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1.
Medicine (Baltimore) ; 99(11): e19485, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176084

RESUMO

Urgent endoscopy (UE) is important to the diagnosis and treatment of liver cirrhosis patients with esophageal variceal bleeding (EVB). It was reported that a second-look endoscopy may benefit acute upper gastrointestinal bleeding (UGIB) caused by peptic ulcer, while whether it could improve UGIB caused by liver cirrhosis associated EVB remains unclear. This study aimed to investigate the characteristics of second UE for liver cirrhosis with EVB and further examined the potential prognostic factors.Patients aged ≥18 years who underwent UE for EVB within 2 hours after the admission were included and divided into scheduled second-look group (n = 245) and uncontrolled bleeding group (n = 352) based on the indications for second UE within 48 hours after initial endoscopy. Demographic and clinical data were collected and analyzed. Univariate and multivariate analysis were used to identify the risk factors for prognosis. The value of different scoring system was compared.Statistical differences were found on history of bleeding and hepatocellular carcinoma, ascites, endoscopic type of bleeding, between scheduled second-look group and uncontrolled bleeding group. Univariate and multivariate logistic regression analysis confirmed that ascites, hemoglobin <60 g/L, AIMS65 score and failure to identify in initial UE were independent risk factors for bleeding uncontrolled after initial UE, and age, bilirubin level, initial unsatisfactory UE hemostasis, failure to identify bleeding on initial UE and tube/urgent TIPS suggested in initial UE were independent risk factors for 42-day mortality.A second-look UE could bring benefit for liver cirrhosis patients with EVB without increasing the complication rate.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/estatística & dados numéricos , Cirrose Hepática/complicações , Cirurgia de Second-Look/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Árvores de Decisões , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/mortalidade , Humanos , Modelos Logísticos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
2.
Br J Radiol ; 93(1108): 20190751, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32017608

RESUMO

OBJECTIVE: To determine the utility of low-dose gelatin sponge particles and 5% ethanolamine oleate iopamidol (EOI) mixture in retrograde transvenous obliteration (GERTO) for gastric varices (GV). METHODS: 57 consecutive patients who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) for GV were divided into three groups with Hirota's grade by balloon-occluded retrograde transvenous venography. Hirota's Grade 1 patients were assigned to G1 group and underwent treatment with 5% EOI. Grade ≥ 2 patients prior to August 2015 were G ≥ 2 group treated with 5% EOI, and those treated thereafter were GERTO group. The amount of EOI used per unit GV volume (EOI/GV ratio), the times to embolization and recurrence rate of GV were evaluated. RESULTS: The EOI/GV ratio was 0.66 ± 0.19 in G1, 1.5 ± 0.8 in G ≥ 2, and 0.58 ± 0.23 in GERTO (G ≥ 2 vs GERTO, p < 0.0001). The times to embolization were 26.5 ± 10.5 min for G1, 39.2 ± 26.8 for G ≥ 2, and 21.4 ± 9.4 for GERTO (G ≥ 2 vs GERTO, p = 0.005). The recurrence rate was not significantly different in any of the groups. CONCLUSION: GERTO was performed in lower amount of sclerosants and in less time compared to conventional B-RTO in Hirota's grade ≥2. ADVANCES IN KNOWLEDGE: Feasibility of low-dose gelatin sponge particles and 5% EOI mixture as sclerosants for GV.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Gelatina/administração & dosagem , Iopamidol/administração & dosagem , Ácidos Oleicos/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Idoso , Oclusão com Balão/efeitos adversos , Combinação de Medicamentos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Flebografia/métodos
3.
Medicine (Baltimore) ; 99(5): e18913, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000397

