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Samy M, Gamal D, Othman MHM, Ahmed SA. Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Esophageal variceal hemorrhage (EVH) has been shown to be a leading cause of mortality in patients with portal hypertension. Our purpose was to assess the utility of multi-detector computed tomography (MDCT) features in the assessment of esophageal varices (EVs) and esophageal variceal hemorrhage (EVH). This prospective study included 85 cirrhotic patients who underwent MDCT and Upper Gastrointestinal Tract (UGIT) endoscopy within 2 weeks. Four radiologists evaluated the presence of EVs and the presence and size of different collaterals. Multivariable logistic regression analysis was calculated to investigate the significant predictors influencing EV and EVH.
Results
Findings of EV with MDCT were the best predictor of EV or EVH. The presence (and/or size) of following collaterals had significant association with both EV and EVH: paraesophageal (p < 0.001, < 0.001), short gastric (p = 0.024, 0.010), gastric varicosities (p < 0.001, < 0.001), coronary (p < 0.001, < 0.001), and main coronary vein (MCV) (p < 0.001, = 0.011). We proposed an imaging-based model (presence of coronary collaterals, main coronary vein size > 3.5 mm, presence of short gastric collaterals, presence of gastric varicosities, size > 1.5 mm) with 97% sensitivity, 91% specificity, and 94% accuracy to predict EVs. We suggested another model (presence of paraesophageal collaterals, presence of short gastric vein (SGC), SGC size > 2.5 mm, main coronary vein size > 3.5 mm, gastric varicosities size > 1.5 mm, size of EVs > 4 mm, and Child C score) to predict EVH with 98% sensitivity, 81% specificity, and 89.5% accuracy. Inter-observer agreement was high in the detection of EVs (W. Kappa = 0.71–0.88).
Conclusion
MDCT is an effective modality in the diagnosis of EVs. At MDCT, the presence and/or size of various collaterals including para-esophageal, short gastric, coronary collaterals, and gastric varicosities are accurate predictors for either EVs existence or EVH. We suggested two computed tomography imaging-based models with high reproducibility and acceptable accuracy for the prediction of EV and EVH. With cirrhotic patients, we recommend that radiologists report collaterals in their daily practice.
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Elhendawy M, Eldesouky AF, Soliman SS, Mansour L, Abd-Elsalam S, Hawash N. AIMS65 and PALBI Scores as Predictors of Six Months’ Mortality in Cirrhotic Patients with Acute Variceal Bleeding. THE OPEN BIOMARKERS JOURNAL 2022; 12. [DOI: 10.2174/18753183-v12-e2207040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/01/2022] [Accepted: 03/17/2022] [Indexed: 09/01/2023]
Abstract
Background & Aims:Bleeding gastroesophageal varices are a cause of high mortality among cirrhotic patients. We aimed to investigate late mortality predictors and prognostic models using easily verified factors at admission in cirrhotic patients with acute variceal bleeding (AVB).Methods:Between January 2020 and June 2020, 142 patients with AVB from Tanta university hospital were included. Investigating multiple prognostic models was done using multiple logistic regression after identifying significant predictors of 6 months' mortality. Mortality prediction accuracy was assessed with area under the receiver operating characteristic (AUROC) curve.Results:The 6 months’ overall mortality rate was 31% (44 patients had died). AIMS56, Child-Turcotte-Pugh (CTP) grade C and MELD scores were significantly higher among non survivors (p<0.001) while Platelet-albumin-bilirubin (PALBI) was significantly more negative among survivors (P=0.001). Hepatocellular carcinoma was not significantly related to the mortality (p =0.364). Univariate analysis showed that high CTP, MELD, AIMS65 and PALBI scores were predictors of mortality and associated with decreased survival with high sensitivity and low specificity; while multivariate analysis showed that only AIMS56 was independently associated with mortality (p 0.004).Conclusion:CTP, MELD, AIMS65 and PALBI scores are simple, bed side risk scores that can be used for the prediction of 6 months’ mortality after AVB in cirrhotic patients with high sensitivities and lower specificities.
