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1.
Medicine (Baltimore) ; 100(16): e25347, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879664

RESUMO

INTRODUCTION: Gastric varices can be present in up to 20% of patients with portal hypertension. However, a varix of the left gastroepiploic vein (LGV) is extremely rare. Surgery is required if bleeding occurs; thus, precise diagnosis is crucial. We present a successful case of preoperative diagnosis intraabdominal varix of the LGV using three-dimensional-computed tomography angiography (3D-CTA) followed by laparoscopic resection. This is the first report of a case with variant LGV. Our study demonstrates the efficacies of 3D-CTA and laparoscopic surgery for the diagnosis and safe resection of the intraabdominal varix, respectively. PATIENT CONCERNS: A 74-year-old woman was referred to our department with a tumor in the abdominal cavity. On physical examination, no lumps were palpable in the upper abdomen. DIAGNOSIS: The enhanced CT was revealed that the tumor was not enhanced in the early phase, but in the equilibrium phase. Moreover, 3D-CTA clearly revealed that the tumor was being supplied by the LGV. Thus, it was diagnosed as a variant of the LGV. INTERVENTIONS: Surgical resection was performed laparoscopically as per the guidance of preoperative 3D-CTA findings. During surgery, a dark tumor was found along the gastroepiploic vessels, supplied by the LGV. The tumor was resected safely based on the preoperative information. OUTCOMES: Histopathological examination of the tumor showed accumulation of various vessels, but no malignant cells. Therefore, we made a final diagnosis of the tumor as an LGV varix. For follow-up, an annual CT examination was performed and after 3 years postoperation, no recurrence was observed. CONCLUSIONS: In the present case, we have achieved a successful preoperative diagnosis using 3D-CTA, and resection was safely accomplished using laparoscopy guided by preoperative anatomical information. This is the first report of an LGV variant. Appropriate management is crucial because bleeding is a catastrophic event. Therefore, imaging procedures such as 3D-CTA for diagnosis, followed by safe resection by laparoscopic surgery, are effective tools for the treatment of epiploic vein varices.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Varizes Esofágicas e Gástricas/cirurgia , Imageamento Tridimensional/métodos , Laparoscopia/métodos , Estômago/irrigação sanguínea , Idoso , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Humanos , Cuidados Pré-Operatórios
2.
Yonsei Med J ; 62(2): 182-186, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33527799

RESUMO

Fever is a common complication of endoscopic variceal obturation (EVO) therapy for gastric variceal bleeding. However, fungemia related to EVO therapy has not yet been reported. Herein, we report two cases of post-EVO fungemia in cirrhotic patients who underwent therapeutic EVO for gastric variceal bleeding. Both patients developed sustained high fever after repeated EVO procedures while on prophylactic antibiotic use. In both patients, blood cultures revealed yeast, and they were finally diagnosed with Candida infection. Candida is a common member of the intestinal flora; however, it can cause invasive infection with consequent poor prognosis in cirrhotic patients. The route of Candida invasion is unclear; however, repeated EVO may predispose patients to Candida infection, particularly those who are in the end stage of liver disease and receiving prophylactic antibiotics. Our cases highlight that repeated invasive procedures can increase the risk of fungal infections, and fungemia should be considered in the differential diagnosis of post-EVO fever.


Assuntos
Endoscopia/efeitos adversos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Fungemia/etiologia , Hemorragia Gastrointestinal/cirurgia , Feminino , Fungemia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
3.
Z Gastroenterol ; 59(1): 24-34, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33429447

