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1.
Rev. esp. enferm. dig ; 115(12): 734-735, Dic. 2023. tab
Artigo em Inglês, Espanhol | IBECS | ID: ibc-228724

RESUMO

Up until approximately 10 years ago, the treatment for acute refractory esophageal variceal bleeding was balloon tamponading. Esophageal fully covered self-expanding stents are considered as effective as balloons and also much safer. They are kept in situ for longer periods, what eases the access to more definitive treatments with a low complication rate. We present 6 cases of patients with cirrhosis and massive bleeding due to esophageal varices refractory to conventional treatment, successfully treated with an esophageal fully covered self-expanding stent. There were no major complications, achieving an effective bleeding control in all cases.(AU)


Assuntos
Humanos , Masculino , Feminino , Próteses e Implantes , Implantação de Prótese/métodos , Varizes Esofágicas e Gástricas/cirurgia , Falha de Tratamento , Hemorragia Gastrointestinal
2.
Rev. esp. enferm. dig ; 115(12): 735-736, Dic. 2023. mapas
Artigo em Inglês | IBECS | ID: ibc-228725

RESUMO

NETs (neuroendocrine tumors) constitute a heterogeneous group of epithelial-type neoplasms with a predominantly neuroendocrine differentiation. Although the most common locations are the pancreas, digestive tract, and lung, this type of neoplasm can arise in virtually any organ in the body. They are rare tumors with a wide variety of clinical presentations. Symptomatic tumors are more frequent in younger patients and present at more advanced pathological stages. We present the case of a 42-year-old male with idiopathic splenomegaly and bicytopenia (anaemia and thrombocytopenia) under study by haematology department who was admitted due to an episode of melena and hemoglobin of 4.5 mg/dl. Isolated gastric varices (IGV1) with red spots were confirmed at gastroscopy and endoscopic variceal obturation using cyanoacrylate was performed in two sessions. An endoscopic ultrasonography was performed, showing thrombosis of the splenic vein extending towards the splenoportal confluence with anechoic serpiginous structures outside and inside the gastric wall suggestive of collateral circulation with gastric varices (GV). An increase in portal caliber was observed, with no signs of liver cirrhosis. Computed tomography confirms the findings. Two months/week/days later he was readmitted with rebleeding signs after starting anticoagulant treatment, so it was decided to perform a splenectomy due to failure of the endoscopic treatment. Histology revealed infiltration of the spleen by a well-differentiated neuroendocrine tumor (NET). Gallium PET/CT and Octreotid scan showed uptake in the body and tail of the pancreas with positivity for somatostatin receptors previously undetected by other means. Finally, treatment was completed with distal pancreatectomy and splenoportal axis trombectomy with vascular esplenic resection and the patient was discharged from hospital.(AU)


Assuntos
Humanos , Masculino , Adulto , Varizes Esofágicas e Gástricas/complicações , Trato Gastrointestinal/lesões , Tumores Neuroendócrinos/tratamento farmacológico , Hemorragia Gastrointestinal , Neoplasias Pancreáticas , Resultado do Tratamento , Pacientes Internados , Exame Físico , Tumores Neuroendócrinos/diagnóstico , Tomografia Computadorizada por Raios X , Pâncreas/lesões
6.
Rev. esp. enferm. dig ; 114(9): 534-542, septiembre 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-210717

RESUMO

El desarrollo de una hipertensión portal es el elemento más importante en la historia natural de la enfermedad hepática crónica avanzada y el responsable de la mayoría de las descompensaciones de la cirrosis. La correcta estratificación del riesgo de complicaciones permite diseñar estrategias de tratamiento personalizadas. Además, la naturaleza dinámica de la enfermedad hepática crónica obliga a refinar los métodos de diagnóstico invasivo y no invasivo en cada estadio. El tratamiento con betabloqueantes no cardioselectivos y la supresión del factor etiológico mejoran la hipertensión portal y disminuyen la probabilidad de descompensación en los pacientes de alto riesgo. Los pacientes ingresados por hemorragia varicosa se benefician también de un manejo personalizado, donde la inserción de un TIPS preventivo en los casos de mayor riesgo juega un papel relevante. (AU)


Assuntos
Humanos , Antagonistas Adrenérgicos beta/uso terapêutico , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico
7.
Cir. pediátr ; 35(2): 1-6, Abril, 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-203572

