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https://www.readbyqxmd.com/read/28718261/modern-management-of-duodenal-variceal-bleeding
#1
Amer Rehman Farooqi, Lawrence Sunderraj
Duodenal variceal bleeding is an uncommon cause of gastrointestinal bleeding. Treatment strategies are reliant on case reports and case series with new developments in interventional treatment modalities including endoscopic therapy, radiological intervention, and surgery. Endoscopic treatment includes injection sclerotherapy using various agents, banding of varices and clipping of varices. Interventional radiological procedures include Transjugular Intrahepatic porto-systemic shunt (TIPSS), and Balloon- Occluded Retrograde Transvenous Obliteration (BRTO)...
April 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28718228/early-initiation-of-beta-blockers-following-primary-endoscopic-therapy-for-bleeding-oesophageal-varices-in-cirrhotics
#2
Adnan Salim, Kashif Malik, Muhammad Omer Farooq, Umair Butt, Arshad Kamal Butt, Altaf Alam
BACKGROUND AND AIMS: Beta-blockers provide secondary prophylaxis following endoscopic therapy for variceal bleeding. Guidelines recommend starting beta-blockers 6 days after endoscopy to prevent masking hemodynamic signs of re-bleeding. We aimed to see safety of earlier initiation of betablockers. METHODS: Cirrhotic patients with upper GI bleed were given intravenous vasoactive agents until undergoing endoscopy. Patients with only oesophageal varices as source of bleed were recruited...
April 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28714072/survival-of-patients-with-cirrhosis-and-acute-peptic-ulcer-bleeding-compared-with-variceal-bleeding-using-current-first-line-therapies
#3
Alba Ardevol, Gemma Ibañez-Sanz, Joaquim Profitos, Carles Aracil, Josep M Castellvi, Edilmar Alvarado, Alba Cachero, Diana Horta, Josep Miñana, Bárbara Gomez-Pastrana, Oana Pavel, Eva Dueñas, Meritxell Casas, Montserrat Planella, Jose Castellote J, Candid Villanueva
The presence of cirrhosis increases the mortality of patients with peptic ulcer bleeding (PUB). Both acute variceal bleeding (AVB) and PUB are associated with substantial mortality in cirrhosis. This multicenter cohort study was performed to assess whether the mortality of cirrhotic patients with PUB is different from that of those with AVB. Patients with cirrhosis and acute gastrointestinal bleeding were consecutively included and treated with somatostatin and PPI infusion from admission and with antibiotic prophylaxis...
July 17, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28713067/eus-guided-drainage-of-peripancreatic-fluid-collections-with-lumen-apposing-metal-stents-and-plastic-double-pigtail-stents-comparison-of-efficacy-and-adverse-event-rates
#4
Gabriel D Lang, Cassandra Fritz, Trisha Bhat, Koushik K Das, Faris M Murad, Dayna S Early, Steven A Edmundowicz, Vladimir M Kushnir, Daniel K Mullady
BACKGROUND AND AIMS: Transmural drainage with double-pigtail plastic stents (DPPSs) was the mainstay of endoscopic therapy for symptomatic peri-pancreatic fluid collections (PPFCs) until the introduction of lumen-apposing covered self-expanding metal stents (LAMSs). Currently, there is limited data regarding the efficacy and adverse event rate of LAMS compared with DPPS. METHODS: A retrospective analysis of EUS-guided PPFC drainages at a single tertiary care center between 2008 and 2015 was performed...
July 13, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28706365/obstetric-outcome-in-women-with-chronic-liver-disease
#5
Pinky Jena, C N Sheela, Rao Preethi Venkatachala, Harshad Devarbhavi
AIM: This study determines the prevalence, causes and outcome of pregnancy in women with chronic liver diseases in a tertiary level teaching institute in Southern India. METHODS: Retrospective analysis of case records was carried out between December 2010 and May 2015 in the departments of Obstetrics and Gynecology and Gastroenterology including pregnant women diagnosed to have chronic liver diseases prenatally or during pregnancy. RESULTS: The frequency of chronic liver disease in pregnancy was 50 among 10,823 deliveries (0...
August 2017: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/28702754/endoscopic-cyanoacrylate-injection-with-post-injection-audible-doppler-assessment-of-gastric-varices-a-single-institution-experience
#6
Tom D Catron, George B Smallfield, Le Kang, Richard K Sterling, Mohammad S Siddiqui
BACKGROUND AND AIMS: Gastric varices (GV) have higher rates of morbidity and mortality from hemorrhage than esophageal varices. Several studies have shown the safety and efficacy of cyanoacrylate (CA) injection for acute gastric variceal hemorrhage. We report data from our experience with CA injection for GV before and after routine use of post-injection audible Doppler assessment (ADA) for GV obturation and describe long-term outcomes after this therapy. METHODS: We retrospectively identified patients who had documented GV, underwent CA injection, and had at least 2 weeks of follow-up...
