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Esophageal variceal bleeding treatment

Yung-Kuan Tsou, Chia-Yuan Liu, Kuang-I Fu, Cheng-Hui Lin, Mu-Shien Lee, Ming-Yao Su, Ken Ohata, Cheng-Tang Chiu
BACKGROUND: Esophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients. AIM: To report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients. METHODS: Forty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis...
October 21, 2016: Digestive Diseases and Sciences
Ahmed Kamel Abdel-Aal, Nabila Dawoud, Amr Soliman Moustafa, Maysoon F Hamed, Souheil Saddekni
We report a case of 59-year-old female with non-alcoholic-steato-hepatitis (NASH) induced cirrhosis, who presented with hematochezia. The patient had a history of bleeding esophageal varices treated with endoscopic variceal ligation (EVL). Colonoscopy showed large rectal varices which were the source of her lower gastrointestinal bleeding (LGIB). Since endoscopic treatment for LGIB are limited, and because the patient had portal vein thrombosis which contraindicated transjugular intrahepatic portosystemic shunt (TIPS), we performed percutaneous transhepatic embolization of her rectal varices using a new mixture of embolic and sclerotic agents, followed by Amplatzer plug 2 (AVP 2)...
September 2016: Journal of Radiology Case Reports
Takaki Emura, Kenji Hosoda, Shota Harai, Noboru Oyachi, Takeyuki Suzuki, Ken Takada, Koji Kobayashi, Hisatake Ikeda
BACKGROUND: Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION: A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis...
October 19, 2016: Journal of Medical Case Reports
Mohamed Balaha, Samah Kandeel, Waleed Barakat
Carvedilol is an anti-oxidant non-selective β-blocker used for reduction of portal blood pressure, prophylaxis of esophageal varices development and bleeding in chronic liver diseases. Recently, it exhibited potent anti-inflammatory, anti-fibrotic, anti-proliferative and anti-carcinogenic effects. In the present study, we evaluated the possible suppressive effect of carvedilol on circulating and hepatic IL-6 levels responsible for hepatocarcinogenesis in a rat model of hepatic cirrhosis. Besides, its effect on hepatic STAT-3 levels, function tests, oxidative stress markers, and hydroxyproline content, hepatic tissue histopathological changes and immunohistochemical expression of E & N-cadherin...
October 13, 2016: Toxicology and Applied Pharmacology
Yi-Chao Shi, Xin Ma, Zhi-Yuan Guo, Xi Luo, Guo-Hui Sun, Hua Jiang, Wei-Feng Wang, Gang Sun, Yun-Sheng Yang
AIM: Endoscopic variceal sclerotherapy (EVS) is usually performed at weekly intervals in patients with esophageal variceal bleeding (EVB). However, some patients receive sclerotherapy at irregular intervals. The reasons and risk factors for irregular-interval treatment need to be clarified. METHODS: We retrospectively analyzed of hospital records from the Chinese PLA General Hospital, from December 2013 to June 2015. A total of 244 patients were admitted for EVS, which was scheduled to be repeated at regular weekly intervals...
October 11, 2016: Journal of Digestive Diseases
Václav Hejda
Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality...
2016: Vnitr̆ní Lékar̆ství
T Stuber, B Schmitz, H J Brambs
Introduction: Portal hypertension may lead to severe esophageal or rectal variceal bleeding. Case report: We present a case of a 67-year-old patient presenting with recurrent rectal variceal bleeding who was non-responsive to endoscopic treatment. We are reporting on an interventional therapeutic approach found in interdisciplinary consensus. Discussion: Endoscopy, surgery or TIPS (transjugular intrahepatic portosystemic shunt) can be performed in patients with gastrointestinal bleeding due to portal hypertension in liver cirrhosis...