RESUMO

INTRODUCTION: In the management of patients with decompensated liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) insertion is well-established but common recommendations in the follow up management are inconsistent. Doppler sonography is commonly used for detection for TIPS dysfunction whilst data on the impact of elective invasive examinations are scarce. AIM: The aim of this retrospective analysis is to evaluate potential benefits of elective invasive examinations in the follow up management of patients after TIPS insertion METHODS: Data of all patients receiving TIPS at the university hospitals of Muenster and Bonn between 2013 and 2018 (n = 534) were collected. The impact of performance of elective invasive examinations at 12 months after TIPS insertion on the occurrence of liver related events (LREs) and frequency of TIPS revisions within 24 months after TIPS insertion was analyzed. RESULTS: No significant differences were found concerning occurrence of liver related events after 24 months depending on whether an elective invasive examination was performed. Occurrence of hepatic encephalopathy, relapse of initial indication for TIPS, as well as death or liver transplantation all did not differ. These findings were verified by a subgroup analysis including only patients who did not experience a LRE or TIPS revision within the first 12 months after TIPS procedure. CONCLUSION: The analyzed data suggest no evidence for a beneficial impact due to implementation of an elective invasive examination program after TIPS insertion. Invasive examinations should remain reserved to patients with suspected TIPS dysfunction.


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Varizes Esofágicas e Gástricas/cirurgia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Varizes Esofágicas e Gástricas/etiologia , Seguimentos , Encefalopatia Hepática , Humanos , Hipertensão Portal/complicações , Derivação Portossistêmica Transjugular Intra-Hepática/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
4.
Z Gastroenterol ; 59(1): 43-49, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33429449

RESUMO

Non-cirrhotic portal vein thrombosis (PVT) in patients with antiphospholipid syndrome (APS) is a rare complication, and the management has to be determined individually based on the extent and severity of the presentation. We report on a 37-year-old male patient with non-cirrhotic chronic PVT related to a severe thrombophilia, comprising APS, antithrombin-, factor V- and factor X-deficiency. Three years after the initial diagnosis of non-cirrhotic PVT, the patient presented with severe hemorrhagic shock related to acute bleeding from esophageal varices, requiring an emergency transjugular intrahepatic portosystemic stent shunt (TIPSS). TIPSS was revised after a recurrent bleeding episode due to insufficient reduction of the portal pressure. Additionally, embolization of the dilated V. coronaria ventriculi led to the regression of esophageal varices but resulted simultaneously in a left-sided portal hypertension (LSPH) with development of stomach wall and perisplenic varices. After a third episode of acute esophageal varices bleeding, a surgical distal splenorenal shunt (Warren shunt) was performed to reduce the LSPH. Despite anticoagulation with low molecular weight heparin and antithrombin substitution, endoluminal thrombosis led to a complete Warren shunt occlusion, aggravating the severe splenomegaly and pancytopenia. Finally, a partial spleen embolization (PSE) was performed. In the postinterventional course, leukocyte and platelet counts increased rapidly and the patient showed no further bleeding episodes. Overall, this complex course demonstrates the need for individual assessment of multimodal treatment options in non-cirrhotic portal hypertension. This young patient required triple modality porto-systemic pressure reduction (TIPSS, Warren shunt, PSE) and involved finely balanced anticoagulation and bleeding control.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Trombofilia , Trombose Venosa , Adulto , Varizes Esofágicas e Gástricas/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/diagnóstico , Masculino , Equipe de Assistência ao Paciente , Veia Porta/fisiopatologia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Stents
5.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370938

RESUMO

A 31-year-old woman with hepatocellular carcinoma suffered from recurrent oesophageal variceal bleeding due to portal hypertension, which was caused by severe compression of the portal vein by metastatic lymph nodes. Endoscopic band ligation and pharmacological treatment did not suffice to prevent recurrence of variceal bleeding. Eventually, after the fifth variceal bleeding within 6 months, the patient was admitted to the intensive care unit in a haemodynamic shock. A Sengstaken-Blakemore tube was inserted and all treatment options were discussed, but only percutaneous transhepatic recanalisation of the portal vein with stent placement to reduce portal vein pressure was thought to be feasible with any chance to relieve portal vein pressure. After successful portal vein stenting, our patient did not have any recurrent bleeding in the remaining year of her life. We suggest that percutaneous transhepatic portal vein stenting may be a feasible and adequate last line treatment for complications of portal hypertension.


