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Esophageal varices

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https://www.readbyqxmd.com/read/29453471/significance-of-non-invasive-markers-as-predictor-of-esophageal-varices-in-liver-cirrhosis
#1
Dipendra Khadka, Sushil Prajapati, Sudhamshu Kc, Jeetendra Kaji Shrestha, Niyanta Karki, Bikash Jaishi, Kiran Regmi, Sandip Khadka
INTRODUCTION: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis. METHODS: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017...
October 2017: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/29451184/the-long-term-outcomes-of-cirrhotic-patients-with-pleural-effusion
#2
Tsung-Hsing Hung, Chih-Wei Tseng, Chih-Chun Tsai, Chen-Chi Tsai, Kuo-Chih Tseng, Yu-Hsi Hsieh
Background/Aim: A pleural effusion is an abnormal collection of fluid in the pleural space and may cause related morbidity or mortality in cirrhotic patients. Currently, there are insufficient data to support the long-term prognosis for cirrhotic patients with pleural effusion. In this study, we investigated the short- and long-term effects of pleural effusion on mortality in cirrhotic patients and evaluated the benefit of liver transplantation in these patients. Patients and Methods: The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to identify 3,487 cirrhotic patients with pleural effusion requiring drainage between January 1, 2007 and December 31, 2010...
January 2018: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
https://www.readbyqxmd.com/read/29451181/the-use-of-nonselective-beta-blockers-is-a-risk-factor-for-portal-vein-thrombosis-in-cirrhotic-patients
#3
Rosa Zampino, Rita Lebano, Nicola Coppola, Margherita Macera, Anna Grandone, Luca Rinaldi, Ilario De Sio, Antonella Tufano, Gianfranca Stornaiuolo, Luigi E Adinolfi, Emanuele Durante-Mangoni, Gaeta G Battista, Alferio Niglio
Background/Aim: A reduction in portal vein inflow velocity seems to predispose to the emergence of portal vein thrombosis (PVT). Nonselective β-blockers (NSBBs), used to prevent variceal bleeding, may increase the development of PVT by reducing portal vein inflow velocity. In this retrospective case-control study, we evaluated the risk factors and clinical features of a first event of PVT in 130 cirrhotics, 19 (15%) with (PVT group) and 111 (85%) without PVT (non-PVT group). Patients and Methods: Patient evaluation and NNBB treatment were carried out according to the AASLD guidelines...
January 2018: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
https://www.readbyqxmd.com/read/29438423/immature-platelet-fraction-and-thrombopoietin-in-patients-with-liver-cirrhosis-a-cohort-study
#4
Philip Rauber, Frank Lammert, Katharina Grotemeyer, Beate Appenrodt
BACKGROUND AND AIMS: Thrombocytopenia occurs frequently in patients with cirrhosis. The immature platelet fraction (IPF%) is measured to differentiate the causes of thrombocytopenia. To date the relevance of thrombopoietin (TPO) in the context of cirrhosis is unknown. The aim of our study was to investigate the cause of thrombocytopenia in patients with liver cirrhosis by measuring IPF%, TPO and spleen size. In addition we examined the use of IPF% to evaluate the severity of cirrhosis and its complications...
2018: PloS One
https://www.readbyqxmd.com/read/29417267/modified-balloon-occluded-retrograde-transvenous-obliteration-brto-techniques-for-the-treatment-of-gastric-varices-vascular-plug-assisted-retrograde-transvenous-obliteration-parto-coil-assisted-retrograde-transvenous-obliteration-carto-balloon-occluded-antegrade
#5
David J Kim, Michael D Darcy, Naganathan B Mani, Auh Whan Park, Olaguoke Akinwande, Raja S Ramaswamy, Seung Kwon Kim
Gastric varices in the setting of portal hypertension occur less frequently than esophageal varices but occur at lower portal pressures and are associated with more massive bleeding events and higher mortality rate. Balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices has been well documented as an effective therapy for portal hypertensive gastric varices. However, BRTO requires lengthy, higher-level post-procedural monitoring and can have complications related to balloon rupture and adverse effects of sclerosing agents...
