophageal varices and acute variceal bleeding in liver cirrhosis. Proton pump inhibitors (PPIs) are widely used for various gastric acid-related diseases. However, the effects of PPIs on the development of post-EVT complications, especially gastrointestinal bleeding (GIB), remain controversial.
AIM To evaluate the effects of postoperative use of PPIs on post-EVT complications in patients with liver cirrhosis during hospitalization.
METHODS Patients with a diagnosis of liver cirrhosis who were admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command, treated by an attending physician between January 2016 and June 2020 and underwent EVT during their hospitalization were included. Logistic regression analyses were performed to explore the effects of postoperative use of PPIs on the development of post-EVT complications during hospitalization. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
RESULTS A total of 143 patients were included. The incidence of post-EVT GIB and other post-EVT complications was 4.90% and 46.85%, respectively. In the overall analyses, postoperative use of PPIs did not significantly reduce the risk of post-EVT GIB (OR = 0.525, 95%CI = 0.113-2.438, P = 0.411) or other post-EVT complications (OR = 0.804, 95%CI = 0.413-1.565, P = 0.522). In the subgroup analyses according to the enrollment period, type and route of PPIs after the index EVT, use of PPIs before the index EVT, use of vasoactive drugs after the index EVT, indication of EVT (prophylactic and therapeutic), and presence of portal venous system thrombosis, ascites, and hepatocellular carcinoma, the effects of postoperative use of PPIs on the risk of post-EVT GIB or other post-EVT complications remain not statistically significant.
CONCLUSION Routine use of PPIs after EVT should not be recommended in patients with liver cirrhosis for the prevention of post-EVT complications during hospitalization.
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Affiliation(s)
- Yi-Yan Zhang
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Le Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Xiao-Dong Shao
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Yong-Guo Zhang
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Shao-Ze Ma
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Meng-Yuan Peng
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Shi-Xue Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Yue Yin
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Xiao-Zhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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Image Features of Dynamic Enhanced Computed Tomography Scanning Combined with Digestive Endoscopy in the Treatment of Gastroesophageal Varices and Nursing of Esophagogastric Gastric Varices Bleeding. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7926114. [PMID: 35770117 PMCID: PMC9236783 DOI: 10.1155/2022/7926114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 12/27/2022]
Abstract
The objective of this study was to investigate the application of dynamic contrast-enhanced CT images in the nursing of patients with gastroesophageal varices (GOV) treated by digestive endoscopy and its role in relieving bleeding symptoms. A total of 60 patients with liver cirrhosis and GOV were selected as the research objects. According to whether CT was used to evaluate the position of tissue adhesion embolism, the patients were divided into the control group (24 cases) and the observation group (36 cases). The treatment effect and bleeding situation of patients in the two groups were analyzed and compared. The results showed that the main portal vein pressure (17.24 ± 1.02 cmH2O), liver function recovery effect (2.84 ± 0.45 points), and total effective rate (100%) in observation group were better than those in control group (9.70 ± 1.22 cmH2O, 0.95 ± 0.72 points, and 79.17%, respectively) (P < 0.05). In addition, the bleeding rate in observation group (0%) was significantly lower than that in control group (16.67%) (P < 0.05). In conclusion, dynamically enhanced CT scan images combined with digestive endoscopy can help improve the therapeutic effect of GOV and reduce postoperative bleeding, which was worthy of clinical application and promotion.
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Yi F, Guo X, Zeng QL, Yang B, He Y, Yuan S, Arora A, Qi X. Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis. Can J Gastroenterol Hepatol 2022; 2022:3231144. [PMID: 35719322 PMCID: PMC9200601 DOI: 10.1155/2022/3231144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/23/2022] [Accepted: 05/11/2022] [Indexed: 12/05/2022] Open
Abstract
Spontaneous portosystemic shunt (SPSS) refers to collateral vessels that communicate between the portal vein system and systemic circulation. SPSS mainly includes esophageal varices, gastric varices, left gastric vein, recanalized paraumbilical vein, abdominal wall varices, and spontaneous splenorenal shunt. SPSS contributes to the development of hepatic encephalopathy caused by portal vein inflow bypassing and carries a higher risk of death in liver cirrhosis. Abdominal contrast-enhanced computed tomography is a major imaging approach to establish a diagnosis of SPSS and evaluate its location and feature. This review primarily describes the main contrast-enhanced CT features of SPSS in liver cirrhosis.