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Nakazawa M, Imai Y, Sugawara K, Uchida Y, Saitoh Y, Fujii Y, Uchiya H, Ando S, Nakayama N, Tomiya T, Mochida S. Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices. PLoS One 2022; 17:e0264359. [PMID: 35290384 PMCID: PMC8923466 DOI: 10.1371/journal.pone.0264359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Aim To establish a therapeutic strategy for cirrhosis patients with gastric variceal bleeding. Methods The outcomes of 137 patients with bleeding gastric varices were evaluated. Results The bleeding source was gastroesophageal varices (GOV) in 86 patients, and gastric fundal varices (FV) in 51 patients. The Child-Turcotte-Pugh classes were A, B, and C in 26, 79, and 32 patients, respectively; 34 patients (24.8%) had hepatocellular carcinoma (HCC), of which 11 also had complicating portal venous tumor thrombosis (PVTT). Patients with GOV were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with FV were treated by EIS with cyanoacrylate; 29 patients with FV also underwent additional balloon-occluded retrograde transvenous obliteration (BRTO). Hemostasis was successfully achieved in 136 patients (99.3%), and the cumulative 1-year, 3-year, and 5-year rebleeding rates were 18.1%, 30.8%, and 30.8%, respectively, in the patients with GOV, and 2.2%, 12.5% and 12.5%, respectively, in the patients with FV. The overall 1-year, 3-year, and 5-year survival rates were 79.7%, 71.5% and 64.4%, respectively, in the patients with GOV, and 91.0%, 76.9% and 59.5%, respectively, in the patients with FV. Multivariable analysis identified PVTT and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival. Conclusions Endoscopic therapies with or without BRTO appeared to be useful therapeutic strategies to prevent rebleeding in patients with gastric variceal bleeding, and favorable outcomes were obtained, except in patients with underlying HCC associated with PVTT and/or severe liver damage.
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Affiliation(s)
- Manabu Nakazawa
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Yukinori Imai
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Kayoko Sugawara
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Yoshihito Uchida
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Yoichi Saitoh
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Yohei Fujii
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Hiroshi Uchiya
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Satsuki Ando
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Nobuaki Nakayama
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Tomoaki Tomiya
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Satoshi Mochida
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
- * E-mail:
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Rakotondrainibe A, Rahanitriniaina NM, Randriamizao HM, Raelison JG, Ramanampamonjy RM, Rajaonera AT, Sztark F. Clinical mortality risk factors of variceal upper gastrointestinal bleeding in a Malagasy surgical intensive care unit. Afr J Emerg Med 2020; 10:188-192. [PMID: 33299747 PMCID: PMC7700958 DOI: 10.1016/j.afjem.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/14/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Variceal upper gastrointestinal bleeding is a dreadful complication of portal hypertension with a significant morbidity and mortality. Different prognostic scores can be used. However, in the local context of Madagascar, the completion of paraclinical investigations can be delayed by the limited financial means of patients. Hence, determining clinical mortality risk factors of variceal upper gastrointestinal bleeding could be interesting. The aim of the study was to evaluate the clinical mortality risk factors of variceal gastrointestinal bleeding (VUGIB). METHOD An observational, cohort retrospective study was conducted over an 8-year period (2010-2017), at the surgical intensive care unit of the J.R. Andrianavalona University Hospital, Antananarivo, in patients admitted for VUGIB confirmed by upper gastrointestinal endoscopy and whose clinical examination was performed at admission. The primary endpoint was intensive care unit (ICU) mortality. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for ICU mortality, with OR defining odds ratio. A p value <0.05 was considered significant. RESULTS 1920 patients were admitted for gastrointestinal bleeding of any digestive causes; the source of bleeding was variceal in 269 patients (14%). The predominantly male population (sex ratio = 2.5), aged 47.1 ± 13.7 years was mostly American Society of Anesthesiologists (ASA) 1 classification (58.4%). In 56.5% of patients, the gastrointestinal bleeding had not occurred before. The mortality rate was 16.0%. Three major clinical factors of mortality were identified: previous endoscopic band variceal ligation (OR = 12.57 [2.18-72.58], p = 0.005), tachycardia >120 bpm (OR = 2.91 [1.04-8.14], p = 0.041), and ascites (OR = 3.80 [1.85-7.81], p < 0.001). CONCLUSION Upper gastrointestinal bleeding may be life-threatening. The mortality scores are certainly useful; however, the identification of clinical factors is interesting in countries like Madagascar, pending the results of paraclinical investigations.