February 7, 2018: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/29391766/beneficial-long-term-effect-of-a-phosphodiesterase-5-inhibitor-in-cirrhotic-portal-hypertension-a-case-report-with-8-years-follow-up
#6
Peter Deibert, Adhara Lazaro, Zoran Stankovic, Denise Schaffner, Martin Rössle, Wolfgang Kreisel
Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5 (PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored...
January 21, 2018: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/29390375/hepatic-artery-embolization-cures-the-acute-pancreatitis-associated-with-a-tiny-arteriobiliary-fistula-after-tips-a-case-report
#7
Xiuli Yin, Xiaofei Lei, Changqing Xu, Jing Yang, Yingying Zhao, Kun Li
RATIONALE: Esophageal variceal bleeding caused by portal hypertension is massive and life-threatening to those patients with decompensated liver cirrhosis. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively stop bleeding. But the process of puncture may lead to bile duct injury and even form fistulas between the hepatic artery and bile duct. PATIENT CONCERNS: The case report illustrated a 52-year-old Chinese female patient who underwent TIPS...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29353997/left-gastric-vein-visualization-with-hepatopetal-flow-information-in-healthy-subjects-using-non-contrast-enhanced-magnetic-resonance-angiography-with-balanced-steady-state-free-precession-sequence-and-time-spatial-labeling-inversion-pulse
#8
Akihiro Furuta, Hiroyoshi Isoda, Tsuyoshi Ohno, Ayako Ono, Rikiya Yamashita, Shigeki Arizono, Aki Kido, Naotaka Sakashita, Kaori Togashi
Objective: To selectively visualize the left gastric vein (LGV) with hepatopetal flow information by non-contrast-enhanced magnetic resonance angiography under a hypothesis that change in the LGV flow direction can predict the development of esophageal varices; and to optimize the acquisition protocol in healthy subjects. Materials and Methods: Respiratory-gated three-dimensional balanced steady-state free-precession scans were conducted on 31 healthy subjects using two methods (A and B) for visualizing the LGV with hepatopetal flow...
January 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
https://www.readbyqxmd.com/read/29352698/gastric-varices-bleed-at-lower-portosystemic-pressure-gradients-than-esophageal-varices
#9
Joseph D Morrison, Nasya Mendoza-Elias, Andrew J Lipnik, R Peter Lokken, James T Bui, Charles E Ray, Ron C Gaba
PURPOSE: To quantify and compare portosystemic pressure gradients (PSGs) between bleeding esophageal varices (EV) and gastric varices (GV). MATERIALS AND METHODS: In a single-center, retrospective study, 149 patients with variceal bleeding (90 men, 59 women, mean age 52 y) with EV (n = 69; 46%) or GV (n = 80; 54%) were selected from 320 consecutive patients who underwent successful transjugular intrahepatic portosystemic shunt (TIPS) creation from 1998 to 2016...
January 15, 2018: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29342262/preliminary-study-of-1940-nm-thulium-laser-usage-in-peroral-endoscopic-myotomy-for-achalasia
#10
J Liu, Y Jiao, Y Niu, L Yu, M Ji, S Zhang
Esophageal achalasia is a type of motility disorder characterized by incomplete relaxation of lower esophageal sphincter (LES) and absence of esophageal peristalsis. Peroral endoscopic myotomy (POEM) is a new treatment option for achalasia that is less invasive, more effective, and safe as compared to surgery. High-frequency electrotome is commonly used in POEM, but takes longer time to make the tunnel in the esophagus and causes many complications. The thulium laser decreases the risk of bleeding and perforation in endoscopy but has not been reported in digestive diseases, especially in POEM...
January 9, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29323459/reliability-and-safety-of-transnasal-compared-to-conventional-endoscopy-for-detecting-esophageal-varices-in-cirrhotic-patients
#11
Elio C Castro Filho, Hugo Perazzo, Raquel Al-Cici P Guimaraes, Lilian Machado, Flavia F Fernandes, Renata M Perez
BACKGROUND & AIMS: Unsedated transnasal endoscopy may be used for detecting esophageal varices. However, few studies evaluated feasibility and accuracy of this technique. We aimed to evaluate accuracy, interobserver agreement and safety of the transnasal ultrathin compared to conventional endoscopy in patients with cirrhosis. METHODS: This cross-sectional study included consecutive patients referred for screening or surveillance of esophageal varices. Patients underwent unsedated transnasal and sedated conventional endoscopies at the same day, which were recorded in a digital video file and randomly analyzed by two double-blinded endoscopists...