RESUMO

Introducción: El shunt portosistémico intrahepático transyugular(TIPS) es un procedimiento para tratar las complicaciones de la hiper-tensión portal. El objetivo del estudio es analizar los resultados de losTIPS realizados en nuestro centro, a pacientes pediátricos como puenteal trasplante hepático (TH).Material y métodos: Estudio retrospectivo y descriptivo de pacien-tes pediátricos con cirrosis hepática a los cuales se les ha realizado unTIPS previo al trasplante hepático entre los años 2015 y 2020.Resultados: Se realizó el TIPS a 10 pacientes. El motivo fue en 7por ascitis de difícil control (70%), un caso por hemorragia digestivaalta por varices esofágicas (10%) y en 2 por hipoplasia portal (20%).No hubo complicaciones intraoperatorias y en todos los casos se logrópermeabilidad de la endoprótesis.En 6 pacientes (60%) se observó permeabilidad del TIPS hasta elTH, en un paciente se observaron signos indirectos de permeabilidad(10%), 2 casos requirieron reintervención, lográndose permeabilidaden el segundo intento (20%) y en otra paciente (10%) no se observópermeabilidad tras 3 intentos.Se apreció una disminución del gradiente portocava (p = 0,001) yun aumento en la velocidad portal (p = 0,006). No se evidenció cambiosen la cifras de plaquetas y se produjo un ligero aumento del amonio,sin ser significativos.Conclusión: El TIPS es un procedimiento seguro y eficaz parapaliar las complicaciones de la hipertensión portal de difícil control enpacientes pediátricos. Nos permite optimizar el estado general, evitarel deterioro y paliar el estrechamiento de la vena porta de los pacientescirróticos como puente al TH.


Introduction: Transjugular intrahepatic portosystemic shunt (TIPS)was designed to treat complications of portal hypertension (PH). Theobjective of this study was to analyze the results of the TIPS performedin pediatric patients in our institution as a previous step to liver trans-plantation (LT).Materials and methods: A retrospective, descriptive study of pedi-atric patients with liver cirrhosis undergoing TIPS prior to LT from 2015to 2020 was carried out.Results: TIPS was performed in 10 patients. The reason for TIPSwas hard-to-control ascites in 7 patients (70%), upper gastrointestinalbleeding due to esophageal varices in 1 patient (10%), and portal hypo-plasia in 2 cases (20%). No intraoperative complications were recorded.Stent patency was achieved in all cases.TIPS patency until LT was observed in 6 patients (60%). Indirectsigns of patency were noted in 1 patient (10%). 2 patients (20%) requiredre-intervention, with patency being achieved in the second attempt. Andfinally, no patency was observed after 3 attempts in 1 patient (10%).A decrease in portocaval gradient (p = 0.001) and an increase inportal velocity (p = 0.006) were observed. No platelet count changeswere found. A slight, non-significant increase in ammonia was noted.Conclusion: TIPS is a safe and effective procedure to reduce com-plications of hard-to-control PH in pediatric patients. It allows generalcondition to be optimized, deterioration to be avoided, and portal veinnarrowing to be alleviated in cirrhosis patients as a previous step to LT.


Assuntos
Humanos , Masculino , Feminino , Criança , Transplante de Fígado , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Hipertensão Portal/cirurgia , Hipertensão Portal/etiologia , Pediatria , Cirrose Hepática , Estudos Retrospectivos , Epidemiologia Descritiva , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia
9.
Gastroenterol. hepatol. (Ed. impr.) ; 44(4): 269-276, Abr. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-221166