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Affiliation(s)
- Aurélia Rakotondrainibe
- Unité de Soins, de Formation et de Recherche, Réanimation Chirurgicale, Antananarivo – Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar
| | - Nadia M.P. Rahanitriniaina
- Unité de Soins, de Formation et de Recherche, Réanimation Chirurgicale, Antananarivo – Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar
| | - Harifetra M.R. Randriamizao
- Unité de Soins, de Formation et de Recherche, Réanimation Chirurgicale, Antananarivo – Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar
| | - Jasper G. Raelison
- Unité de Soins, de Formation et de Recherche, Réanimation Chirurgicale, Antananarivo – Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar
| | - Rado M. Ramanampamonjy
- Unité de Soins, de Formation et de Recherche, Hépato-gastro-entérologie, Antananarivo, Madagascar – Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar
| | - Andriambelo T. Rajaonera
- Unité de Soins, de Formation et de Recherche, Réanimation Chirurgicale, Antananarivo – Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar
| | - François Sztark
- Service d'Anesthésie-Réanimation I, CHU de Bordeaux, Place Amélie Raba Léon, Bordeaux, France – Université de Bordeaux, France
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Salahshour F, Mehrabinejad MM, Rashidi Shahpasandi MH, Salahshour M, Shahsavari N, Nassiri Toosi M, Ayoobi Yazdi N. Esophageal variceal hemorrhage: the role of MDCT characteristics in predicting the presence of varices and bleeding risk. Abdom Radiol (NY) 2020; 45:2305-2314. [PMID: 32447415 DOI: 10.1007/s00261-020-02585-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the associated Multi-Detector Computed Tomography (MDCT) features for esophageal varices (EVs) and esophageal variceal hemorrhage (EVH), with particular emphasis on different collateral veins. MATERIALS AND METHODS All cirrhotic patients who had undergone both Upper Gastrointestinal Tract (UGIT) endoscopy and contrast-enhanced MDCT within 6 months from 2013 to 2019 were included in the study. MDCT of 124 patients, 76 males and 48 females, aged between 21 and 73 years old were evaluated for presence of EV and presence and size of different collaterals. The presence and size of collaterals in patients with high-risk EVs or EVH were compared with others. RESULTS Findings of EV in MDCT analysis were the best predictor of EV or EVH, and presence (and/or size) of following collaterals showed a significant relationship with both EV and EVH: coronary (p = 0.006, 0.002), short gastric (SGC) (p = 0.02, < 0.001), and paraesophageal (p = 0.04, 0.01). Those presenting each aforementioned collaterals or with higher collateral size were more likely to develop the EV or EVH. Yet, other collaterals indicated no similar association: para-umbilical, omental, perisplenic, and splenorenal. Main coronary vein (p = 0.02, 0.03) and fundus (p = 0.006, 0.001) varices' sizes were also significantly higher in patients with EV or EVH. Finally, we suggested an imaging-based model (presence of SGC, SGC size > 2.5 mm, presence of EV, and coronary vein size > 3.5 mm) with 75.86% sensitivity, 76.92% specificity, and 76.36% accuracy to predict the presence of EVs according to UGIT endoscopy. Furthermore, we presented another model (presence of SGC, SGC size > 2.5 mm, presence of EV, and MELD score > 11.5 mm) to predict the occurrence of EVH with 75.86% sensitivity, 76.92% specificity, and 76.36% accuracy. CONCLUSION We suggested imaging characteristics for predicting EV and EVH with especial emphasis on the presence and size of various collaterals; then, we recommended reliable imaging criteria with high specificity and accuracy for predicting the EV and EVH.