RESUMO

The use of beta-blockers in decompensated cirrhosis accompanying ascites is still under debate. The aim of this study was to compare overall survival (OS) and incidence of cirrhotic complications between endoscopic variceal ligation (EVL) only and EVL + non-selective beta-blocker (NSBB) combination therapy in cirrhotic patients with significant ascites (≥grade 2).This retrospective study included 271 consecutive cirrhotic patients with ascites who were treated with EVL only or EVL + NSBB combination therapy as a primary prophylaxis of esophageal varices. The primary outcome was all-cause mortality. Propensity score matching was performed between the 2 groups to minimize baseline difference.Median observation period was 42.1 months (interquartile range, 18.4-75.1 months). All patients had deteriorated liver function: 81.1% Child-Pugh class B and 18.9% Child-Pugh class C. All-cause mortality was significantly higher in the EVL + NSBB group than in the EVL only group not only in non-matched cohort, but also in matched cohort (48.9% vs 31.2%; P = .039). More people died from hepatic failure in the EVL + NSBB group than that in the EVL only group (40.5% vs 20.0%; P = .020). However, the incidence of variceal bleeding, hepatorenal syndrome (HRS), or spontaneous bacterial peritonitis (SBP) was not significantly different between the 2 groups.The use of NSBB might worsen the prognosis of cirrhotic patients with significant ascites. These results suggest that EVL alone is a more appropriate treatment option for prophylaxis of esophageal varices than propranolol combination therapy when patients have significant ascites.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Ascite/terapia , Endoscopia/métodos , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Propranolol/uso terapêutico , Ascite/mortalidade , Terapia Combinada , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/mortalidade , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão
4.
Medicine (Baltimore) ; 99(3): e18806, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011485

RESUMO

RATIONALE: Esophagopleural fistula (EPF) is a rare critical life-threatening condition that features high misdiagnosis rate. Although various surgical and conservative techniques have been developed for the treatment of EPF, the mortality rate of EPF remains high. PATIENT CONCERNS: An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding. DIAGNOSES: Upper endoscopy revealed bleeding large esophageal varices, and endoscopic injection sclerotherapy (EIS) was performed. Two weeks after the EIS was performed, the patient developed pyrexia, left-sided pleuritic chest pain. Air and pleural effusion were showed in the left pleural cavity by high-resolution computed tomography (HRCT), and a linear fistulous communication was noticed from the distal esophagus. These findings were consistent with hepatic cirrhosis, esophageal varices, upper gastrointestinal bleeding, and esophagopleural fistula. INTERVENTIONS: The patient was intensively treated with endoscopic self-expandable metallic stent (covered-SEMS) implantation and comprehensive treatments (including thoracic closed drainage, antibiotics, nasojejunal nutrition, and antacids). OUTCOMES: The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments. LESSONS: This case indicates that pleural effusion with food residue is a specific finding in EPF. Thorax CT exhibited high sensitivity for the diagnosis of EPF. Endoscopic self-expandable metallic stent implantation and comprehensive conservative treatments may be preferable for the severe liver disease with EPF.


Assuntos
Endoscopia Gastrointestinal , Fístula Esofágica/etiologia , Varizes Esofágicas e Gástricas/terapia , Escleroterapia , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/terapia , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Masculino , Esquistossomose mansoni/complicações , Esquistossomose mansoni/terapia , Escleroterapia/efeitos adversos , Escleroterapia/métodos , Stents Metálicos Autoexpansíveis
5.
Zhonghua Wai Ke Za Zhi ; 57(12): 885-892, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826590

RESUMO

Portal hypertension is a clinical syndrome which is a consequence of a pathological increase in portal vein pressure due to various causes, among which, cirrhosis being the most common cause. The most basic pathophysiological features of portal hypertension in cirrhosis are increased portal vein pressure due to blocked portal vein blood flow and open collateral circulation. Among the clinical manifestations of portal hypertension in cirrhosis, esophageal and gastric fundus varicose bleeding is the most urgent and the mortality rate is the highest. In order to standardize the diagnosis and treatment plan of esophagogastric variceal bleeding in cirrhotic portal hypertension, the Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, have renewed and revised this consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2015 edition) hope to provide references for the clinical practices.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Hipertensão Portal/fisiopatologia , Cirrose Hepática/fisiopatologia , Consenso , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/fisiopatologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/fisiopatologia , Humanos , Hipertensão Portal/etiologia , Cirrose Hepática/complicações
6.
Medicine (Baltimore) ; 98(47): e17900, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764786