Assuntos
Carcinoma Hepatocelular/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Neoplasias Hepáticas/complicações , Prevenção Secundária/métodos , Choque Hemorrágico/cirurgia , Adulto , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Esofagoscopia , Esôfago/irrigação sanguínea , Esôfago/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Veia Porta/cirurgia , Recidiva , Prevenção Secundária/instrumentação , Choque Hemorrágico/etiologia , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Am Surg ; 86(9): 1049-1055, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33049164

RESUMO

Dr Dean Warren was born in 1924 and died prematurely from cancer in 1989. He was a man of uncommon intelligence, wit, collegiality, integrity, honesty, and a true leader in American surgery. In 1966, he and his colleagues (Drs Zeppa and Fomon) presented a new concept for surgical shunts to control variceal hemorrhage while maintaining portal perfusion or hepatopetal blood flow. He termed this new shunt the distal splenorenal shunt (DSRS), which was the first selective shunt invented. The DSRS selective shunt was a brilliant improvement over the total shunt concept proposed by Nicolai Eck and was practiced worldwide during the 1980s. In a space of 2 decades, Dr Warren's pioneering work would show that the selective DSRS was superior to total shunts for treatment of portal hypertension, but that endoscopic sclerotherapy was a better first-line treatment for variceal hemorrhage than his own creation. His absolute adherence to the principles he espoused in his presidential address to the Society for Surgery of the Alimentary Tract in 1973 were employed in his research and treatment of patients. This paper details Dr Warren's extraordinary research accomplishments and sets a lesson for us that well-designed clinical trials including randomization are essential in the advancement of the care of surgical patients.


Assuntos
Varizes Esofágicas e Gástricas/história , Hemorragia Gastrointestinal/história , Derivação Esplenorrenal Cirúrgica/história , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , História do Século XX , Humanos , Estados Unidos
8.
Acta Gastroenterol Belg ; 83(3): 373-380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33094582

RESUMO

Endoscopic variceal ligation (EVL) has been the standard treatment for acute variceal bleeding (AVB). However, reports of long-term prognosis after EVL are scarce. Therefore, the current work aimed to investigate the long-term outcome and prognostic modifiers of cirrhotic cases presented with acute esophageal variceal bleeding and managed with EVL. The current prospective work comprised primarily 276 consecutive grown-up cirrhotic cases presenting with AVB and managed with EVL. Two-hundred patients who completed the study till death or 3-year follow-up were enrolled in final analysis. The primary outcome measure was occurrence of rebleeding and all-cause mortality. By the end of follow up 56 patients (28%) developed rebleeding and 78 (39%) died. The independent factors associated with rebleeding were lacking follow up EVL (OR: 4.8, 95%CI: 1.9-12.2), BMI > 30 kg/m2 (OR: 0.-, 95%CI: 0.2-0.9), Child class C (OR: 3.8, 95%CI: 1.8-7.8), and grade IV varices (OR: 2.6, 95%CI: 1.3-5.3). The independent factors associated with mortality were: Age > 65 years (OR: 32.4, 95%CI: 8.7-120.3), rebleeding (OR: 98.4, 95%CI: 27.9-347.0), coexistence of HCC (OR: 7.4, 95%CI: 2.0-27.4), and lacking follow up EVL (OR: 6.1, 95%CI: 1.2-31.1). Recurrent bleeding after emergency endoscopic ligation of acute esophageal variceal bleeding in cirrhotic cases is a rather common complication that significantly increases the mortality rate. The liver condition, lack of follow up endoscopy, old age, and severity of esophageal varices are independent prognostic indicator of rebleeding and morality.


