Risk and causes of gastroesophageal bleeding in patients with liver cirrhosis

Prediction of Important Factors for Bleeding in Liver Cirrhosis Disease Using Ensemble Data Mining Approach

The main motivation to conduct the study presented in this paper was the fact that due to the development of improved solutions for prediction risk of bleeding and thus a faster and more accurate diagnosis of complications in cirrhotic patients, mortality of cirrhosis patients caused by bleeding of varices fell at the turn in the 21th century. Due to this fact, an additional research in this field is needed. The objective of this paper is to develop one prediction model that determines most important factors for bleeding in liver cirrhosis, which is useful for diagnosis and future treatment of patients. To achieve this goal, authors proposed one ensemble data mining methodology, as the most modern in the field of prediction, for integrating on one new way the two most commonly used techniques in prediction, classification with precede attribute number reduction and multiple logistic regression for calibration. Method was evaluated in the study, which analyzed the occurrence of variceal bleeding for 96 patients from the Clinical Center of Nis, Serbia, using 29 data from clinical to the color Doppler. Obtained results showed that proposed method with such big number and different types of data demonstrates better characteristics than individual technique integrated into it.

Progress in prevention and treatment of rebleeding after endoscopic band ligation for esophageal variceal bleeding

Hemorrhage from esophageal varices is a serious and common complication of decompensated cirrhosis and carries a significant rate of morbidity and mortality. Endoscopic variceal ligation (EVL) is an effective treatment for esophageal varices; however, there is a very high rate of rebleeding. Prevention and treatment of rebleeding after EVL are important for improving survival in patients with liver cirrhosis. Currently, many measures, including endoscopy, surgery, medication, and a combination of them, have been developed to prevent the occurrence of rebleeding after EVL. Many clinical trials have been done to evaluate the effectiveness of various treatments, alone or in combination, for rebleeding.

Jejunal variceal bleeding successfully treated with percutaneous coil embolization

A 52-yr-old male with alcoholic liver cirrhosis was hospitalized for hematochezia. He had undergone small-bowel resection due to trauma 15 yr previously. Esophagogastroduodenoscopy showed grade 1 esophageal varices without bleeding. No bleeding lesion was seen on colonoscopy, but capsule endoscopy showed suspicious bleeding from angiodysplasia in the small bowel. After 2 weeks of conservative treatment, the hematochezia stopped. However, 1 week later, the patient was re-admitted with hematochezia and a hemoglobin level of 5.5 g/dL. Capsule endoscopy was performed again and showed active bleeding in the mid-jejunum. Abdominal computed tomography revealed a varix in the jejunal branch of the superior mesenteric vein. A direct portogram performed via the transhepatic route showed portosystemic collaterals at the distal jejunum. The patient underwent coil embolization of the superior mesenteric vein just above the portosystemic collaterals and was subsequently discharged without re-bleeding. At 8 months after discharge, his condition has remained stable, without further bleeding episodes.