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Kutaiba N, Chung W, Goodwin M, Testro A, Egan G, Lim R. The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review. Insights Imaging 2024; 15:146. [PMID: 38886297 PMCID: PMC11183036 DOI: 10.1186/s13244-024-01727-3] [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: 08/17/2023] [Accepted: 05/26/2024] [Indexed: 06/20/2024] Open
Abstract
Chronic liver disease is responsible for significant morbidity and mortality worldwide. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) can fully visualise the liver and adjacent structures in the upper abdomen providing a reproducible assessment of the liver and biliary system and can detect features of portal hypertension. Subjective interpretation of CT and MRI in the assessment of liver parenchyma for early and advanced stages of fibrosis (pre-cirrhosis), as well as severity of portal hypertension, is limited. Quantitative and reproducible measurements of hepatic and splenic volumes have been shown to correlate with fibrosis staging, clinical outcomes, and mortality. In this review, we will explore the role of volumetric measurements in relation to diagnosis, assessment of severity and prediction of outcomes in chronic liver disease patients. We conclude that volumetric analysis of the liver and spleen can provide important information in such patients, has the potential to stratify patients' stage of hepatic fibrosis and disease severity, and can provide critical prognostic information. CRITICAL RELEVANCE STATEMENT: This review highlights the role of volumetric measurements of the liver and spleen using CT and MRI in relation to diagnosis, assessment of severity, and prediction of outcomes in chronic liver disease patients. KEY POINTS: Volumetry of the liver and spleen using CT and MRI correlates with hepatic fibrosis stages and cirrhosis. Volumetric measurements correlate with chronic liver disease outcomes. Fully automated methods for volumetry are required for implementation into routine clinical practice.
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Affiliation(s)
- Numan Kutaiba
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
- The University of Melbourne, Parkville, Melbourne, VIC, Australia.
| | - William Chung
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
- Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Mark Goodwin
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Adam Testro
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
- Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Clayton, VIC, 3800, Australia
| | - Ruth Lim
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
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Wang W, Mu Z, Zhu G, Wang T, Lai S, Guo Y, Yin X, Wen L, Chen D. A Nomogram for Predicting Portal Hypertensive Gastropathy in Patients With Liver Cirrhosis: A Retrospective Analysis. Front Med (Lausanne) 2022; 9:834159. [PMID: 35252265 PMCID: PMC8894675 DOI: 10.3389/fmed.2022.834159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThere is an urgent need for non-invasive methods for predicting portal hypertensive gastropathy (PHG). This study aims to develop and validate a non-invasive method based on clinical parameters for predicting PHG in patients with liver cirrhosis (LC).MethodsThe overall survival (OS) and hepatocellular carcinoma (HCC)-free survival were evaluated in LC patients, both with and without PHG. A prediction model for PHG was then constructed based on a training dataset that contained data on 492 LC patients. The discrimination, calibration, and clinical utility of the predicting nomogram were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was conducted using a bootstrapping method, and further external validation using data on the 208 other patients.ResultsLC patients with PHG had a worse prognosis compared with those without PHG. A nomogram was constructed using clinical parameters, such as age, hemoglobin content, platelet count and Child-Pugh class. The C-index was 0.773 (95% CI: 0.730–0.816) in the training cohort, 0.761 after bootstrapping and 0.745 (95% CI: 0.673–0.817) in the validation cohort. The AUC values were 0.767, 0.724, and 0.756 in the training, validation and total cohorts, respectively. Well-fitted calibration curves were observed in the training and validation cohorts. Decision curve analysis demonstrated that the nomogram was clinically useful at a threshold of 15%.ConclusionThe nomogram constructed to predict the risk of developing PHG was found to be clinically viable. Furthermore, PHG is an independent risk factor for OS of LC, but not for the occurrence of HCC.