RESUMO

OBJECTIVE: To observe the immediate and mid-term effects of partial spleen embolization (PSE) in reducing hepatic venous pressure gradient (HVPG) in patients with cirrhotic esophagogastric varices. METHODS: Patients diagnosed with cirrhosis and esophagogastric varices in our hospital between July 2016 and March 2018 were consecutively selected. Forty-three patients were selected based on the eligibility criteria to undergo PSE. The change in HVPG 5 minutes before and after embolization, was used to determine the immediate effect of PSE on HVPG reduction. HVPG was retested after 6 months to observe the change in the antihypertensive effect along with time. RESULTS: Forty-three patients successfully underwent PSE and HVPG measurements. The HVPG was 17.7 ±â€Š3.9 mmHg and 13.9 ±â€Š3.1 mmHg before and after PSE, respectively, showing a significant decrease (21.5%, P < .05). Among them, 18 cases were retested for HVPG at 6 months after PSE, and the results showed significant differences in the HVPG levels before, immediately and 6 months after PSE. Compared with preoperative PSE, HVPG was decreased by 22.9% and 17.7% (P < 0.05) immediately and at 6 months after operation, respectively. There was no significant change at 6 months after PSE when compared with immediate postoperative PSE. No serious complications were observed in patients during their postoperative hospital stay. CONCLUSION: PSE immediately reduced the portal pressure, and HVPG remained stable at 6 months after surgery. PSE is considered as a safe and easy to implement method, and is expected to be one of the treatments for reducing the portal pressure.


Assuntos
Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/fisiopatologia , Varizes Esofágicas e Gástricas/terapia , Pressão na Veia Porta/fisiologia , Baço/irrigação sanguínea , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
7.
Zhonghua Gan Zang Bing Za Zhi ; 27(8): 582-593, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594075

RESUMO

Portal hypertension(PH) is one of the main complications of cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS) is the percutaneous creation of a conduit from the hepatic vein to the portal vein that is used to manage consequences of PH (i.e., variceal bleeding and refractory ascites) and used as a bridging therapy to liver transplant for decompensated cirrhosis. The following Clinical Practice Guidelines (CPGs) presents profession associational recommendations of the Chinese College of Interventionalists(CCI) on TIPS for PH. The CPGs was written by more than 30 experts in the field of TIPS in China (including interventional radiologists, liver surgeons, hepatologists and gastroenterologist, et al.). The panel of experts, produced these CPGs using evidence from PubMed and Cochrane database searches and combined with relevant expert consensuses and high quality clinical researches in China providing up to date guidance on TIPS for PH with the only purpose of improving clinical practice.


Assuntos
Hipertensão Portal/terapia , Derivação Portossistêmica Transjugular Intra-Hepática , China , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Humanos , Cirrose Hepática/terapia , Resultado do Tratamento
8.
Expert Rev Gastroenterol Hepatol ; 13(9): 893-897, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31389265