Assuntos
Carcinoma Hepatocelular , Varizes Esofágicas e Gástricas , Neoplasias Hepáticas , Criança , Endoscopia , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Cirrose Hepática/complicações
9.
Khirurgiia (Mosk) ; (10): 60-67, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047587

RESUMO

OBJECTIVE: To improve prediction of recurrent bleeding after endoscopic sclerotherapy of esophageal varices. MATERIAL AND METHODS: A prospective, observational, case-control study was performed. Immediate and long-term results of endoscopic sclerotherapy of esophageal varices were studied in 91 patients for the period from 2002 to 2016. Multiple regression analysis with binary response model was applied to analyze the prediction models. RESULTS: Recurrent bleeding occurred in 80.5 (20; 182) days after sclerotherapy (range 0-2557 days). Spearman's correlation analysis revealed a significant relationship between bleeding recurrence and erythrocyte count (R= -0.32), Child-Pugh class of liver cirrhosis (R=0.49), Child-Pugh score (5-15) (R=0.54), content of amino acids, HPro/Pro ratio (R=0.71). Prognostic indicators were selected by stepwise inclusion of predictors. Thus, the final version of regression equation is as follows: Y=exp (-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)/[1+exp(-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)]. High risk of recurrent bleeding from esophageal varices within 1 year after endoscopic sclerotherapy is determined by Y-value >0.5. An accuracy of this model is 89.6%, Se 94.3%, Sp 79.2%, PPV 90.9%, NPV 86.4%, OR 63.3, LR + 4.53, LR - 0.07. CONCLUSION: Thus, the proposed method is highly informative, effective, available and can be widely used in clinical practice.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Escleroterapia/efeitos adversos , Estudos de Casos e Controles , Criança , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/cirurgia , Esofagoscopia/efeitos adversos , Esofagoscopia/métodos , Humanos , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Escleroterapia/métodos
11.
Medicine (Baltimore) ; 99(37): e22051, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925738

RESUMO

Addressing pancreaticobiliary disorders concomitant with gastroesophageal varices remains challenging. The goal of this study was to evaluate and compare the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotic and noncirrhotic patients with gastroesophageal varices.We retrospectively analyzed the data of consecutive patients with gastroesophageal varices who underwent ERCP.Two hundred seventy ERCP procedures were performed on 208 patients. The overall technical success rate was 98.5%, and no difference was found between cirrhotic and noncirrhotic patients (98.7% vs 97.7%, P = .511); of these, endoscopic retrograde biliary drainage, endoscopic metal biliary endoprosthesis placement, endoscopic retrograde pancreatic drainage, and stone extraction were conducted in 173/270 (64.1%), 27/270 (10.0%), 26/270 (9.6%), and 116/270 (43.0%) cases, respectively. Endoscopic retrograde biliary drainage and stone extraction were more frequently performed in cirrhotic cases (67.7% versus 45.5%, P = .005; 46.5% versus 25.0%, P = .009, respectively), while the noncirrhotic group had significantly higher rates of endoscopic metal biliary endoprosthesis placement (31.8% versus 5.8%, P = .000) and endoscopic retrograde pancreatic drainage (18.2% versus 8.0%, P = .036) than the cirrhotic group. The overall rate of adverse events was 21.1%, including fever (6.7%), post-ERCP pancreatitis ( 3.0%), hyperamylasemia (6.3%), duodenal papilla bleeding (3.3%), cardiac mucosal laceration (1.1%), and perforation (0.4%). No differences in any of the adverse events were found between the 2 groups. Additionally, gastroesophageal variceal bleeding occurred in 1 patient with grade III varices 7 days after ERCP.ERCP may be effective and safe for patients with gastroesophageal varices, irrespective of the etiologies caused by liver cirrhosis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Varizes Esofágicas e Gástricas/cirurgia , Cirrose Hepática/complicações , Adulto , Idoso , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Hipertensão Portal/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos
12.
Z Gastroenterol ; 58(9): 877-889, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947633