July 12, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28699947/fecal-occult-blood-testing-in-hospitalized-patients-with-upper-gastrointestinal-bleeding
#7
Benji Mathews, Temple Ratcliffe, Raj Sehgal, James Abraham, Bradley Monash
A 47-year-old man with a history of alcohol abuse, cirrhosis, and grade II esophageal varices is admitted for treatment of alcohol withdrawal. He reports having some dark-colored stools a week prior to admission, but his stools since then have been normal in color. A repeat hemoglobin is stable, but a fecal occult blood test is positive. What should be done next?
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28690769/endoscopic-resolution-and-recurrence-of-gastric-antral-vascular-ectasia-after-serial-treatment-with-argon-plasma-coagulation
#8
Shashank Garg, Bilal Aslam, Nicholas Nickl
AIM: To evaluate long-term endoscopic resolution and recurrence rate of gastric antral vascular ectasia (GAVE) after argon plasma coagulation (APC) treatment. METHODS: This was an IRB-approved retrospective single center study that included patients endoscopically treated for GAVE between 1/1/2008 to 12/31/2014. The primary and secondary end points of the study were rate of endoscopic resolution of GAVE after APC treatment and recurrence rate of GAVE after endoscopic resolution, respectively...
June 16, 2017: World Journal of Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28689520/comparison-of-12-hour-with-72-hour-terlipressin-therapy-for-bleeding-esophageal-varices
#9
Adnan Salim, Kashif Malik, Israr Ul Haq, Arshad Kamal Butt, Altaf Alam
OBJECTIVE: To determine the efficacy of 12-hour of Terlipressin therapy as compared to 72-hour therapy in preventing rebleeding after endoscopic therapy. STUDY DESIGN: Interventional study. PLACE AND DURATION OF STUDY: Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital, Lahore, from January to March 2016. METHODOLOGY: Cirrhotic patients presenting to our hospital with GI (gastrointestinal) bleeding received Terlipressin 2 mg intravenous bolus, followed by 1mg 6-hourly until undergoing endoscopy...
June 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28681542/hospital-volume-and-mortality-after-trans-jugular-intrahepatic-portosystemic-shunt-creation-in-the-united-states
#10
Ammar Sarwar, Lujia Zhou, Victor Novack, Elliot B Tapper, Michael Curry, Raza Malik, Muneeb Ahmed
The link between higher procedure volume and better outcomes for surgical procedures is well established. We aimed to determine if procedure volume affected inpatient mortality in patients undergoing transjugular intra-hepatic portosystemic shunt (TIPS). An epidemiological analysis of an all-payer database recording hospitalizations during 2013 in the United States (Nationwide Readmissions Database) was performed. All patients' ≥18 years old undergoing TIPS during a hospital admission (n=5529) without concurrent or prior liver transplantation were selected...
July 6, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28681347/new-concepts-on-the-clinical-course-and-stratification-of-compensated-and-decompensated-cirrhosis
#11
REVIEW
Gennaro D'Amico, Alberto Morabito, Mario D'Amico, Linda Pasta, Giuseppe Malizia, Paola Rebora, Maria Grazia Valsecchi
The clinical course of cirrhosis has been typically described by a compensated and a decompensated state based on the absence or, respectively, the presence of any of bleeding, ascites, encephalopathy or jaundice. More recently, it has been recognized that increasing portal hypertension and several major clinical events are followed by a marked worsening in prognosis, and disease states have been proposed accordingly in a multistate model. The development of multistate models implies the assessment of the probabilities of more than one possible outcome from each disease state...
July 5, 2017: Hepatology International
https://www.readbyqxmd.com/read/28680603/isolated-congenital-hepatic-fibrosis-associated-with-tmem67-mutations-report-of-a-new-genotype-phenotype-relationship
#12
Ida Vogel, Peter Ott, Dorte Lildballe, Stephen Hamilton-Dutoit, Hendrik Vilstrup, Henning Grønbæk
We report an otherwise healthy 32-year-old man with portal hypertension, variceal bleeding, and congenital hepatic fibrosis with ductal plate malformation. Genetic screening identified two TMEM67 mutations. Biallelic TMEM67 mutations are known to cause Joubert/Meckel syndrome or nephronopthisis with hepatic fibrosis, but have never been found in isolated hepatic fibrosis.
July 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28670593/laparotomy-assisted-endoscopic-injection-of-jejunal-varices-for-overt-small-bowel-bleeding
#13
Divyanshoo R Kohli, Marlon F Levy, George B Smallfield
A 54-year old male liver transplant recipient with Roux-en-Y choledochojejunostomy was admitted for symptomatic anemia. Despite endoscopies and a bleeding scan, active bleeding was not visualized. Angiography and abdominal computed tomography demonstrated possible jejunal varices at the choledochojejunal anastomosis. Double-balloon enteroscopy demonstrated varices with overlying clots in the Roux limb at the anastomosis. Due to the extensive loop formation and unstable position of the endoscope, therapeutic intervention could not be performed...