RESUMO

Introduction: The most recent guidelines vary in their approach to the management of variceal bleeding especially with the use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA). This review highlights their clinical use for variceal bleeding from different guidelines perspectives. Areas covered: A comprehensive literature review of three major guidelines including the American Association for the Study of Liver Diseases (AASLD) 2017, United Kingdom (UK) guidelines 2015 and Baveno VI Consensus workshop guidelines in 2015 on the use of ES and ETA in variceal bleeding. Expert opinion: While endoscopic band ligation (EBL) completely replaced endoscopic sclerotherapy (ES) for esophageal varices. There is a valuable use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA) especially for patients with gastroesophageal varices (GOV2) and isolated gastric varices (IGV2). The current standard of care heading toward portosystemic shunting with Trans-jugular-Intrahepatic Portosystemic Shunt (TIPS) and balloon retrograde transvenous obliteration (BRTO). However, recent advancement in endoscopic ultrasound (EUS) allowing direct injection of sclerosant and tissue adhesive into the varix bringing promising results in achieving hemostasis and lowering the risk of complications. Also, ES and ETA have great clinical value in achieving hemostasis for isolated (ectopic) varices and stomal varices.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Escleroterapia/métodos , Adesivos Teciduais/administração & dosagem , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática/complicações
9.
Acta Med Indones ; 51(2): 165-168, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31383832

RESUMO

Non-Cirrhotic Portal Hypertension (NCPH) is a rare cause of hematemesis and melena. Like in cirrhotic patient, hematemesis in NCPH patient was caused by rupture of esophageal varices. But unlike in cirrhotic patient, in NCPH there are no sign of liver failure, because liver physiology is still normal. We reported case of male patient with NCPH that had hematemesis because of rupture of esophageal varices.


Assuntos
Varizes Esofágicas e Gástricas/etiologia , Hematemese/etiologia , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Adolescente , Diagnóstico Diferencial , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas/terapia , Humanos , Cirrose Hepática , Masculino , Ruptura Espontânea
10.
Surg Clin North Am ; 99(5): 921-939, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446918

RESUMO

This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.


Assuntos
Cuidados Paliativos/métodos , Sistema Biliar/diagnóstico por imagem , Colecistostomia/métodos , Drenagem/métodos , Embolização Terapêutica/métodos , Nutrição Enteral/métodos , Varizes Esofágicas e Gástricas/terapia , Vesícula Biliar/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Radiografia , Toracentese/métodos , Ultrassonografia
11.
Emerg Med Clin North Am ; 37(3): 511-527, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262418

RESUMO

Patients with end-stage liver disease (ESLD) who require intensive care unit admission have high rates of mortality. This article reviews the pathophysiology and emergency department assessment and management of the most frequent conditions and complications encountered in critically ill ESLD patients including hepatic encephalopathy, gastrointestinal bleeding, sepsis and bacterial peritonitis, hepatorenal syndrome, severe coagulopathy, and hepatic hydrothorax.


Assuntos
Estado Terminal , Doença Hepática Terminal/complicações , Doença Hepática Terminal/terapia , Manuseio das Vias Aéreas/métodos , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Medicina de Emergência , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapia , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/terapia , Hiperamonemia/etiologia , Hiperamonemia/terapia , Unidades de Terapia Intensiva , Transplante de Fígado , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/terapia , Medição de Risco , Índice de Gravidade de Doença
12.
Medicine (Baltimore) ; 98(26): e16201, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261565