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Jang B, Han JW, Sung PS, Jang JW, Bae SH, Choi JY, Cho YI, Yoon SK. Hemorheological Alteration in Patients Clinically Diagnosed with Chronic Liver Diseases. J Korean Med Sci 2016; 31:1943-1948. [PMID: 27822933 PMCID: PMC5102858 DOI: 10.3346/jkms.2016.31.12.1943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/03/2016] [Indexed: 11/20/2022] Open
Abstract
Since liver function is changed by chronic liver diseases, chronic liver disease can lead to different hemorheological alterations during the course of the progression. This study aims to compare alterations in whole blood viscosity in patients with chronic liver disease, focusing on the gender effect. Chronic liver diseases were classified into three categories by patient's history, serologic markers, and radiologic findings: nonalcoholic fatty liver disease (NAFLD) (n = 63), chronic viral hepatitis B and C (n = 50), and liver cirrhosis (LC) (n = 35). Whole blood viscosity was measured by automated scanning capillary tube viscometer, while liver stiffness was measured by transient elastography using FibroScan®. Both systolic and diastolic whole blood viscosities were significantly lower in patients with LC than NAFLD and chronic viral hepatitis (P < 0.001) in male patients, but not in female patients. In correlation analysis, there were inverse relationships between both systolic and diastolic whole blood viscosity and liver stiffness (systolic: r = -0.25, diastolic: r = -0.22). Whole blood viscosity was significantly lower in male patients with LC than NAFLD or chronic viral hepatitis. Our data suggest that whole blood viscosity test can become a useful tool for classifying chronic liver disease and determining the prognosis for different types of chronic liver diseases.
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Affiliation(s)
- Bohyun Jang
- Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Ji Won Han
- Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Pil Soo Sung
- Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jeong Won Jang
- Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Si Hyun Bae
- Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jong Young Choi
- Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Young I Cho
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Seung Kew Yoon
- Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
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Gjeorgjievski M, Cappell MS. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy. World J Hepatol 2016; 8:231-62. [PMID: 26855694 PMCID: PMC4733466 DOI: 10.4254/wjh.v8.i4.231] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/30/2015] [Accepted: 01/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepatic-portosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. CONCLUSION PHG is important to recognize in patients with cirrhotic or non-cirrhotic portal hypertension because it can cause acute or chronic GI bleeding that often requires pharmacologic therapy.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Mihajlo Gjeorgjievski, Mitchell S Cappell, Division of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
| | - Mitchell S Cappell
- Mihajlo Gjeorgjievski, Mitchell S Cappell, Division of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
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RODRIGUES DAB, da SILVA AR, SERIGIOLLE LC, FIDALGO RDS, FAVERO SSG, LEME PLS. Constriction rate variation produced by partial ligation of the portal vein at pre-hepatic portal hypertension induced in rats. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2014; 27:280-4. [PMID: 25626939 PMCID: PMC4743222 DOI: 10.1590/s0102-67202014000400012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/12/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Partial portal vein ligation causes an increase in portal pressure that remains stable even after the appearance of collateral circulation, with functional adaptation to prolonged decrease in portal blood flow. AIM To assess whether different constriction rates produced by partial ligation of the vein interfere with the results of this experimental model in rats. METHODS Three groups of five rats each were used; in group 1 (sham-operated), dissection and measurement of portal vein diameters were performed. Portal hypertension was induced by partial portal vein ligation, reducing its size to 0.9 mm in the remaining 10 animals, regardless of the initial diameter of the veins. Five animals with portal hypertension (group 2) underwent reoperation after 15 days and the rats in group 3 after 30 days. The calculation of the constriction rate was performed using a specific mathematical formula (1 - π r 2 / π R2) x 100% and the statistical analysis with the Student t test. RESULTS The initial diameter of the animal's portal vein was 2.06 mm, with an average constriction rate of the 55.88%; although the diameter of the veins and the constriction rate in group 2 were lower than in group 3 (2.06 mm - 55,25% and 2.08 mm - 56.51%, respectively), portal hypertension was induced in all rats and no significant macroscopic differences were found between the animals that were reoperated after 15 days and after 30 days respectively, being the shorter period considered enough for the evaluation. Comparing the initial diameter of the vein and the rate of constriction performed in groups 2 and 3, no statistic significance was found (p>0.05). CONCLUSION Pre-hepatic portal hypertension in rat can be induced by the reduction of the portal vein diameter to 0.9 mm, regardless the initial diameter of the vein and the vessel constriction rate.
