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factors affecting risk of recurrent variceal bleeding

S Dango, T Beißbarth, E Weiss, A Seif Amir Hosseini, D Raddatz, V Ellenrieder, J Lotz, B M Ghadimi, A Beham
INTRODUCTION: Upper GI bleeding remains one of the most common emergencies with a substantial overall mortality rate of up to 30%. In severe ill patients, death does not occur due to failure of hemostasis, either medical or surgical, but mainly from comorbidities, treatment complications, and decreased tolerated blood loss. Management strategies have changed dramatically over the last two decades and include primarily endoscopic intervention in combination with acid-suppressive therapy and decrease in surgical intervention...
May 2017: Langenbeck's Archives of Surgery
Felix Brunner, Annalisa Berzigotti, Jaime Bosch
Variceal haemorrhage is a major complication of portal hypertension that still causes high mortality in patients with cirrhosis. Improved knowledge of the pathophysiology of portal hypertension has recently led to a more comprehensive approach to prevent all the complications of this condition. Thus, optimal treatment of portal hypertension requires a strategy that takes into account the clinical stage of the disease and all the major variables that affect the risk of progression to the next stage and death...
January 2017: Liver International: Official Journal of the International Association for the Study of the Liver
Ehab F Mostafa, Asmaa N Mohammad
BACKGROUND AND STUDY AIMS: Variceal bleeding is a severe complication in patients with portal hypertension. Early rebleeding occurs frequently in the first few weeks after band ligation, and the mortality associated with each bleeding episode ranges from 30% to 50%. Our aims were to study the rate of early rebleeding oesophageal varices after band ligation in the Sohag University Hospital, Egypt, and to assess different clinical, biochemical, ultrasonographic, and endoscopic parameters that may predict the risk factors of rebleeding...
September 2014: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
Giovanni Battista Levi Sandri, Quirino Lai, Pierleone Lucatelli, Fabio Melandro, Nicola Guglielmo, Gianluca Mennini, Pasquale B Berloco, Fabrizio Fanelli, Filippo Maria Salvatori, Massimo Rossi
OBJECTIVES: A transjugular intrahepatic portosystemic shunt for treating recurrent variceal bleeding or refractory ascites can be used as bridge therapy in patients awaiting a liver transplant. However, incorrect placement of the transjugular intrahepatic portosystemic shunt may complicate surgery during a liver transplant. This study sought to analyze a cohort of transplanted recipients to underscore whether transjugular intrahepatic portosystemic shunts can negatively affect liver transplant outcomes...
October 2013: Experimental and Clinical Transplantation
Masaki Nio, Motoshi Wada, Hideyuki Sasaki, Hiromu Tanaka, Atsushi Okamura
PURPOSE: Following the Kasai operation, a number of patients have developed liver failure, even after long-term postoperative courses. We assessed the clinical parameters to clarify the early risk factors affecting late-presenting liver failure in biliary atresia. MATERIALS AND METHODS: From 1955 to 1991, 277 patients underwent a Kasai operation. Among those patients, 92 survived with their native liver for more than 20 years, and 72 continue to survive with their native liver in good condition (Group 1)...
December 2012: Journal of Pediatric Surgery
Lucio Amitrano, Maria Anna Guardascione, Francesco Manguso, Raffaele Bennato, Antonio Bove, Claudio DeNucci, Giovanni Lombardi, Rossana Martino, Antonella Menchise, Luigi Orsini, Salvatore Picascia, Elisabetta Riccio
OBJECTIVES: The mortality from esophageal variceal hemorrhage in liver cirrhosis patients remains approximately 15-20%. Predictors of short-term outcomes, such as the hepatic venous pressure gradient, are often unavailable in the acute setting. Clinical variables seem to have a similar predictive performance, but some variables including active bleeding during endoscopy have not been reevaluated after the utilization of endoscopic banding as endoscopic procedure. In addition, patients with severe liver failure are often excluded from clinical trials...
December 2012: American Journal of Gastroenterology
Mamata Ravipati, Srikanth Katragadda, Paari Dominic Swaminathan, Janos Molnar, Edwin Zarling
BACKGROUND: Previous clinical trials on the treatment of esophageal variceal bleeding yielded mixed results regarding the efficacy of endoscopic procedures compared with pharmacotherapy only. OBJECTIVE: To compare the efficacy of endoscopic procedures with that of pharmacotherapy in the prevention of mortality and rebleeding. DESIGN AND SETTING: A systematic literature review was performed to identify randomized, controlled trials of the efficacy of pharmacotherapy and endoscopic therapy...
October 2009: Gastrointestinal Endoscopy
Tanja Müller, Alan N Barkun, Myriam Martel
OBJECTIVES: To compare outpatients (OPs) presenting with non-variceal upper gastrointestinal bleeding (NVUGIB) to those who started hemorrhaging while in a hospital (inpatients, IPs) in a contemporary setting and to better identify predictors of outcome. METHODS: Retrospective data from the Canadian Registry of Patients With Upper Gastrointestinal Bleeding Undergoing Endoscopy (RUGBE). Descriptive, inferential, and multivariate logistic regression models were carried out in 469 IPs (68...
February 2009: American Journal of Gastroenterology
K Thomopoulos, G Theocharis, K Mimidis, Ch Lampropoulou-Karatza, E Alexandridis, V Nikolopoulou
BACKGROUND AND AIM: Variceal bleeding is a severe complication of portal hypertension with a mortality rate between 30% and 60% in previous studies. During the last two decades the treatment of these patients has been improved. The aim of this study was to investigate the clinical outcome of patients after an episode of acute variceal bleeding and to identify risk factors for early and late mortality in these patients. MATERIALS AND METHODS: All patients with acute variceal bleeding hospitalised at two large hospitals between January 1, 1999 and June 30, 2004, were retrospectively enrolled in this study...