January 11, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29317268/combination-of-albumin-bilrubin-grade-and-platelet-to-predict-compensated-patient-with-hepatocellular-carcinoma-who-do-not-require-endoscopic-screening-for-esophageal-varices
#12
Ping-Hsien Chen, Wei-Yao Hsieh, Chien-Wei Su, Ming-Chih Hou, Yen-Po Wang, I-Fang Hsin, Tsung-Chieh Yang, Wei-Chih Liao, Han-Chieh Lin, Fa-Yauh Lee, Jaw-Ching Wu
BACKGROUND: s & Aims: There is no consensus for screening high-risk esophageal varices (HRV) in patients with hepatocellular carcinoma (HCC). Here, we aimed to investigate the prevalence and risk factors of HRV in HCC patients and to assess the combination of albumin-bilirubin grade and platelet count (ALBI-PLT score) for predicting compensated patients who do not need unnecessary endoscopic screening for HRV. METHODS: The ALBI-PLT score was calculated by adding ALBI grade and point of platelet count (1 point if platelet count >150,000 /mm3 and 2 points if ≦150,000 /mm3)...
January 6, 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29314222/impact-of-clinically-evident-portal-hypertension-on-clinical-outcome-of-patients-with-hepatocellular-carcinoma-treated-by-transarterial-chemoembolization
#13
Nam Hee Kim, Taeheon Lee, Yong Kyun Cho, Byung Ik Kim, Hong Joo Kim
BACKGROUND AND AIM: To determine the impact of clinically evident portal hypertension (CEPH) on prognosis of hepatocellular carcinoma (HCC) patients with Child-Pugh A cirrhosis who underwent transarterial chemoembolization (TACE). METHODS: A retrospective data analysis was performed for a total of 388 treatment-naïve HCC patients with Child-Pugh A cirrhosis who underwent TACE as first-line treatment from January 2000 to June 2014. Cumulative occurrence rate of complete response (CR), progression free survival (PFS), and overall survival (OS) were compared between patients with CEPH and those without CEPH [esophageal/gastric varices or low platelet count (<100,000/mm3 ) associated with splenomegaly]...
January 3, 2018: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29284759/portomesenteric-venous-stenting-for-palliation-of-ascites-and-variceal-bleeding-caused-by-prehepatic-portal-hypertension
#14
Rahul A Sheth, Sharjeel H Sabir, Philip Parmet, Roshon Amin, Joshua D Kuban, Steven Y Huang, Armeen Mahvash, David Fogelman, Milind Javle, Michael J Wallace
BACKGROUND: The purpose of this study was to evaluate percutaneous transhepatic portal vein stenting (PVS) for palliation of refractory ascites and/or variceal bleeding caused by extrahepatic portomesenteric venous stenosis in patients with pancreaticobiliary cancer. MATERIALS AND METHODS: A single-institution, retrospective review of patients who underwent PVS between January 2007 and July 2015 was performed. A total of 38 patients were identified, of whom 28 met the inclusion criterion of PVS performed primarily for refractory ascites or variceal bleeding...
December 28, 2017: Oncologist
https://www.readbyqxmd.com/read/29283964/the-american-association-for-the-surgery-of-trauma-uniform-grading-of-hemorrhagic-emergency-general-surgery-diseases
#15
Gail T Tominaga, Carlos V R Brown, John T Schulz, Ronald R Barbosa, Suresh Agarwal, Nathaniel McQuay, Garth Utter, Marie Crandall
Consistent grading of Emergency General Surgery (EGS) diseases is important for comparison of outcomes and development of EGS registries. The American Association for the Surgery of Trauma (AAST) Patient Assessment Committee has previously determined common EGS diseases and developed a grading system for measuring anatomic severity of 16 inflammatory/infectious EGS diseases. The specific aim of this project was to develop a uniform grading template for hemorrhagic EGS diseases managed by acute care surgeons and apply the template to common hemorrhagic EGS diseases...