RESUMO

BACKGROUND: To compare the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of gastric variceal bleeding (GVB) caused by liver cirrhosis with the traditional sandwich method no accompanied by lauromacrogol via a meta-analysis. METHODS: The Cochrane Library, Pubmed, the China National Knowledge Infrastructure (CNKI) database, the Chinese Wanfang database, and the Chongqing VIP database were searched to identify cohort studies comparing modified to traditional sandwich method in the treatment of GVB with liver cirrhosis. The relative risk for hemostasis rate, gastric varices (GV) remission rate, re-bleeding rate, the incidence of post-operative complications (pain, fever, ulcer or erosion, ectopic embolism), and all-cause mortality were calculated. The mean difference for average tissue adhesive dosage per case was calculated. Relevant data were analyzed with the Reviewer Manager 5.3.5. RESULTS: Four cohort studies with a total of 587 patients were included in this meta-analysis. In the treatment of GVB with liver cirrhosis, compared with the traditional sandwich method, the modified sandwich method was associated with a higher GV remission rate (RR: 1.24, 95% CI: 1.09-1.42; P = .001) according to the pooled results. There were no statistically significant differences between the 2 methods in the rate of hemostasis, re-bleeding, pain, fever, ulcer or erosion, ectopic embolism, and all-cause mortality (P ≧ .05). CONCLUSIONS: This meta-analysis indicated that the modified sandwich method with lauromacrogol is more effective than the traditional sandwich method without lauromacrogol. Due to the limited number of studies and samples, more RCT studies are needed to further validate the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of GVB with liver cirrhosis.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia/terapia , Cirrose Hepática/terapia , Escleroterapia , Varizes Esofágicas e Gástricas/complicações , Hemorragia/etiologia , Humanos , Cirrose Hepática/complicações , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Adesivos Teciduais/uso terapêutico
13.
J Laparoendosc Adv Surg Tech A ; 29(9): 1135-1143, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313965

RESUMO

Introduction: The first-line treatment for gastric variceal rebleeding in cirrhotic patients is endoscopic cyanoacrylate injection. We focused on the efficacy and prognosis of cyanoacrylate combined with Lauromacrogol® for gastric varices (GV) in a retrospective study of long-term follow-up. Materials and Methods: One hundred thirty patients with cirrhosis and GV from March 2011 to February 2013 were included. Sixty-eight patients underwent endoscopic cyanoacrylate injection with Lauromacrogol and 62 patients without Lauromacrogol. The median follow-up was 40.1 and 38.8 months, respectively. Results: The volumes of cyanoacrylate used for the GV eradication in the Lauromacrogol group were significantly lower than those in the Ethiodol® group (1.6 ± 0.8 versus 2.1 ± 1.2 mL, P = .029). No ectopic embolisms were observed during follow-up. The 1- and 3-year rebleeding-free rate did not differ between groups (83.7% and 59.2% versus 75.8% and 62.5%; P = .797). The same was observed for mortality (86.6% and 83.5% versus 85.5% and 83.7%; P = .955). New portal venous thrombosis (PVT) and progression of previous partial PVT were independently associated with rebleeding (hazard ratio [HR] 5.127, 95% confidence interval [CI], 2.430-10.817, P = .000) and death (HR 10.093, 95% CI, 3.988-25.548, P = .000). Conclusions: Endoscopic cyanoacrylate injection with Lauromacrogol might minimize the required dosage of cyanoacrylate, but it did not improve rebleeding rate or survival. Exacerbation of PVT was associated with rebleeding and death.


Assuntos
Cianoacrilatos/administração & dosagem , Endoscopia do Sistema Digestório/métodos , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Polidocanol/administração & dosagem , Varizes Esofágicas e Gástricas/diagnóstico , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Soluções Esclerosantes/administração & dosagem
14.
Cochrane Database Syst Rev ; 6: CD012673, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31220333