RESUMO

Introduction: The aim of this study was to investigate the accuracy of liver and spleen stiffness measurement by transient elastography for the prediction of gastroesophageal varices in patients with HCV-associated cirrhosis treated with new direct-acting antiviral agents. Patients and methods: This cross-sectional observational study included patients with compensated HCV-related cirrhosis and sustained virological response after direct-acting antiviral therapy. Patients underwent liver and spleen stiffness measurement, abdominal ultrasound and oesophago-gastroduodenoscopy. Clinical and laboratory data and non-invasive markers such as the liver stiffness–spleen diameter to platelet ratio score, variceal risk index and platelet count to spleen diameter ratio were analyzed. Results: Ninety-seven consecutive patients were included. Liver stiffness measurement (12.2 vs 16; p=0.02), spleen stiffness measurement (39.4 vs 46.05; p=0.04), liver stiffness–spleen diameter to platelet ratio score (1.21 vs 2.02; p=0.008), platelet count to spleen diameter ratio (1102.19 vs 829.7; p=0.04) and variceal risk index (−3.4 vs −1.02; p=0.01) showed significant differences between patients without/with gastroesophageal varices. The best cut-off value to discard the presence of gastroesophageal varices was 12.3kPa for liver stiffness measurement and 27kPa for spleen stiffness measurement. However, diagnostic accuracy was moderate (AUROC: 0.671 and 0.624 respectively). Combining different non-invasive parameters did not significantly improve the overall performance. Discussion: Liver and spleen stiffness measurement showed suboptimal results for non-invasive assessment of gastroesophageal varices in HCV cirrhotic patients treated with direct-acting antiviral agents. Our results suggest that non-invasive methods cannot substitute standard procedures for predicting gastroesophageal varices in this population.(AU)


Introducción: El objetivo de este estudio fue evaluar la rigidez hepática y esplénica medidas con Fibroscan® para la predicción de várices esofágicas (VE), en pacientes con cirrosis hepática por VHC tratados con antivirales orales. Pacientes y métodos: Estudio observacional y transversal que incluyó pacientes con cirrosis hepática por VHC compensada y respuesta virológica sostenida tras tratamiento. Se recogieron datos clínico-analíticos, ecográficos y endoscópicos y marcadores no invasivos como el Fibroscan® hepático y esplénico, el modelo predictivo «Liver stiffness-spleen diameter to platelet ratio score» (LSPS), el «Varices Risk Index» (VRI) y el índice n° plaquetas/diámetro mayor del bazo. Resultados: Se incluyeron 97 pacientes consecutivos. Los valores del Fibroscan® hepático (12,2 vs. 16; p = 0,02), esplénico (39,4 vs. 46,05; p = 0,04), LSPS (1,21 vs. 2,02; p = 0,008), índice n.° plaquetas/diámetro mayor del bazo (1.102,19 vs. 829,7; p = 0,04) y VRI (-3,4 vs. -1,02; p = 0,01) mostraron diferencias significativas entre pacientes sin/con VE. El mejor punto de corte del fibroscán hepático y esplénico para descartar la presencia de várices fue 12,3 y 27 kPas, respectivamente, con precisión diagnóstica moderada (AUROC: 0,671 y 0,624, respectivamente). La combinación de los parámetros no invasivos no mejoró el rendimiento global de estas pruebas. Discusión: Los valores del Fibroscan® hepático y esplénico mostraron resultados subóptimos para la evaluación no invasiva de VE en pacientes cirróticos por VHC tratados con antivirales orales. Nuestros resultados sugieren que estas pruebas no pueden sustituir a los procedimientos estándar para predecir la presencia de várices en esta subpoblación.(AU)


Assuntos
Humanos , Varizes Esofágicas e Gástricas , Cirrose Hepática , Antivirais , Hepacivirus , Estudos Transversais , Técnicas de Imagem por Elasticidade
10.
Rev. esp. enferm. dig ; 112(6): 456-461, jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-199793

RESUMO

INTRODUCCIÓN: existe controversia sobre la necesidad de mantener el tratamiento vasoconstrictor tras lograr una adecuada hemostasia mediante ligadura endoscópica, en la hemorragia aguda por varices esofágicas. Dado que es muy complejo hacer un gradiente "pre y posligadura urgente" en el sangrante por varices, nuestro objetivo es conocer las variaciones hemodinámicas tras la terapia endoscópica, midiendo un gradiente venoso hepático "pre" y otro 24 horas "posprocedimiento" en los cirróticos con ligadura programada como profilaxis de la hemorragia varicosa. MATERIAL Y MÉTODOS: estudio prospectivo, de cohorte, unicéntrico. Los pacientes, en protocolo de erradicación endoscópica, fueron sometidos a un gradiente de presión venosa hepática basal (GPVH PRE), sin modificar su tratamiento habitual con beta-bloqueantes. Después, se procedió a ligadura endoscópica, según guías de práctica clínica. Tras 24 horas del procedimiento, se realizó una segunda medida de presiones (GPVH POST). RESULTADOS: 30 pacientes. Las medianas de los GPVH PRE y POST ligadura fueron 16,5 mmHg (14-20) y 19,5 mmHg (17-21) respectivamente, con un aumento significativo tras el procedimiento (p < 0,001). Las variaciones porcentuales de presión portal, según cifra de gradiente basal (12, 16 y 20 mmHg), eran mayores en pacientes con menor GVPH frente a mayor GPVH basal en cualquiera de las categorías comparadas (p = 0,087, p = 0,016 y p < 0,001, respectivamente). En nuestra serie, el 36,7 % de los pacientes presentó un incremento de gradiente ≥ 20 % tras la ligadura. CONCLUSIÓN: la ligadura con bandas de varices esofágicas condiciona un aumento de presión portal, al menos transitorio, objetivado mediante gradiente de presión venosa hepática