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Affiliation(s)
- Daren Athiê Boy RODRIGUES
- Trabalho realizado no Laboratório de Habilidades Cirúrgicas
Avançadas da Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Aline Riquena da SILVA
- Trabalho realizado no Laboratório de Habilidades Cirúrgicas
Avançadas da Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Leonardo Carvalho SERIGIOLLE
- Trabalho realizado no Laboratório de Habilidades Cirúrgicas
Avançadas da Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Ramiro de Sousa FIDALGO
- Trabalho realizado no Laboratório de Habilidades Cirúrgicas
Avançadas da Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Sergio San Gregorio FAVERO
- Trabalho realizado no Laboratório de Habilidades Cirúrgicas
Avançadas da Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Pedro Luiz Squilacci LEME
- Trabalho realizado no Laboratório de Habilidades Cirúrgicas
Avançadas da Universidade Nove de Julho, São Paulo, SP, Brasil
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Buchanan PM, Kramer JR, El-Serag HB, Asch SM, Assioun Y, Bacon BR, Kanwal F. The quality of care provided to patients with varices in the department of Veterans Affairs. Am J Gastroenterol 2014; 109:934-40. [PMID: 24989087 DOI: 10.1038/ajg.2013.487] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Practice guidelines define the criteria and standards of care in patients with cirrhosis and varices. However, the extent to which the patients receive recommended care is largely unknown. We evaluated the quality of varices related care and factors associated with receipt of such care. METHODS We conducted a retrospective cohort study of 550 patients with cirrhosis who sought care at three VA facilities between 2000 and 2007. Using administrative and clinical data, we assessed quality of varices care as measured by eight explicit Delphi panel-derived quality indicators. We also conducted a structured implicit review of patients' medical records to explore the role of patients' refusal, receipt of care outside the VA, or justifiable exclusions to certain care processes as explanations for non-adherence to the quality indicators. RESULTS Quality scores (max. 100%) varied across individual indicators, ranging from 24.3% for upper endoscopy for varices screening to 72.4% for secondary prophylaxis for variceal bleeding. Justifiable exclusions to indicated care documented in charts were common for primary prophylaxis in patients with varices; receipt of endoscopy; and endoscopic treatment in patients with active bleeding. In contrast, significant shortfalls remained in the receipt of screening endoscopy, use of beta-blockers (in the absence of varices), and use of somatostatin analogs, antibiotics, and secondary prophylaxis in patients with variceal bleeding. Younger patients (<60 vs. >60 year, odds ratio (OR)=1.29, 95% confidence interval (CI) 1.01-1.68), those who saw a gastroenterologist (OR=1.55, 95% CI=1.09-2.21), or those who were seen in the facility with academic affiliation (OR=1.26, 95% CI=1.01-1.58) received higher quality care. CONCLUSIONS Health-care quality, measured according to whether patients received recommended varices-related care, was suboptimal in this health-care setting. Care that included gastroenterologists was associated with high quality.
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Affiliation(s)
- Paula M Buchanan
- Center for Outcomes Research, Saint Louis University, Saint Louis, Missouri, USA
| | - Jennifer R Kramer
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Hashem B El-Serag
- 1] Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA [2] Division of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Steven M Asch
- Department of Medicine and Health Services Research, Palo Alto VA Healthcare System, Palo Alto, California, USA
| | - Youssef Assioun
- Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Bruce R Bacon
- Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Fasiha Kanwal
- 1] Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA [2] Division of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Prediction of portal pressure from intraoperative ultrasonography. J Surg Res 2014; 192:395-401. [PMID: 24974153 DOI: 10.1016/j.jss.2014.05.069] [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: 03/14/2014] [Revised: 05/01/2014] [Accepted: 05/23/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Portal hypertension is a major risk factor for hepatic failure or bleeding in patients who have undergone hepatectomy, but it cannot be measured indirectly. We attempted to evaluate the intraoperative ultrasonography parameters that correlate with portal pressure (PP) in patients undergoing hepatectomy. METHODS We examined 30 patients in whom PP was directly measured during surgery. The background liver conditions included chronic viral liver disease in seven patients, chemotherapy-associated steatohepatitis in four patients, fatty liver in one patient, hepatolithiasis in one patient, obstructive jaundice in one patient, and a normal liver in 16 patients. A multivariate logistic analysis and linear regression analysis were conducted to develop a predictive formula for PP. RESULTS The mean PP was 10.4 ± 4.1 mm Hg. The PP tended to be increased in patients with chronic viral hepatitis. A univariate analysis identified the association of the six following parameters with PP: the platelet count and the maximum (max), minimum (min), endo-diastolic, peak-systolic, and mean velocity in the portal vein (PV) flow. Using multiple linear regression analysis, the predictive formula using the PV max and min was as follows: Y (estimated PP) = 18.235-0.120 × (PV max.[m/s])-0.364 × (PV min). The calculated PP (10.44 ± 2.61 mm Hg) was nearly the same as the actual PP (10.43 ± 4.07 mm Hg). However, there was no significant relationship between the calculated PP and the intraoperative blood loss and post hepatectomy morbidity. CONCLUSIONS This formula, which uses ultrasonographic Doppler flow parameters, appears to be useful for predicting PP.