RESUMO

BACKGROUND: The presence of oesophageal varices is associated with the risk of upper gastrointestinal bleeding. Endoscopic variceal ligation is used to prevent this occurrence but the ligation procedure may be associated with complications. OBJECTIVES: To assess the beneficial and harmful effects of band ligation versus no intervention for primary prevention of upper gastrointestinal bleeding in adults with cirrhosis and oesophageal varices. SEARCH METHODS: We combined searches in the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, and Science Citation Index with manual searches. The last search update was 9 February 2019. SELECTION CRITERIA: We included randomised clinical trials comparing band ligation verus no intervention regardless of publication status, blinding, or language in the analyses of benefits and harms, and observational studies in the assessment of harms. Included participants had cirrhosis and oesophageal varices with no previous history of variceal bleeding. DATA COLLECTION AND ANALYSIS: Three review authors extracted data independently. The primary outcome measures were all-cause mortality, upper gastrointestinal bleeding, and serious adverse events. We undertook meta-analyses and presented results using risk ratios (RRs) with 95% confidence intervals (CIs) and I2 values as a marker of heterogeneity. In addition, we calculated the number needed to treat to benefit (NNTTB) for the primary outcomes . We assessed bias control using the Cochrane Hepato-Biliary domains; determined the certainty of the evidence using GRADE; and conducted sensitivity analyses including Trial Sequential Analysis. MAIN RESULTS: Six randomised clinical trials involving 637 participants fulfilled our inclusion criteria. One of the trials included an additional small number of participants (< 10% of the total) with non-cirrhotic portal hypertension/portal vein block. We classified one trial as at low risk of bias for the outcome, mortality and high risk of bias for the remaining outcomes; the five remaining trials were at high risk of bias for all outcomes. We downgraded the evidence to moderate certainty due to the bias risk. We gathered data on all primary outcomes from all trials. Seventy-one of 320 participants allocated to band ligation compared to 129 of 317 participants allocated to no intervention died (RR 0.55, 95% CI 0.43 to 0.70; I2 = 0%; NNTTB = 6 persons). In addition, band ligation was associated with reduced risks of upper gastrointestinal bleeding (RR 0.44, 95% CI 0.28 to 0.72; 6 trials, 637 participants; I2 = 61%; NNTTB = 5 persons), serious adverse events (RR 0.55, 95% CI 0.43 to 0.70; 6 trials, 637 participants; I2 = 44%; NNTTB = 4 persons), and variceal bleeding (RR 0.43, 95% CI 0.27 to 0.69; 6 trials, 637 participants; I² = 56%; NNTTB = 5 persons). The non-serious adverse events reported in association with band ligation included oesophageal ulceration, dysphagia, odynophagia, retrosternal and throat pain, heartburn, and fever, and in the one trial involving participants with either small or large varices, the incidence of non-serious side effects in the banding group was much higher in those with small varices, namely ulcers: small versus large varices 30.5% versus 8.7%; heartburn 39.2% versus 17.4%. No trials reported on health-related quality of life.Two trials did not receive support from pharmaceutical companies; the remaining four trials did not provide information on this issue. AUTHORS' CONCLUSIONS: This review found moderate-certainty evidence that, in patients with cirrhosis, band ligation of oesophageal varices reduces mortality, upper gastrointestinal bleeding, variceal bleeding, and serious adverse events compared to no intervention. It is unlikely that further trials of band ligation versus no intervention would be considered ethical.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Cirrose Hepática/complicações , Adulto , Varizes Esofágicas e Gástricas/mortalidade , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Hipertensão Portal/complicações , Ligadura/efeitos adversos , Ligadura/instrumentação , Ligadura/métodos , Ligadura/mortalidade , Pessoa de Meia-Idade , Números Necessários para Tratar , Prevenção Primária/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Conduta Expectante
15.
Drug Discov Ther ; 13(2): 118-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080203

RESUMO

Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. The association between endoscopic injection sclerotherapy (EIS) and PVT is unclear. In this paper, we reported that a male cirrhotic patient developed acute mesenteric vein thrombosis after EIS for secondary prophylaxis of esophageal variceal bleeding. Immediate anticoagulation therapy was effective and safe in this patient.


Assuntos
Heparina de Baixo Peso Molecular/uso terapêutico , Escleroterapia/efeitos adversos , Trombose Venosa/etiologia , Endoscopia , Varizes Esofágicas e Gástricas/terapia , Humanos , Cirrose Hepática/complicações , Masculino , Veias Mesentéricas , Pessoa de Meia-Idade , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
16.
Biomed Res Int ; 2019: 2674758, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073523