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Varizes Esofágicas e Gástricas/sangue , Varizes Esofágicas e Gástricas/cirurgia , Monitorização Hemodinâmica , Hemodinâmica/fisiologia , Endoscopia , Ligadura , Estudos Prospectivos , Estudos de Coortes
17.
Radiología (Madr., Ed. impr.) ; 60(4): 290-300, jul.-ago. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-175253

RESUMO

La hipertensión portal (HTP) es una condición clínica definida por una presión hidrostática >5mmHg en el territorio venoso portal, siendo clínicamente significativa cuando es ≥10mmHg. A partir de este umbral pueden desarrollarse complicaciones, como sangrado de varices esofágicas, aparición de ascitis o encefalopatía hepática. Las técnicas de imagen tienen un papel importante como método no invasivo para determinar la presencia de HTP. En este artículo se analizan varios hallazgos radiológicos que pueden sugerir HTP y contribuir a definir su etiología, gravedad y posibles complicaciones


Portal hypertension is a clinical entity defined by a hydrostatic pressure greater than 5mm Hg in the portal territory, being clinically significant when it is greater than or equal to 10mm Hg. Starting from this threshold, complications can develop, such as the bleeding of esophageal varices, the appearance of ascites, or hepatic encephalopathy. Imaging techniques play an important role as a noninvasive method for determining whether portal hypertension is present. This article analyzes various imaging findings that can suggest the presence of portal hypertension and can help to define its etiology, severity, and possible complications


Assuntos
Humanos , Hipertensão Portal/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Cirrose Hepática/diagnóstico por imagem , Índice de Gravidade de Doença , Ascite/prevenção & controle , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Encefalopatia Hepática/diagnóstico por imagem , Biomarcadores/análise , Derivação Portossistêmica Transjugular Intra-Hepática , Circulação Colateral
19.
Rev. esp. enferm. dig ; 109(10): 704-707, oct. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-166824

RESUMO

Background and aims: According to the Baveno VI consensus, patients with liver stiffness < 20 kPa and a platelet count > 150,000 ul have very low risk of clinically significant varices and do not need a screening endoscopy. The aim of this study was to evaluate non-invasive methods as predictors of esophageal varices according to the Baveno VI recommendations, in real life clinical practice. Methods: Retrospective evaluation of patients with chronic liver disease who underwent transient elastography between January 2013 and December 2015. Results: One hundred and four patients were included in the study, the median age was 56.8 years and 69.2% were male. The etiology of liver disease was hepatitis C in 80% of patients (including 20% with HIV co-infection), alcohol in 12%, hepatitis B in 4% and other causes in 5%. Varices were present in 25% of patients. A liver stiffness < 20 kPa had a sensitivity of 92.3% and a specificity of 84.6%. When considering high risk varices (small with red wales or large varices), a liver stiffness < 20 kPa had 100% sensitivity. A platelet count > 150,000/l had a sensitivity of 84.6% and a specificity of 64.1%. Four patients with a platelet count (PLT) > 150,000/l had esophageal varices. When both criteria were applied to the patient cohort, according to the Baveno VI consensus, the sensitivity was 100% and the specificity, 61.5%. Conclusion: In this study, the Baveno VI criteria had 100% sensitivity but a relatively low specificity for the non-invasive diagnosis of esophageal varices. In clinical practice, all patients with varices are identified but many patients have a subsequent negative endoscopy (AU)


No disponible


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Varizes Esofágicas e Gástricas , Endoscopia do Sistema Digestório/métodos , Sensibilidade e Especificidade , Estudos Retrospectivos , Técnicas de Imagem por Elasticidade/métodos , 28599
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