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Nanashima A, Abo T, Arai J, Tsuchiya T, Miyazaki T, Takagi K, Chen X, Nagayasu T. Comprehensive Predictors of Portal Pressure from Functional Liver Reserve in Patients Who Underwent Hepatectomy. Indian J Surg 2014; 77:923-9. [PMID: 27011484 DOI: 10.1007/s12262-014-1065-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/27/2014] [Indexed: 12/31/2022] Open
Abstract
Portal hypertension is a major risk factor for hepatic failure or intestinal bleeding in patients with liver disease but cannot be measured indirectly. We attempted to comprehensively evaluate preoperative parameters of functional liver reserve that correlated with portal pressure (PP) in patients with various liver diseases. We examined 93 patients in whom portal pressure was directly measured during preoperative portal vein embolization (PVE) or operation. Background liver included chronic viral liver disease in 43 patients, obstructive jaundice in 29 patients, and normal liver in 21. Multivariate logistic analysis and linear regression analysis were applied to create a predictive formula for PP. Mean PP was 13.4 ± 4.9 cm H2O, and PP was significantly associated with severity of liver injury, hepatic fibrosis, intraoperative blood loss, and post-hepatectomy morbidity (p < 0.05 each). Mean PP after PVE (22.5 ± 7.8 cm H2O) was significantly increased compared to that before embolization (13.1 ± 4.7 cm H2O; p < 0.01). Univariate analysis identified seven significant parameters of preoperative liver function associated with PP: indocyanine green (ICG) test result, liver uptake and clearance index (HH15) on (99m)Tc-galactosyl serum albumin liver scintigraphy, total bilirubin level, prothrombin activity, and hyaluronate level. Using multiple linear regression analysis, the predictive formula using ICG and HH15 was as follows: Y (estimated PP) = 0.273 + 0.086 × ICGR15 + 0.193 × HH15. The calculated PP (11.5 ± 4.6 cm H2O (-1.9 cm H2O)) was lower than true PP, which was significantly associated with post-hepatectomy morbidity (p < 0.05). The correlation between true and calculated PP was weak, and prediction using the conventional liver functional parameters was limited at present and, however, estimating PP appears to be useful in evaluating portal hypertension and post-hepatectomy morbidity.
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Affiliation(s)
- Atsushi Nanashima
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501 Japan ; Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Takafumi Abo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501 Japan
| | - Junichi Arai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501 Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501 Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501 Japan
| | - Katsunori Takagi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501 Japan
| | - Xiaohui Chen
- Division of Oncological Surgery, Teaching Hospital of Fujian Medical University, Fujian Fuzhou, People's Republic of China
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501 Japan
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Morisaka H, Motosugi U, Ichikawa S, Sano K, Ichikawa T, Enomoto N. Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease. J Magn Reson Imaging 2013; 41:117-24. [PMID: 24243628 DOI: 10.1002/jmri.24505] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/16/2013] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To identify magnetic resonance imaging (MRI)-based parameters associated with gastroesophageal varices (GEVs) in patients with chronic liver disease. MATERIALS AND METHODS Ninety-three patients were divided into three groups based on endoscopic findings: group 1 with no GEVs (n = 49), group 2 with mild GEVs (n = 30), and group 3 with severe GEVs (n = 14). We used a multivariate logistic regression analysis to assess liver stiffness, aspartate aminotransferase-to-platelet ratio index, spleen stiffness and volume, portal vein velocity, cross-sectional area, and flow volumes potential independent associators of any (mild and severe) GEVs or severe GEVs. RESULTS The analysis showed that spleen and liver stiffness and spleen volume were independently associated with any GEVs (spleen stiffness, odds ratio [95% confidence interval], 1.25 [1.04-1.68], P = 0.018; liver stiffness, 1.52 [1.13-2.17], P = 0.006; spleen volume, 1.01 [1.00-1.01], P = 0.016), whereas spleen stiffness was associated with severe GEVs (1.82 [1.25-2.95]; P = 0.005). CONCLUSION Liver and spleen stiffness and spleen volume are associated with GEVs in patients with chronic liver disease. Compared with liver stiffness and spleen volume, spleen stiffness is more strongly associated with severe GEVs.