December 2006: Digestive and Liver Disease
Kyung Sik Park, Young Hwan Kim, Jin Soo Choi, Jae Seok Hwang, Jung Hyeok Kwon, Byoung Kuk Jang, Woo Jin Chung, Kwang Bum Cho, Sung Min Ko
BACKGROUND/AIMS: Although balloon-occluded retrograde transvenous obliteration (BRTO) has been used as a new procedure for gastric variceal bleeding due to its feasibility and minimal invasiveness, reports regarding the results of BRTO are not well presented in Korea. Therefore, we analyzed the results of our experience in recent 39 months. METHODS: Twenty eight patients who received BRTO for primary hemostasis or secondary prevention of gastric variceal bleeding from December 2001 to March 2005 were analyzed retrospectively...
May 2006: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
T D Boyer
A rise in pressure in the portal vein is a frequent occurrence in patients with cirrhosis. One common manifestation affecting at least 50% of cirrhosis patients is the development of gastroesophageal varices and portal hypertensive gastropathy. Bleeding from gastric or esophageal varices will occur in approximately 1/4 of cirrhotic patients with an associated high mortality. Large esophageal varices that have red color signs and isolated gastric varices in the fundus of the stomach are most likely to hemorrhage...
May 1997: Clinics in Liver Disease
A Luca, G D'Amico, R La Galla, M Midiri, A Morabito, L Pagliaro
PURPOSE: To compare the effects of transjugular intrahepatic portosystemic shunt (TIPS) creation with those of endoscopic treatment with or without propranolol administration (i.e, conventional treatment) on recurrent bleeding, encephalopathy, and mortality by using meta-analysis of 11 published randomized clinical trials. MATERIALS AND METHODS: Data from 11 relevant studies were retrieved by means of computerized and manual search. The combinability of the studies was assessed in terms of clinical and statistical criteria...
August 1999: Radiology
B L Thomsen, T I Sørensen
BACKGROUND/AIMS: Multiple recurrences of bleeding with high mortality in cirrhosis with esophageal varices have been inadequately analyzed in previous trials. We propose analysis by the multistage competing-risks model, specifying the effect on overall mortality as an effect on mortality during bleeding, rate of cessation of bleeding, mortality rate without bleeding, and rate of rebleeding. METHODS: The Copenhagen Esophageal Varices Project enrolled patients after first bleeding and randomized 94 to usual treatment and 93 to sclerotherapy as supplement...
January 1998: Journal of Hepatology
U Scheurer
Hematemesis is the cardinal sign of upper gastrointestinal bleeding. It is a sign related to numerous affections, with a prognosis depending on the underlying lesion, the degree of bleeding, the accompanying disease and other risk factors. Mortality rates are generally close to 10%, although if hematemesis is secondary to variceal bleeding, as high as 30%. 65% of hemorrhages subside spontaneously, but 25% bleed recurrently (after initial cessation) and in 10% bleeding persists. Three quarters of all renewed bleeding occurs within two days after the initial hemorrhage...
April 17, 1993: Schweizerische Medizinische Wochenschrift
W K Huizinga, I B Angorn, L W Baker
In a prospective randomized trial of 76 patients at high risk with bleeding esophageal varices, transection of the esophagus with the EEA stapling apparatus was compared with injection sclerotherapy in the management of patients with Child's class B and C liver status. Thirty-nine patients underwent transection and 37 patients, sclerotherapy with a total of 92 injection procedures (2.4 per patient). The perioperative mortality (less than 30 days) was 28.9 per cent overall; 33.3 per cent for esophageal transection and 24...
June 1985: Surgery, Gynecology & Obstetrics
F T de Dombal, J R Clarke, S E Clamp, G Malizia, M R Kotwal, A G Morgan
This presentation draws upon the experience of the O.M.G.E. Multi-national Upper G.I. Bleeding Survey, using data collected during 1980-1982 by 185 clinicians from 44 centres in 21 countries to discuss two questions. First, can prognostic factors be identified in patients presenting to hospital with upper G.I. bleeding, and if so what are they? Second, is it possible - by combining the two technologies of endoscopy and computers - to provide an individual patient with a short-term prognostic prediction sufficiently accurate to affect patient management...
May 1986: Endoscopy
R S Chung, J Dearlove
The sources of recurrent hemorrhage during long-term sclerotherapy undertaken by a single surgeon were studied prospectively in a consecutive series of 53 patients for a period of 2 to 6 years. Recurrent hemorrhage, defined as upper gastrointestinal bleeding requiring transfusion or hospitalization or both, in the course of chronic sclerotherapy was investigated aggressively by means of endoscopy and the findings archived with videotape recording. In 24 patients 51 episodes of recurrent hemorrhage developed in the entire series...
October 1988: Surgery
G P Spina, J M Henderson, L F Rikkers, J Teres, A K Burroughs, H O Conn, L Pagliaro, R Santambrogio
Meta-analysis was used to evaluate 4 clinical trials comparing distal spleno-renal shunt (DSRS) with endoscopic sclerotherapy (EVS) in the prevention of variceal rebleeding: the interval between bleeding and therapy ranges from < 14 days to > 100 days. A questionnaire was sent to each author of the published trials concerning methods, definitions and results of the trials in order to obtain more detailed and up-to-date information. The selected end-points for the meta-analysis were: rebleeding, mortality and chronic encephalopathy...
November 1992: Journal of Hepatology
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