RESUMO

For 30 years the transjugular intrahepatic portosystemic shunt (TIPS) is successfully used for the treatment of portal hypertension. Indication for TIPS in relation to variceal bleeding and refractory ascites is scientifically documented and defined by national and international guidelines. For rare indications such as hepatorenal syndrome, portal vein thrombosis or the neodjuvant TIPS larger evidence-based studies are missing. An important contraindication and the leading clinical complication after TIPS is the development of hepatic encephalopathy (HE). Reduction of post-TIPS HE is therefore aimed through development of further technical enhancements of the TIPS-stents.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Encefalopatia Hepática/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
13.
Dig Liver Dis ; 52(9): 937-941, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32703730

RESUMO

BACKGROUND: The COVID-19 pandemic had a huge impact on national and regional health systems. The impact of SARS-CoV-2 on the quality of care for patients with liver disease is still unknown. AIMS: The Italian Association for the Study of the Liver (AISF) conducted a survey to assess the impact of SARS-CoV-2 on hepatology units activities in Italy. METHODS: A prospective web-based survey was proposed to all AISF active members. The survey was available online from April 8 2020, to May 3 2020, (lockdown phase in Italy). RESULTS: 194 AISF members answered the questionnaire, most of whom were specialists in Gastroenterology (41%) or Internal Medicine (28%), and worked in Northern Italy (51%). 26% of hepatology wards had been converted into COVID-19 wards, and 33% had bed reductions. All hepatological activities, including the management of patients with decompensated liver disease, liver transplant and HCC had been significantly reduced/stopped. The number of physicians answering that their practices had not been modified ranged between 0.6% (for chronic hepatitis) to 47% (for the execution of paracentesis). The recorded answers were consistent among different regions, and did not show any north-south gradient CONCLUSION: COVID-19 outbreak significantly impacted on hepatological clinical activity. This survey can serve as a basis to compare the impact of future measures aimed at delivering an acceptable level of liver care during a national pandemic or crisis.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Gastroenterologia/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hepatopatias/terapia , Pneumonia Viral/epidemiologia , Antivirais/uso terapêutico , Betacoronavirus , Carcinoma Hepatocelular/terapia , Doença Crônica , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/cirurgia , Hepatite B Crônica/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Itália/epidemiologia , Cirrose Hepática/terapia , Neoplasias Hepáticas/terapia , Transplante de Fígado/estatística & dados numéricos , Programas de Rastreamento , Pandemias , Paracentese/estatística & dados numéricos , Qualidade da Assistência à Saúde , Inquéritos e Questionários
14.
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
15.
Dig Endosc ; 32(5): 812-815, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32289878

RESUMO

COVID-19, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), is now a global pandemic with serious health consequences. Currently, many strict control measures are applied in health care settings, including endoscopy units, in order to limit virus spread. Several recommendations called to limit endoscopic procedures to emergent endoscopies; however, several uncertainties still exist concerning patient safety, protective measures, and infection control methods in emergency endoscopic settings. In this case report, we present a case of successful endoscopic band ligation for bleeding esophageal varices in man with COVID-19 disease who presented with an acute attack of hematemesis while on mechanical ventilation (MV). Esophago-gastroduodenoscopy was performed in the ICU room after preparing the setting, and revealed large, risky esophageal varices. Endoscopic band ligation was done with successful control of bleeding. Third-level measures of medical protection were applied for the participating medical personnel, and patient monitoring was maintained all through the procedure. After the procedure, the bleeding stopped, and the patient was vitally stable and conscious. We conclude that emergency endoscopic interventions could be performed safely with appropriate arrangements in patients with confirmed COVID-19 on MV.