October 5, 2016: Zeitschrift Für Gastroenterologie
Adriana Cavași, Voicu Mercea, Ofelia Anton, Ion Cosmin Puia
Although transjugular intrahepatic portosystemic shunts are most frequently used for the management of portal hypertension, the surgical approach is preferred for symptomatic portal cavernoma cholangiopathy. We present the case of a 25-year old female patient with a portal cavernoma secondary to catheterization of the umbilical vein at birth. She had had two episodes of esophageal variceal bleeding, successfully treated by endoscopic banding. and an episode of acute cholangitis secondary to portal cavernoma cholangiopathy...
September 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
Mathieu Duché, Béatrice Ducot, Oanez Ackermann, Florent Guérin, Emmanuel Jacquemin, Olivier Bernard
BACKGROUND AND AIMS: Primary prophylaxis of bleeding is debated for children with portal hypertension because of the limited number of studies on its safety and efficacy, the lack of a known endoscopic pattern carrying a high risk of bleeding for all causes, and the assumption that the mortality of a first bleed is low. We report our experience with these issues. METHODS: From 1989 to 2014, we managed 1300 children with portal hypertension. Endoscopic features were recorded; high-risk varices were defined as: grade 3 esophageal varices, grade 2 varices with red wale markings, or gastric varices...
September 20, 2016: Journal of Hepatology
Sofía Verdaguer D, Juan Cristóbal Gana A
BACKGROUND: There is a paucity of good quality research about the diagnosis of esophageal varices and the prophylaxis and treatment of variceal bleeding in pediatric patients with portal hypertension There is little consensus and practically no evidence-based approach about the management of these patients. AIM: To describe the behavior and preferences of pediatric gastroenterologists in Chile in the management of portal hypertension in children. MATERIAL AND METHODS: An online survey was sent to Chilean pediatric gastroenterologists, with questions evaluating the physicians’ approaches to screening of esophageal varices in children with portal hypertension, and their preferred methods of prophylaxis and initial management of variceal bleeding...
July 2016: Revista Médica de Chile
Renata P Colaneri, Fabrício F Coelho, Roberto de Cleva, Paulo Herman
AIM: To propose a laparoscopic treatment for schistosomal portal hypertension. METHODS: Ten patients with schistosomiasis and portal hypertension, with previous gastrointestinal hemorrhage from esophageal varices rupture, were evaluated. Patients were subjected to a laparoscopic procedure, with ligature of splenic artery and left gastric vein. Upper gastrointestinal endoscopy was performed on the 30th postoperative day, when esophageal varices diameter was measured and band ligature performed...
September 22, 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Thomas S Maldonado, Sheila N Blumberg, Sharvil U Sheth, Gabriel Perreault, Mikel Sadek, Todd Berland, Mark A Adelman, Caron B Rockman
BACKGROUND: Mesenteric venous thrombosis (MVT) is a relatively uncommon but potentially lethal condition associated with bowel ischemia and infarction. The natural history and long-term outcomes are poorly understood and under-reported. METHODS: A single-institution retrospective review of noncirrhotic patients diagnosed with MVT from 1999 to 2015 was performed using International Classification of Diseases, Ninth Revision and radiology codes. Patients were excluded if no radiographic imaging was available for review...
October 2016: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Manon C W Spaander, Todd H Baron, Peter D Siersema, Lorenzo Fuccio, Brigitte Schumacher, Àngels Escorsell, Juan-Carlos Garcia-Pagán, Jean-Marc Dumonceau, Massimo Conio, Antonella de Ceglie, Janusz Skowronek, Marianne Nordsmark, Thomas Seufferlein, André Van Gossum, Cesare Hassan, Alessandro Repici, Marco J Bruno
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations for malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence)...
October 2016: Endoscopy
Vipin Gupta, Ramakant Rawat, Shalimar, Anoop Saraya
BACKGROUND AND AIMS: Endoscopic variceal ligation (EVL) plus beta blocker is the mainstay treatment after index bleed to prevent rebleed. Primary objective of this study was to compare EVL plus propranolol versus EVL plus carvedilol on reduction of HVPG after 1 month of therapy. METHODS: Patients of cirrhosis presenting with index esophageal variceal bleed received standard treatment (Somatostatin therapy f/b EVL) following which HVPG was measured and patients were randomized to propranolol or carvedilol group if HVPG was >12 mmHg...