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Affiliation(s)
- Faeze Salahshour
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Liver Transplantation Research Center, Imam-Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Mohammad-Mehdi Mehrabinejad
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Hossein Rashidi Shahpasandi
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maede Salahshour
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Shahsavari
- Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohssen Nassiri Toosi
- Liver Transplantation Research Center, Imam-Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Niloofar Ayoobi Yazdi
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Liver Transplantation Research Center, Imam-Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran.
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Lesmana CRA, Kalista KF, Sandra S, Hasan I, Sulaiman AS, Kurniawan J, Jasirwan COM, Nababan SH, Lirendra M, Aprilicia G, Gani RA. Clinical significance of isolated gastric varices in liver cirrhotic patients: A single‐referral‐centre retrospective cohort study. JGH Open 2020; 4:511-518. [PMID: 32514463 PMCID: PMC7273693 DOI: 10.1002/jgh3.12292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/23/2019] [Accepted: 12/01/2019] [Indexed: 12/14/2022]
Abstract
Introduction Gastric varices (GVs) occur in 10–30% of liver cirrhotic patients, with a mortality rate of up to 45%. Rupture of isolated GVs (IGVs) is less prevalent but often results in more severe hemorrhage and a higher risk of mortality than rupture of esophageal varices (EVs). However, there is no clear consensus yet about the optimal management for incidentally discovered IGVs. Objective To determine the clinical significance of IGVs in liver cirrhotic patients. Methods This was a retrospective cohort endoscopy database study within a 2‐year period (2016–2017). All study subjects were liver cirrhotic patients with OVs or GVs. The exclusion criteria were noncirrhotic portal hypertension, presence of malignancy, absence of varices, and incomplete data. Statistical analysis was performed using IBM SPSS 23. Results A total of 153 patients were included in this study. IGVs were found in 13 (8.49%) patients, whereas OVs were found in 112 (73.20%) patients and gastro‐OVs were found in 28 (18.30%) patients. Child‐Pugh class C (CP C) score was the strongest independent risk factor for variceal bleeding in bivariate analysis (hazard ratio [HR]: 10.21, 95% confidence interval [CI]: 4.15–25.12, P = 0.001) and multivariate analysis (HR: 12.49, 95% CI: 4.95–31.54, P 0.001); however, the presence of IGVs was not an independent risk factor. CP C score was also the only significant risk factor associated with 1‐year mortality in liver cirrhotic patients on multivariate analysis (HR: 26.77, 95% CI: 6.01–119.34, P 0.001). Conclusion The presence of IGVs has no clinical significance in the occurrence of 1‐year rebleeding and in patient survival.
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Affiliation(s)
- Cosmas Rinaldi A Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
- Digestive Disease & GI Oncology CentreMedistra Hospital Jakarta Indonesia
| | - Kemal F Kalista
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Sharon Sandra
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Irsan Hasan
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Andri Sanityoso Sulaiman
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Juferdy Kurniawan
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Chyntia O M Jasirwan
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Saut H Nababan
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Mutiara Lirendra
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Gita Aprilicia
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
| | - Rino A Gani
- Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General HospitalUniversitas Indonesia Jakarta Indonesia
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He L, Li P, Jiang Y, Hu J, Ma J, Ye X, Yang J, Zhou Y, Liang X, Ai Z, Lin Y, Wei H. A new algorithm for predicting long-term survival in chronic hepatitis B patients with variceal bleeding after endoscopic therapy. Dig Liver Dis 2019; 51:1166-1171. [PMID: 30723020 DOI: 10.1016/j.dld.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS A predictive algorithm for survival is urgently needed in clinical practice. This study aimed to establish an algorithm to predict long-term survival in chronic hepatitis B (CHB) patients with hepatic cirrhosis and variceal bleeding after endoscopic therapy. METHODS This was a retrospective study in which 603 patients who followed-up for three years were randomly assigned into a training cohort and a validation cohort in a 2:1 ratio. A new score model was devised based on the result of Cox regression analysis in the training cohort, and was verified in the validation cohort. RESULTS A prediction score model composed of age, neutrophil-lymphocyte ratio, gamma-glutamyl transpeptidase and MELD score was established. The score ranged from 0 to 11. Areas under the ROC curve of the score were 0.821 (p < 0.001, 95% CI: 0.769-0.873) and 0.827 (p < 0.001, 95% CI: 0.753-0.900) in the training cohort and validation cohort, respectively. Scores 0-4 and 5-11 identified patients as low-risk and high-risk categories, respectively. The cumulative 3-year survival rate was significantly higher in the low-risk group than in the high-risk group (p < 0.001). CONCLUSION The new score model can be used to predict long-term survival in CHB patients with hepatic cirrhosis and variceal bleeding after endoscopic therapy.
