classification of oesophageal varices

OBJECTIVES: Portal hypertension has been reported as a negative prognostic factor and a relative contraindication for liver resection. This study considers a possible role of fibrosis evaluation by transient elastography (FibroScan(®)) and its correlation with portal hypertension in patients with cirrhosis, and discusses the use of this technique in planning therapeutic options in patients with hepatocellular carcinoma (HCC). METHODS: A total of 77 patients with cirrhosis, 42 (54...

The authors share their experience with transjugular intrahepatic portosystemic shunt (TIPS) procedures preformed in a total of fifty-nine patients diagnosed with and hence operated on for class B and C hepatocirrhosis (according to the Child-Turcotte-Pugh classification), portal hypertension, grade 3 varicosely dilated oesophageal veins, or ascites. Of these, there were 12 women and 47 men (average age 56.3 years). Three types of stents were used: matrix stents (PERICO), self-expanding (ZA-stents, OptiMedsinus-SuperFlex- Visualstents, Zilverstents, SMART), and coated self-expanding stents (Gore Viatorr TIPS Endoprosthesis)...

BACKGROUND: Extrahepatic metastases represent a major obstacle for further improving prognosis of hepatocellular carcinoma. AIM: To assess clinical predictors of extrahepatic metastases in a large cohort followed in a single centre. METHODS: We evaluated clinical files of 520 consecutive patients with hepatocellular carcinoma admitted from 1994 to 2002 to our Liver Unit. The following risk factors were assessed: age, gender, hepatitis viruses, alcohol, diabetes, size, number and differentiation of hepatocellular carcinoma, percutaneous biopsy, portal thrombosis, alpha-fetoprotein, Child-Pugh, Cancer Liver Italian Program and Model for End-stage Liver Disease scores, Barcelona Clinic Liver Cancer classification, varices, hepatocellular carcinoma treatment...

BACKGROUND: To date, no study has analyzed nationwide trends of in-hospital mortality related to oesophageal variceal hemorrhage in the USA. The aim of this study was to analyze trends of in-hospital mortality related to oesophageal variceal bleeding over the past two decades using a large national database. In addition, our aim was to study patient demographics and to identify risk factors for in-hospital mortality based on administrative data routinely collected in this population. METHODS: The nationwide inpatient sample database was used from 1988 to 2004...

BACKGROUND: TIPS, as non-operative treatment of portal hypertension allows for safe awaiting liver transplantation for patients otherwise at high risk of hemorrhage from oesophageal varices veins. When endoscopic treatment fails, TIPS is a plausible and less hazardous alternative for surgical porto-systemic shunts. It is of particular importance in patients with liver failure and unacceptable operative risk (group C in Child-Pugh classification). MATERIAL/METHODS: TIPS was done in 96 patients aged 16-68 years (average 52 years)...

A prospective study was conducted on liver disease patients without previous history of bleeding (haematemesis and/or melena) to identify those at highest risk of bleeding. A hundred and twenty non-alcoholic patients (96 males and 24 females), ages ranging from 30 to 60 years were studied. Patients were followed for up to two years or to time of bleeding (mean 18 +/- 7.3 months), during which 34 (28.3%) patients bled. Schistosomal patients showed less incidence of bleeding (12.1%, p < 0.05) than those with mixed aetiology (Schistosoma and cirrhosis 23...

INTRODUCTION: Acute upper gastrointestinal tract bleeding is a cause of significant morbidity and mortality and is a reason for urgent endoscopy. Besides an age and associated diseases, prognosis of patients influence also localisation and type of bleeding. The aim of our retrospective analysis was to discover causes of bleeding into upper GI tract and its characteristics over a 4 year period. METHODOLOGY: A survey of urgent upper GI tract endoscopies in the Clinic of Internal Medicine in Motol in Prague because of an acute GI tract bleeding (hematemesis or melena) was done...

Portal hypertension is a common clinical syndrome with chronic liver diseases and is characterised by a pathological increase in portal pressure. Moreover, portal hypertension is associated with increased portal blood flow. Increased vascular resistance in portal hypertension is because of an increase in both intrahepatic and portosystemic collateral resistance. Chronic elevations in systemic and splanchnic blood flow have been documented as key elements of hyperdynamic circulatory state of hypertensive animals and humans...

OBJECTIVE: To review our policy of screening patients at risk of developing hepatocellular carcinoma (HCC), and to present 10 years' experience of hepatic resection for small HCC (< 5 cm). DESIGN: Retrospective study. SETTING: Teaching hospital, Germany. SUBJECTS: 861 patients with hepatic cirrhosis and oesophageal varices of whom 151 (18%) had HCC confirmed histologically; 30 of these tumours (20%) were less than 5 cm in diameter and suitable for resection...

Thirty-seven patients aged 36-75 years with cirrhosis of the liver secondary to chronic hepatitis were included in the study. They were divided into three groups according to the modified Child's classification for cirrhotic severity, where A = good, B = fair and C = poor. In addition, the patients were divided according to the presence or absence of each of the following: ascites, splenomegaly and oesophageal varices. Radionuclide-labelled solid meals were used to evaluate gastric emptying and the 14C-urea breath test was used to detect Helicobacter pylori infection...