RESUMO

Aims: To evaluate the safety and effectiveness of percutaneous transhepatic antegrade embolization (PTAE) with 2-octyl cyanoacrylate assisted with balloon occlusion of the left renal vein or gastrorenal shunts (GRSs) for the treatment of isolated gastric varices (IGVs) with large GRSs. Methods: Thirty patients with IGVs associated with large GRSs who had underwent PTAE assisted with a balloon to block the opening of the GRS in the left renal vein were retrospectively evaluated and followed up. Clinical and laboratory data were collected to evaluate the technical success of the procedure, complications, changes in the liver function using Child-Pugh scores, worsening of the esophageal varices, the rebleeding rate, and survival. Laboratory data obtained before and after PTAE were compared (paired-sample t-test). Results: PTAE was technically successful in all 30 patients. No serious complications were observed except for one nonsymptomatic pulmonary embolism. During a mean follow-up of 30 months, rebleeding was observed in 4/30 (13.3%) patients, worsening of esophageal varices was observed in 4/30 (13.3%) patients, and newly developed or aggravated ascites were observed on CT in 3/30 (10%) patients. Significant improvement was observed in Child-Pugh scores (p=0.009) and the international normalized ratio (INR) (p=0.004) at 3 months after PTAE. The cumulative survival rates at 1, 2, 3, and 5 years were 96.3%, 96.3%, 79.9%, and 79.9%, respectively. Conclusion: Balloon-assisted PTAE with 2-octyl cyanoacrylate is technically feasible, safe, and effective for the treatment of IGV associated with a large GRS.


Assuntos
Oclusão com Balão/métodos , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/terapia , Cirrose Hepática/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Oclusão com Balão/efeitos adversos , Cianoacrilatos/administração & dosagem , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Fístula/fisiopatologia , Fístula/terapia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/patologia , Hemorragia/complicações , Hemorragia/patologia , Humanos , Estimativa de Kaplan-Meier , Fígado/fisiopatologia , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Veias Renais/efeitos dos fármacos , Veias Renais/cirurgia , Adesivos Teciduais/administração & dosagem , Resultado do Tratamento
17.
Cardiovasc Intervent Radiol ; 42(8): 1204-1207, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31073821

RESUMO

A 49-year-old man with alcoholic liver cirrhosis was admitted to our hospital with abdominal pain. Contrast-enhanced CT demonstrated massive hemorrhagic ascites and ectopic varices fed by right colic and ileocolic veins. The varices were treated with selective embolization via a recanalized paraumbilical vein using N-butyl cyanoacrylate. Currently, no complications and rebleeding have occurred for 7 months. Antegrade embolization via a recanalized paraumbilical vein is feasible and less-invasive in a patient with massive ascites. Flow reduction may be effective for intraabdominal hemorrhage from ruptured ectopic varices. LEVEL OF EVIDENCE: Level 5, case report.


Assuntos
Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática Alcoólica/complicações , Embucrilato/uso terapêutico , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Arq Gastroenterol ; 56(1): 99-105, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141079

RESUMO

BACKGROUND: One of the most feared complications with the use of cyanoacrylate for treatment of gastric varices is the occurrence of potentially life-threatening systemic embolism. Thus, endoscopists are turning towards new techniques, including endoscopic coiling, as a potentially safer and more effective treatment option. However, no studies have been performed comparing the two techniques. OBJECTIVE: This study aims to compare the safety and efficacy of endoscopic ultrasound guided coil and cyanoacrylate injection versus the conventional technique of injection of cyanoacrylate alone. DESIGN: A pilot randomized controlled trial. METHODS: Patients randomized into group I were treated with coil and cyanoacrylate, and those in group II with cyanoacrylate alone. Flow within the varix was evaluated immediately after the treatment session and one month following initial treatment. If thrombosis was confirmed, additional follow-up was performed 4 and 10 months following initial treatment. All patients underwent a thoracic computerized tomography scan after the procedure. RESULTS: A total of 32 patients, 16 in each group, were followed for an average of 9.9 months (range 1-26 months). Immediately after the procedure, 6 (37.5%) group-I patients and 8 (50%) group-II patients presented total flow reduction in the treated vessel (P=0.476). After 30 days, 11 (73.3%) group-I patients and 12 (75%) group-II patients were found to have varix thrombosis. In both groups, the majority of patients required only one single session for varix obliteration (73.3% in group I versus 80% in group II). Asymptomatic pulmonary embolism occurred in 4 (25%) group-I patients and 8 (50%) group-II patients (P=0.144). No significant difference between the groups was observed. CONCLUSION: There is no statistical difference between endoscopic ultrasound guided coils plus cyanoacrylate versus conventional cyanoacrylate technique in relation to the incidence of embolism. However, a greater tendency towards embolism was observed in the group treated using the conventional technique. Both techniques have similar efficacy in the obliteration of varices. Given the small sample size of our pilot data, our results are insufficient to prove the clinical benefit of the combined technique, and do not yet justify its use, especially in light of higher cost. Further studies with larger sample size are warranted.