2017: ACG Case Reports Journal
https://www.readbyqxmd.com/read/28663672/gastric-varices-in-cirrhosis-vs-extrahepatic-portal-venous-obstruction-and-response-to-endoscopic-n-butyl-2-cyanoacrylate-injection
#14
Barjesh C Sharma, Shivakumar Varakanahalli, Jatinder P Singh, Siddharth Srivastava
BACKGROUND: Gastric varices (GV) are found in patients with portal hypertension. Incidence of bleeding from GV is relatively low, but is severe, and associated with higher mortality. AIMS AND OBJECTIVES: To compare the types of GV in cirrhosis vs. extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection. METHODS: Four hundred and fifty-four patients undergone glue injection of GV for primary prophylaxis or control of bleeding for first episode of bleeding from GV between August 2010 and August 2015 were analyzed...
June 2017: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/28661458/adipokines-in-liver-cirrhosis
#15
REVIEW
Christa Buechler, Elisabeth M Haberl, Lisa Rein-Fischboeck, Charalampos Aslanidis
Liver fibrosis can progress to cirrhosis, which is considered a serious disease. The Child-Pugh score and the model of end-stage liver disease score have been established to assess residual liver function in patients with liver cirrhosis. The development of portal hypertension contributes to ascites, variceal bleeding and further complications in these patients. A transjugular intrahepatic portosystemic shunt (TIPS) is used to lower portal pressure, which represents a major improvement in the treatment of patients...
June 29, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28658682/variceal-bleeds-in-patients-with-biliary-atresia
#16
Daan B van Wessel, Mauri Witt, Niels Bax, Henkjan J Verkade, René Scheenstra, Ruben H de Kleine, Jan B Hulscher
No abstract text is available yet for this article.
June 28, 2017: European Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28656336/multicenter-evaluation-of-first-line-endoscopic%C3%A2-treatment%C3%A2-with-the%C3%A2-otsc-in-acute-non-variceal-upper-gastrointestinal%C3%A2-bleeding-and-comparison-with-the-rockall-cohort-the-fletrock-study
#17
E Wedi, A Fischer, J Hochberger, C Jung, S Orkut, H J Richter-Schrag
INTRODUCTION: The over-the-scope clip (OTSC) overcomes limitations of standard clips and achieves a more efficient and reliable hemostasis in non-variceal upper gastrointestinal bleeding (NVUGIB). The study aims to evaluate mortality, rebleeding, and mortality after rebleeding of patients in whom the OTSC was used as the first-line endoscopic treatment (FLET) of NVUGIB. PATIENTS AND METHODS: In total, 118 patients (FLET cohort) with a median age of 73.5 years (range 29-93 years; mean (±SD) 71...
June 27, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28651302/useful-endoscopic-ultrasonography-parameters-and-a-predictive-model-for-the-recurrence-of-esophageal-varices-and-bleeding-after-variceal-ligation
#18
Soung Won Jeong, Hye Soo Kim, Sang Gyune Kim, Jeong-Ju Yoo, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Ji Sung Lee, Young Seok Kim, Boo Sung Kim
Background/Aims: To identify the usefulness of endoscopic ultrasonography with a mini-probe (EUM) and to create a predictive model for esophageal variceal (EV) recurrence and bleeding following esophageal variceal ligation (EVL). Methods: A total of 144 patients who received EUM prior to prophylactic EVL and met the inclusion criteria were enrolled. EUM findings, EV diameter, paraesophageal vein diameter, and the number of perforating veins were assessed. Results: EV recurrence was observed in 42 patients (29...
June 27, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28639036/customization-of-laparoscopic-gastric-devascularization-and-splenectomy-for-gastric-varices-based-on-ct-vascular-anatomy
#19
Hirofumi Kawanaka, Tomohiko Akahoshi, Yoshihiro Nagao, Nao Kinjo, Daisuke Yoshida, Yoshihiro Matsumoto, Norifumi Harimoto, Shinji Itoh, Tomoharu Yoshizumi, Yoshihiko Maehara
BACKGROUND: Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy. METHODS: We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging...
June 21, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28634688/acute-variceal-bleeding-risk-stratification-and-management-including-tips
#20
REVIEW
Virginia Hernández-Gea, Claudia Berbel, Anna Baiges, Juan C García-Pagán
Acute variceal bleeding should be suspected in all patients with cirrhosis presenting with upper gastrointestinal bleeding. Vasoactive drugs and prophylactic antibiotics must be started as soon as possible, even before performing the diagnostic endoscopy. Once the patient is hemodynamically stable, upper gastrointestinal endoscopy should be performed in order to confirm the diagnosis and provide endoscopic therapy (preferably banding ligation). After this initial approach, the most appropriate therapy to prevent both early and late rebleeding must be instituted following a risk stratification strategy...
June 20, 2017: Hepatology International
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