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Affiliation(s)
- Lingling He
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ping Li
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yu Jiang
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Julong Hu
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jiali Ma
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Ye
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Junru Yang
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuling Zhou
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiuxia Liang
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhenglin Ai
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yijun Lin
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongshan Wei
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
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8
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Vine LJ, Subhani M, Acevedo JG. Update on management of gastric varices. World J Hepatol 2019; 11:250-260. [PMID: 30967903 PMCID: PMC6447419 DOI: 10.4254/wjh.v11.i3.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
Gastric varices (GV) have different physiology and clinical characteristics compared to oesophageal varices (OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies’ recommendations are based are scrutinised in this review and areas of research are identified.
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Affiliation(s)
- Louisa J Vine
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, PL68DH, United Kingdom
| | - Mohsan Subhani
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, PL68DH, United Kingdom
| | - Juan G Acevedo
- South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, PL68DH, United Kingdom
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9
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Zhao H, Zhao R, Hu J, Zhang X, Ma J, Shi Y, Ma W, Sheng J, Li L. Upper gastrointestinal hemorrhage in acute-on-chronic liver failure: prevalence, characteristics, and impact on prognosis. Expert Rev Gastroenterol Hepatol 2019; 13:263-269. [PMID: 30791764 DOI: 10.1080/17474124.2019.1567329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Upper gastrointestinal hemorrhage (UGH) is a life-threatening complication in patients with cirrhosis; however, data regarding the role of UGH in acute-on-chronic liver failure (ACLF) are limited. METHODS A prospective, observational cohort study was performed from February 2014 to Mach 2015. RESULTS UGH was identified in 170 of 492 cirrhotic patients with acute decompensation (AD) at the time of admission. Logistic regression analysis showed that fecal occult blood test positivity was an independent risk factor for UGH in patients with or without ACLF [OR(95%CI): 8.31(4.89-14.10), p < 0.001; and 6.29 (1.48-26.76), p = 0.031]. Other independent risk factors were a history of gastrointestinal bleeding [OR(95% CI): 13.43 (7.17-25.15), p < 0.001], older age [OR(95% CI): 0.98(0.96-0.99), p = 0.003], greater INR level [OR(95% CI): 0.48(0.28-0.81), p = 0.007] in patients without ACLF. Multivariate Cox proportional hazard model analysis indicated that UGH did not increase mortality at different times in cirrhotic patients with acute decompensation. CONCLUSIONS UGH is a frequent complication in cirrhotic patients with AD, even those with ACLF. Positive fecal occult blood tests and previous GI bleeding were shown to be associated with the risk of UGH. UGH did not significantly increase the risk of mortality in cirrhotic patients with AD or ACLF.
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Affiliation(s)
- Hong Zhao
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Ruihong Zhao
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Jianhua Hu
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Xuan Zhang
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Jianke Ma
- b Department of Infectious Diseases , Cixi People's Hospital , Cixi , China
| | - Yemin Shi
- c Department of Infectious Diseases , Yuyao People's Hospital , Ningbo , China
| | - Weihang Ma
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Jifang Sheng
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
| | - Lanjuan Li
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine , Zhejiang University , Hangzhou , China
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