Assuntos
Cianoacrilatos/administração & dosagem , Varizes Esofágicas e Gástricas/terapia , Adulto , Idoso , Endossonografia/métodos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Óleo Etiodado/administração & dosagem , Feminino , Hemostase Endoscópica/métodos , Humanos , Injeções Intralesionais/efeitos adversos , Injeções Intralesionais/métodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Embolia Pulmonar/etiologia , Resultado do Tratamento
19.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092493

RESUMO

Oesophageal balloon tamponade tubes are a rare cause of ST-segment elevation (STE), thought to result from extrinsic compression of coronary arteries. This case describes STE following the use of a Sengstaken-Blakemore tube (SBT) under traction for management of bleeding oesophageal varices during orthotopic liver transplantation. This case is the first to report a significant troponin rise with STE indicative of myocardial injury following the use of SBT. Interestingly, we found that releasing traction from the SBT resulted in resolution of STE within minutes, suggesting that SBT traction may reversibly impede coronary perfusion. We recommend vigilant monitoring of patients following SBT insertion and for clinicians to consider that SBT traction may impair coronary perfusion and result in myocardial injury in patients without pre-existing coronary artery disease.


Assuntos
Oclusão com Balão/efeitos adversos , Varizes Esofágicas e Gástricas/terapia , Transplante de Fígado/efeitos adversos , Isquemia Miocárdica/etiologia , Drenagem , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
20.
Chirurg ; 90(8): 614-620, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30963209

RESUMO

BACKGROUND: Esophageal variceal bleeding is a life-threatening complication in patients with liver cirrhosis, which is pathophysiologically explained by the presence of portal hypertension. The incidence of such bleeding greatly depends on the severity of the underlying liver disease. OBJECTIVE: The aim of this article is to present the current treatment concepts for acute esophageal variceal bleeding, the management in acute situations and the indications for treatment of the causal portal hypertension with a transjugular intrahepatic portosystemic shunt (TIPS). RESULTS: In patients with liver cirrhosis or any other disease causing portal hypertension, a staging examination by esophagogastroduodenoscopy is first carried out for determination of the stage of the varices and the resulting necessary treatment. In addition, determination of the portal pressure gradient is useful. In patients with varices a medicinal or endoscopic bleeding prophylaxis should subsequently additionally be initiated. After an acute variceal bleeding event, under clearly defined prerequisites an evaluation for TIPS implantation should be considered. This is the only effective treatment for reducing portal hypertension. CONCLUSION: With appropriate indications implantation of a TIPS is an effective strategy to lower portal hypertension and therefore prevent recurrent variceal bleeding. The resulting improvement of the portal hemodynamics leads to an improvement in kidney function; however, it also leads to deterioration of liver function with subsequent development or deterioration of a previously existing hepatic encephalopathy.


Assuntos
Varizes Esofágicas e Gástricas , Encefalopatia Hepática , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal , Encefalopatia Hepática/complicações , Humanos
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