September 13, 2016: Hepatology International
Andrea Iannone, Mariabeatrice Principi, Michele Barone, Giuseppe Losurdo, Enzo Ierardi, Alfredo Di Leo
Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations"...
September 2016: Clinics and Research in Hepatology and Gastroenterology
Celina Maria Costa Lacet, João Batista Neto, Laercio Tenório Ribeiro, Francisco Silva Oliveira, Rozangela Fernandes Wyszomirska, Edna Strauss
UNLABELLED:  Background. Upper gastrointestinal bleeding is a major cause of morbidity and mortality in patients with portal hypertension secondary to schistosomiasis mansoni. AIM: To evaluate the efficacy of combined surgery and sclerotherapy versus endoscopic treatment alone in the prophylaxis of esophageal variceal rebleeding due to portal hypertension in schistosomiasis. MATERIAL AND METHODS: During a two-years period consecutive patients with schistosomiasis and a recent bleeding history were evaluated for prospective randomization...
September 2016: Annals of Hepatology
Jason Shayne Dazley, Lakshmi Durga Sriramulu, Jihad Slim
Hepatitis C virus infection is a hot topic for both effective treatment and elevated cost. This case series describes the cost saving for the healthcare system of any nation of treating HCV in many situations, including that of overt cirrhosis. Case#1 is of a HCV/HIV infected cirrhotic patient with MELD score of 17, Child Pugh score B, recurrent esophageal bleeds ceased after successful treatment with sofosbuvir and simepravir. Case#2 is a patient also co-infected with HCV/HIV MELD score of 18, Child Pugh score B, with grade 3 esophageal varices and frequent bleed with significant anemia...
July 30, 2016: Journal of Infection and Public Health
Martin Janicko, Sylvia Drazilova, Daniel Pella, Jan Fedacko, Peter Jarcuska
Statins are a class of molecules that inhibit HMG CoA reductase. They are usually prescribed as a lipid lowering medication. However, there is accumulating evidence that statins have multiple secondary effects both related and unrelated to their lipid-lowering effect. This narrative review of the literature aims to provide the reader with information from clinical studies related to the effect of statin and statins' potential use in patients with liver diseases. In patients with advanced liver disease due to any etiology, statins exhibit an antifibrotic effect possibly through the prevention of hepatic sinusoidal microthrombosis...
July 21, 2016: World Journal of Gastroenterology: WJG
Qin Jiang, Ming-Quan Wang, Guo-Bing Zhang, Qiong Wu, Jian-Ming Xu, De-Run Kong
AIM: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with stomach and esophageal variceal embolization (SEVE) in cirrhotic patients with a large gastrorenal vessel shunt (GRVS). METHODS: Eighty-one cirrhotic patients with gastric variceal bleeding (GVB) associated with a GRVS were enrolled in the study and accepted TIPS combined with SEVE (TIPS + SEVE), by which portosystemic pressure gradient (PPG), biochemical, TIPS-related complications, shunt dysfunction, rebleeding, and death were evaluated...
July 18, 2016: World Journal of Hepatology
Tsung-Hsing Hung, Chen-Chi Tsai, Chih-Wei Tseng, Kuo-Chih Tseng, Yu-Hsi Hsieh, Chih-Chun Tsai
OBJECTIVE: To study the differences in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding (EVB) and renal functional impairment (RFI). METHODS: The National Health Insurance Database, part of the Taiwan National Health Insurance Program, was used to enroll cirrhotic patients who had received endoscopic variceal ligation plus somatostatin or terlipressin for EVB and who were hospitalized between 1 January 2007 and 31 December 2010...
November 2016: European Journal of Gastroenterology & Hepatology
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