Assuntos
Infecções por Coronavirus/diagnóstico , Endoscopia do Sistema Digestório/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hematemese/cirurgia , Pneumonia Viral/diagnóstico , Técnicas de Laboratório Clínico , Infecções por Coronavirus/prevenção & controle , Emergências , Hematemese/etiologia , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Respiração Artificial/métodos , Medição de Risco , Resultado do Tratamento
16.
Sci Rep ; 10(1): 4046, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32132589

RESUMO

Although current guidelines recommend performing endoscopy within 12 hours for acute variceal bleeding (AVB), the optimal timing remains controversial. This study aimed to assess the effect of endoscopy timing on the mortality and rebleeding rates in AVB through a systematic review and meta-analysis of all eligible studies. PubMed, Cochrane Library, and Embase were searched for relevant publications up to January 2019. Overall mortality, rebleeding rate, and other clinical outcomes were determined. For the non-randomized studies, the risk of bias assessment tool was used to assess the methodological quality of the included publications. The Mantel-Haenszel random-effects model of the RevMan software (Cochrane) and the inverse variance method were used to analyse binary end points and continuous outcomes, respectively. This meta-analysis included five studies with 854 and 453 participants who underwent urgent (≤12 hours) and non-urgent endoscopies (>12 hours), respectively. All the included studies were retrospective in nature, because of obvious ethical issues. No significant differences in the severity indexes were found between the urgent and non-urgent groups. Three studies showed 6-week mortality and the others in-hospital mortality as main outcomes. No significant difference in overall mortality rate was found between the groups (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.36-1.45, p = 0.36). The rebleeding rate was similar between the two groups (OR: 1.21, 95% CI: 0.76-1.93, p = 0.41). Other outcomes such as successful haemostasis, need for salvage therapy, length of hospital stay, and number of blood transfusions were also similar between the groups. We demonstrated that endoscopy timing does not affect the mortality or rebleeding rate of patients with AVB. Therefore, an appropriate timing of endoscopy would be more important than an urgent endoscopy depending on each patient's condition.


Assuntos
Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Varizes , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/mortalidade , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/cirurgia , Humanos , Fatores de Tempo , Varizes/complicações , Varizes/mortalidade , Varizes/cirurgia
17.
Niger J Clin Pract ; 23(3): 429-433, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32134046

RESUMO

Bleeding oesophageal varices is a rare condition in children and most of them are usually of extrahepatic causes. Neonatal umbilical catheterization even though safe has been identified as a cause of portal vein thrombosis and oesophaeal varices. We report a 9-year old Nigerian girl who had massive upper gastrointestinal bleeding from oesophageal varices secondary to pulmonary vein stenosis. She had umbilical catheterization for exchange blood transfusion as a neonate. She was sequentially managed with endoscopic sclerotherapy and band ligation We seek to highlight the need for a high index of suspicion of oesophageal varices in children with upper gastrointestinal bleeding who had neonatal umbilical catheterization.">.


Assuntos
Cateterismo/efeitos adversos , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Veias Umbilicais/cirurgia , Transfusão de Sangue , Criança , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Recém-Nascido , Nigéria
18.
Radiol Med ; 125(7): 609-617, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32072390

RESUMO

BACKGROUND: This study aims to evaluate radiation exposure in patients with complete portal vein thrombosis (CPVT) or portal cavernoma (PC) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation using real-time ultrasound guidance for portal vein targeting. MATERIALS AND METHODS: This is a single institution retrospective analysis. Between August 2009 and September 2018, TIPS was attempted in 49 patients with CPVT or PC. Radiation exposure (dose area product [DAP], air KERMA (AK) and fluoroscopy time [FT]), technical success, clinical success, complications and survival were analyzed. RESULTS: In total, 29 patients had CPVT and 20 patients had PC. 41/49 patients had cirrhosis. TIPS indications were refractory ascites (n = 25), variceal bleeding (n = 16) and other (n = 8). TIPS was successfully placed in 94% (46/49) of patients via a transjugular approach alone (n = 40), a transjugular/transhepatic approach (n = 5) and a transjugular/transsplenic approach (n = 1). Median DAP was 261 Gy * cm2 (range 29-950), median AK was 0.2 Gy (range 0.05-0.5), and median FT was 28.2 min (range 7.7-93.7). Mean portosystemic pressure gradient decreased from 16.8  ±  5.1 mmHg to 7.5  ±  3.3 mmHg (P <  0.01). There were no major procedural complications. Overall clinical success was achieved in 77% of patients (mean follow-up of 21.1 months). Encephalopathy was observed in 16 patients (34%), grade II-III encephalopathy in 7 patients (15%). TIPS revision was performed in 15 patients (32%). Overall survival rate was 75%. CONCLUSION: In our experience, the use of real-time ultrasound guidance allowed the majority of the TIPS to be performed via a transjugular approach alone with a reasonably low radiation exposure considering the high technical difficulties of the selected cohort of patients with CVPT or PC.