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Tian NN, Xiang HL, Lv HM, Wang F, Nie XH. Factors affecting re-bleeding after injection of cyanoacrylate for gastric varices. Shijie Huaren Xiaohua Zazhi 2013; 21:908-914. [DOI: 10.11569/wcjd.v21.i10.908] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the rate of re-bleeding after injection of cyanoacrylate for gastric varices in patients with large gastric varices and to identify probable risk factors for re-bleeding.
METHODS: A retrospective analysis was carried out in 52 cirrhotic patients who had large gastric varices and underwent endoscopic cyanoacrylate injection at our hospital from June 2010 to April 2012. To identify probable risk factors for re-bleeding after injection of cyanoacrylate for gastric varices, various factors were collected and analyzed, including gender, age, types of cirrhosis, coexistent hepatocellular carcinoma, Child-Pugh classification, presence of ascites, portal vein thrombosis, diameter of portal vein and spleen vein, spleen length, spleen thickness, routine blood tests, liver function tests, renal function tests, coagulation function tests, fasting blood sugar, α fetal protein, Child score, MELD score, and endoscopic variceal characteristics.
RESULTS: Recurrent bleeding occurred in 18 patients (34.62%) after initial cyanoacrylate injection, and the mean re-bleeding time was 5.5 mo ± 4.9 mo. Logistic regression analysis revealed that Child-Pugh classification, gamma-glutamyl transpeptidase (GGT) and spleen length were probable risk factors for recurrent bleeding after cyanoacrylate injection (P = 0.036, 0.009, 0.033; OR = 15.262, 47.684, 38.249; 95%CI: 1.197-194.573, 2.604-873.328, 1.339-1 092.543). The areas under ROC curve of GGT and spleen length in the diagnosis of re-bleeding were 0.773 and 0.704, with sensitivities of 66.7% and 93.8% and specificities of 85.7% and 52.6%.
CONCLUSION: Recurrent bleeding after injection of cyanoacrylate for gastric varices is affected by Child-Pugh B or C, GGT and spleen length.
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Sikuler E, Kravetz D, Groszmann RJ, Gomes HMP, Rodrigues DAB, Leme PLS. Evolution of portal hypertension and mechanisms involved in its maintenance in a rat model. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 1985; 26:206-12. [PMID: 4003545 DOI: 10.1590/s0102-67202013000300010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/16/2013] [Indexed: 12/16/2022]
Abstract
In rats with portal hypertension induced by partial ligation of the portal vein, we have recently demonstrated an increased portal venous inflow that becomes an important factor in the maintenance of portal hypertension. The sequence of events that leads into this circulatory disarray is unknown. We evaluated chronologically the chain of hemodynamic changes that occurred after portal hypertension was induced by partial ligation of the portal vein. In this model it is possible to follow, from the initiation of the portal-hypertensive state, the interaction between blood flow and resistance in the portal system as well as the relation between the development of portal-systemic shunting and the elevated portal venous inflow. The study was performed in 45 portal-hypertensive rats and in 29 sham-operated rats. Blood flow and portal-systemic shunting were measured by radioactive microsphere techniques. The constriction of the portal vein was immediately followed by a resistance-induced portal hypertension characterized by increased portal resistance (9.78 +/- 0.89 vs. 4.18 +/- 0.71 dyn X s X cm-5 X 10(4), mean +/- SE, P less than 0.01), increased portal pressure (17.7 +/- 0.9 vs. 9.5 +/- 0.6 mmHg, P less than 0.001), and decreased portal venous inflow (3.93 +/- 0.26 vs. 6.82 +/- 0.49 ml X min-1 X 100 g body wt-1, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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