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Affiliation(s)
- Fangfang Yi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases, Wenzhou 325006, China
| | - Xiaozhong Guo
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
| | - Qing-Lei Zeng
- Department of Infectious Diseases and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang 110840, China
| | - Yanglan He
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
- Postgraduate College, China Medical University, Shenyang 110122, China
| | - Shanshan Yuan
- Department of Gastroenterology, Xi'an Central Hospital, Xi'an 710003, China
| | - Ankur Arora
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China
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Dajti E, Alemanni LV, Marasco G, Montagnani M, Azzaroli F. Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests? Hepat Med 2021; 13:25-36. [PMID: 33776492 PMCID: PMC7987277 DOI: 10.2147/hmer.s278077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Portal hypertension is the main driver of complications in patients with advanced chronic liver disease (ACLD) and is defined by values of hepatic venous pressure gradient measurement (HVPG) >5 mmHg. Values of HVPG ≥10 mmHg determine the presence of clinically significant portal hypertension (CSPH), the main predictor of the risk of variceal bleeding, hepatic decompensation, and mortality. However, its measurement is invasive and requires high expertise, so its routine use outside third level centers or clinical trials is limited. In the last decades, several non-invasive tests (NITs) have been developed and validated for the diagnosis of portal hypertension. Among these, liver (LSM) and spleen stiffness measurement (SSM) are the most promising tools available, as they have been proven accurate to predict CSPH, high-risk esophageal varices, decompensation, and mortality in patients with ACLD. In the last Baveno VI Consensus proceedings, LSM evaluation was recommended for the first time for diagnosis of CSPH (LSM >20-25 kPa) and the screening of patients with a low probability of having high-risk varices (LSM <20 kPa and platelet count >150.000/mm3). In this review, we aimed to summarize the growing evidence supporting the use of non-invasive tests for the evaluation of portal hypertension in patients with chronic liver disease.
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Affiliation(s)
- Elton Dajti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luigina Vanessa Alemanni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Marco Montagnani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Azzaroli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Yudin AL, Yumatova EA, Yagubova KV. Additional criterion for assessing the risk of gastric variceal bleeding according to multispiral computed tomography. ANNALY KHIRURGICHESKOY GEPATOLOGII = ANNALS OF HPB SURGERY 2021; 26:59-65. [DOI: 10.16931/1995-5464.2021159-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Aim. To establish the parameters of gastric varices which determine a high risk of gastric bleeding according to the results of multispiral computed tomography.Material and methods. The results of studies of 39 patients with liver cirrhosis and gastric varices were retrospectively studied. Nine of them had signs of previous bleeding on endoscopic examination or the corresponding data in the medical history. In 3 patients gastric bleeding occurred 30-47 days after multispiral computed tomography.Results. According to the results of multispiral computed tomography with multiplanar reconstructions gastric bleeding was detected in 12 patients with protrusion of submucosal varicose veins into the gastric lumen by 5 mm or more with a vein diameter >7 mm.Conclusion. The results of multispiral computed tomography, complemented by the hydro-computed tomography technique, provide important additional information on predicting the development of gastric bleeding in the selection of patients for preventive minimally invasive interventions on the veins of the stomach.
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Affiliation(s)
- A. L. Yudin
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia
| | - E. A. Yumatova
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia
| | - K. V. Yagubova
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia
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Wang R, Silva-Junior G, Guo X, Qi X. Prognostic Assessment of Variceal Bleeding in Liver Cirrhosis. VARICEAL BLEEDING IN LIVER CIRRHOSIS 2021:161-169. [DOI: 10.1007/978-981-15-7249-4_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Efficacy of CTPV for Diagnostic and Therapeutic Assessment: Comparison with Endoscopy in Cirrhotic Patients with Gastroesophageal Varices. Gastroenterol Res Pract 2020; 2020:6268570. [PMID: 32565783 PMCID: PMC7293743 DOI: 10.1155/2020/6268570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022] Open
Abstract
Background and Aims Computed tomography portal venography (CTPV) shows potential in detecting varices that need treatment and their drainage pathways. However, its agreement with endoscopy requires further study. We investigated the feasibility of CTPV as an alternative tool to endoscopy in screening gastroesophageal varices (GEVs) and developed a CTPV-based model to provide a less invasive assessment of endotherapy for cirrhotic patients with GEVs. Methods The study included 33 cirrhotic patients with a recent history of variceal hemorrhage. The presence, grade, and classification of GEVs on endoscopy and CTPV were compared (kappa test). Twenty-four patients were treated endoscopically, including 12 for esophageal varices (EVs), 8 for gastric varices (GVs), and 4 for GEVs. Treatment efficacies were assessed with the newly developed CTPV-based method at 1 week and 1 month after treatment. Efficiency evaluated by CTPV and endoscopy was compared by Fisher's exact test to determine whether CTPV is efficient in the assessment of endotherapy efficacy. Results For the screening and grading/classification of EVs and GVs, substantial agreement (EV kappa: 0.63 and 0.68; GV kappa: 0.62 and 0.75, respectively) was noted between endoscopy and CTPV. The therapeutic efficacy of EVs was higher when assessed by CTPV than when evaluated by endoscopy (37.50% vs. 12.50% at 1 week postoperation, P = 0.22; 62.50% vs. 25.00% at 1 month postoperation, P = 0.07), but without statistical significance. The same trend was also found in the assessment of therapeutic efficacy for GVs (25.00% vs. 16.67% at 1 week postoperation, P = 1; 58.33% vs. 41.67% at 1 month postoperation, P = 0.68). Conclusion CTPV is comparable to endoscopy in the detection of GEVs and in the evaluation of endotherapy efficacy, which suggests that it could be a less invasive alternative for endoscopy in cirrhotic patients with GEVs needing treatment.
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