OBJECTIVE: To test prospectively whether serum laminin levels, which is taken to indicate portal hypertension, can predict the occurrence of severe complications in advanced cirrhosis of the liver. PATIENTS AND METHODS: In 38 patients (21 men, 17 women; mean age 55.6 +/- 13.4 years) with liver fibrosis (n = 4) or liver cirrhosis (n = 34) serum laminin was measured by a commercially available radioimmunoassay (Behring, Marburg). The severity of liver cirrhosis was graded according to the Child-Pugh-Christensen criteria...

BACKGROUND/AIMS: This comparative study was conducted on 111 patients to evaluate the long term outcome of endoscopic variceal therapy in patients with portal hypertension, and particularly with schistosomiasis. PATIENTS AND METHODS: There were 45 patients with chronic liver disease due to schistosomiasis, 31 with chronic hepatitis B and 21 with chronic NNb hepatitis. The remaining 14 had chronic liver disease of other etiologies. The mean follow up period was 40 months...

AIM OF STUDY: The haemodynamic role of the spleen in portal hypertension remains unclear. Duplex sonography was undertaken prospectively to discover the relationship of splenomegaly and splenic vein flow to type and severity of liver cirrhosis and portal vein flow, as well as to the degree of oesophageal varices. PATIENTS AND METHODS: 89 patients (54 men, 35 women; mean age 52 [26-81] years), diagnosed in the second half of 1993 as having liver cirrhosis were consecutively included in the study...

Endoscopic sclerotherapy of bleeding gastroesophageal varices was carried out in 52 patients within a sclerosis program for acute hemorrhage. According to Child's classification, 18 (34.6%) were A, 12 (23.1%) B and 22 (42.3%) C. The hemorrhagic focus was endoscopically proven in oesophageal varices in 45 (86.5%) and in 7 (13.5%) in gastric varices. The sclerotherapy was performed by both intra and extravascular injections of 3% ethanolamine according to treatment for emergency bleeding. The procedure was repeated on the 7th day or when necessary for recurrent hemorrhage...

Per-rectal portal scintigraphy with Tc-99m pertechnetate is a method to evaluate portosystemic shunting (shunt index) in inferior mesenteric vein. In this study the shunt index was estimated in patients with chronic liver disease in relation to the severity of liver injury, portal hypertension and incidence of oesophageal varices. Shunt index was elevated in patients with non-cirrhotic liver disease as compared with healthy normals (34 +/- 6% vs 8 +/- 2%; p < 0.0005). Moreover, patients with cirrhosis had the shunt index of 65 +/- 4% which was higher than in other groups...

The aim of the present study is to evaluate in both "in vitro" and clinical conditions the reliability of the method for measuring the oesophageal varices pressure by means of a sclerosing needle. The perfusion system was validated "in vitro", comparing the tracings obtained with two different perfusion apparatus, with two different perfusional agents and with the needle either completely or partially inserted in a venous catheter perfused with saline solution, either in the same direction as the flow or the opposite one...

A study was performed to evaluate radio-isotopic imaging using technetium-99m hexakis 2-methoxyisobutyl isonitrile administered per rectum to assess portal collateral circulation. The heart-liver ratios (H/L; mean +/- standard deviation) in 15 controls, 13 cases of histologically confirmed viral hepatitis and 57 cirrhosis patients were 0.27 +/- 0.11, 0.43 +/- 0.14 and 1.00 +/- 0.28, respectively (P < 0.001). Among the cirrhosis patients those with the Child-Pugh classification A, B and C had H/L of 0.56 +/- 0...

OBJECTIVES: The aim of this study was to evaluate the usefulness of whole gut irrigation with a mannitol solution in the prevention of hepatic encephalopathy in patients with cirrhosis and bleeding oesophageal or gastric varices. METHODS: The randomized prospective study included 40 patients with a mean age of 59.6 +/- 9.6 years. Bleeding was controlled by a Blakemore or Linton haemostatic tube, in all cases. The patients were divided into a "mannitol" group (n = 20) treated by whole gut irrigation with a 5 L solution containing 40 g/L of mannitol, and a "control" group (n = 20)...

HISTORY AND CLINICAL FINDINGS: A 53-year-old man had been passing tarry stools and bright red blood per rectum for 6 days. He had a history of pyloroplasty for duodenal ulcers, alcoholic liver cirrhosis, stage B in Child's classification, a Le Veen shunt for ascites, grade I oesophageal varices and several episodes of intestinal bleeding of uncertain cause on repeated endoscopies. Haemoglobin levels was now 4.4 g/dl. Neither oesophago-gastro-duodenoscopy nor colposcopy, radiological examination of the small intestine nor scintigraphy discovered the source of bleeding...

Longterm sclerotherapy by flexible endoscopy was done in 109 patients with acute bleeding from oesophageal varices in a prospective follow-up study. The severity of the liver disease was classified according to Child (Pugh's modification) at the beginning of treatment. Patients were followed-up for at least 12 months with a maximum of 44 months. The one-year survival rate for all patients was 67%. Child-A patients (100%) and child-B patients (84%) had a significantly better survival than Child-C patients (36%; P less than 0...