December 28, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29282637/changing-epidemiology-of-upper-gastrointestinal-hemorrhage-in-the-last-decade-a-nationwide-analysis
#16
Brandon A Wuerth, Don C Rockey
BACKGROUND: Upper gastrointestinal hemorrhage (UGIH) is common and carries substantial mortality requiring frequent hospitalizations. AIM: To investigate trends in etiology and outcome of UGIH in hospitalized patients in the USA. METHODS: Retrospective, observational cohort study of the Nationwide Inpatient Sample from 2002 to 2012 was carried out. UGIH was identified in hospitalizations with a principle ICD-9-CM diagnosis of UGIH or secondary diagnosis of UGIH with a principal diagnosis of hematemesis, blood in stool, or gastrointestinal bleeding...
December 27, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29245287/an-inflammatory-myofibroblastic-tumor-in-the-transplanted-liver-displaying-quick-wash-in-and-wash-out-on-contrast-enhanced-ultrasound-a-case-report
#17
Jing Shang, Yun-Yue Wang, Ying Dang, Xin-Juan Zhang, Yan Song, Li-Tao Ruan
RATIONALE: Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal neoplasm, and its presence in a grafted liver is exceedingly rare. PATIENT CONCERNS: A 54-year-old woman was admitted to our hospital with a half-month history of intermittent melena. She had undergone deceased-donor liver transplantation (LT) for hepatitis B virus related liver cirrhosis without hepatocellular carcinoma 5 months previously. DIAGNOSIS: Laboratory examination showed impaired liver and renal functions and Epstein-Barr virus (EBV) infection, but tumor markers within normal ranges...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29243516/gas6-as-a-predictor-of-esophageal-varices-in-patients-affected-by-hepatitis-c-virus-related-chronic-liver-disease
#18
Mattia Bellan, Pier Paolo Sainaghi, Margherita Tran Minh, Rosalba Minisini, Luca Molinari, Marco Baldrighi, Livia Salmi, Matteo Nazzareno Barbaglia, Luigi Mario Castello, Paolo Ravanini, Gian Carlo Avanzi, Mario Pirisi
AIM: Plasma Gas6 was tested as an alternative to Baveno VI criteria (liver stiffness <20 kPa and platelet count >150 × 109/l) in an endoscopy-sparing strategy. METHODS:  A total of 160 patients with chronic hepatitis C and advanced fibrosis/cirrhosis underwent, on the same occasion, liver elastography, upper endoscopy, a platelet count and serum Gas6 measurement. RESULTS:  A total of 74/160 (46%) patients had esophageal varices, that were small (diameter <5 mm) in 57/160 (34%) and large in 17/160 (11%) cases...
January 2018: Biomarkers in Medicine
https://www.readbyqxmd.com/read/29234193/results-of-portosystemic-shunt-embolization-in-selected-patients-with-cirrhosis-and-recurrent-hepatic-encephalopathy
#19
Narendra S Choudhary, Sanjay Saran Baijal, Sanjiv Saigal, Amit Agarwal, Neeraj Saraf, Rohit Khandelwal, Vaibhav Jain, Anubhav Harish Khandelwal, Abhay Kapoor, Deepak Jain, Smurti R Misra, Rajesh Puri, Randhir Sud, Arvinder S Soin
Background: Large portosystemic shunts (PSSs) may lead to recurrent encephalopathy in patients with cirrhosis and embolization of these shunts may improve encephalopathy. Material and methods: Five patients underwent balloon-occluded retrograde transvenous obliteration (BRTO) or plug-assisted retrograde transvenous obliteration (PARTO) of a large PSS at our center in last 2 years for recurrent hepatic encephalopathy (HE) at a tertiary care center at north India...
December 2017: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/29234190/can-non-selective-beta-blockers-nsbbs-prevent-enlargement-of-small-esophageal-varices-in-patients-with-cirrhosis-a-meta-analysis
#20
Ashish Kumar, Praveen Sharma, Shrihari A Anikhindi, Ritesh Prajapati, Rachit Agarwal, Bhupendra Sharma, Naresh Bansal, Vikas Singla, Anil Arora
Background: Non-selective beta-blockers (NSBBs) are recommended for prophylaxis of first variceal bleeding in patients of cirrhosis with large esophageal varices. However, the data is conflicting whether NSBBs can also prevent growth of small esophageal varices to large size. Aim: To perform a meta-analysis of the randomized clinical trials comparing NSBBs with placebo for prevention of development of large esophageal varices in patients of cirrhosis with small esophageal varices...
December 2017: Journal of Clinical and Experimental Hepatology
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