Assuntos
Hemangioma Cavernoso/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática , Exposição à Radiação , Ultrassonografia de Intervenção , Trombose Venosa/diagnóstico por imagem , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Feminino , Fluoroscopia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Hemangioma Cavernoso/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose Venosa/cirurgia
19.
Einstein (Sao Paulo) ; 18: eRC4934, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994612

RESUMO

Varicose gastrointestinal bleeding is one of the major causes of morbidity and mortality in patients with chronic liver disease. Endoscopic treatment is the first therapeutic line for these patients, however, for those whom this therapeutic modality fail, a broad knowledge of alternative treatment options may improve the prognosis. We describe a case of a patient who were successfully embolized from gastroesophageal varices via transsplenic access.


Assuntos
Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Veia Esplênica/cirurgia , Adulto , Angiografia/métodos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Veia Porta/cirurgia , Veia Esplênica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia Doppler/métodos , Trombose Venosa/cirurgia
20.
J Gastroenterol Hepatol ; 35(8): 1397-1403, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31900982

RESUMO

BACKGROUND AND AIM: This aims to study incidence of re-bleeding on anticoagulation and survival of Budd-Chiari syndrome (BCS) patients presenting with variceal bleeding. METHODS: Budd-Chiari syndrome patients presenting with variceal bleed between 01/01/2007 and 01/05/2019 were retrospectively studied. Patients underwent endoscopic treatment ± endovascular therapy, followed by anticoagulation. Variceal re-bleed (on anticoagulation) and survival were studied. RESULTS: Of 376 BCS patients diagnosed during the study period, 40 (10.7%) patients, presenting with variceal bleed (age 33 [25-40] years; male patients 70%; Rotterdam score 1.13 [0.63-1.22]), Group 1 were compared with 40 randomly selected age-matched BCS patients presenting with ascites, no bleeds (40 [23-42] years; male patients 42.5%; Rotterdam score 1.11 [1.09-1.16]), Group 2. The commonest site of obstruction was hepatic vein (65%) in Group 1 and combined hepatic veins and inferior vena cava (57.5%) in Group 2 (P < 0.01). Thirty-six Group 1 patients underwent endoscopic intervention (variceal ligation, 33; sclerotherapy, 2; glue injection, 1). Endovascular intervention was performed in 30 Group 1 patients (angioplasty ± stent, 22; endovascular shunt, 8) and in 34 Group 2 patients (angioplasty ± stent, 26; endovascular shunt, 8). All 80 patients were started on anticoagulation. Variceal bleed on anticoagulation occurred in five patients in Group 1 and three patients in Group 2. One-year and 5-year survival were 94.2% and 87.5%, respectively, in Group 1 and 100% and 80%, respectively, in Group 2. CONCLUSIONS: About one-tenth of BCS patients present with variceal bleed. On management with endoscopic ± endovascular therapy, followed by anticoagulation, variceal re-bleed in these patients were comparable with those in BCS patients presenting with ascites and survival was excellent at 1 and 5 years.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome de Budd-Chiari/complicações , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/cirurgia , Adulto , Endoscopia Gastrointestinal , Procedimentos Endovasculares , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
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