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Variceal bleeding

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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
#1
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
#2
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
#3
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
https://www.readbyqxmd.com/read/28632515/p4-stump-approach-for-intraoperative-portal-vein-stenting-in-pediatric-living-donor-liver-transplantation-an-innovative-technique-for-a-challenging-problem
#4
Chao-Long Chen, Yu-Fan Cheng, Viola Huang, Ting-Lung Lin, Yi-Chia Chan, Hsin-You Ou, Chee-Chien Yong, Shih-Ho Wang, Chih-Che Lin
OBJECTIVE: The aim of this study was to evaluate the utility of the P4 stump stenting approach for treating portal vein (PV) complications in pediatric living donor liver transplantation (LDLT). BACKGROUND: PV complications cause significant morbidity and mortality in pediatric LDLT. Biliary atresia in the backdrop of pathological PV hypoplasia and sclerosis heightens the complexity of PV reconstruction. The authors developed a novel approach for intraoperative PV stenting via the graft segment 4 PV stump (P4 stump) to address this challenge...
June 19, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28616396/management-for-non-variceal-upper-gastrointestinal-bleeding-in-elderly-patients-the-experience-of-a-tertiary-university-hospital
#5
Koichiro Kawaguchi, Hiroki Kurumi, Yohei Takeda, Kazuo Yashima, Hajime Isomoto
BACKGROUND: Peptic ulcer bleeding (PUB) is the main cause of non-variceal upper gastrointestinal bleeding (UGIB). Endoscopic treatment and acid suppression with proton-pump inhibitors (PPIs) are most important in the management of PUB and these treatments have reduced mortality. However, elderly patients sometimes have a poor prognostic outcome due to severe comorbidities. METHODS: A retrospective study was performed on 504 cases with acute non-variceal UGIB who were examined in our hospital, in order to reveal the risk factor of a poor outcome in elderly patients...
April 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28614248/endoscopic-variceal-ligation-induced-ulcer-bleeding-what-are-the-risk-factors-and-treatment-strategies
#6
Eunae Cho, Chung Hwan Jun, Sung Bum Cho, Chang Hwan Park, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew
This study was aimed to determine the risk factors of endoscopic variceal ligation-(EVL) induced ulcer bleeding.The prevalence of EVL-induced ulcer bleeding is reported to be 3.6%. However, there are only limited reports of this serious complication, and the risk factors and the treatment methods are not well established.A total of 430 patients who had undergone EVL in Chonnam National University Hospital from January 2014 to October 2016 were studied. EVL was performed for prophylaxis or acute hemorrhage. The patients were classified into 2 groups: a bleeding group (n = 33) and a non-bleeding group (n = 397)...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28612224/extrahepatic-portal-venous-obstruction-what-should-be-the-mainstay-of-treatment
#7
Richa Lal, Moinak Sen Sarma, Manish K Gupta
The two cornerstones of management for Extrahepatic portal vein obstruction (EHPVO) are endotherapy and surgery [Porto-systemic shunts (PSS)/Mesorex bypass (MRB)]. Endotherapy is the mainstay of treatment for acute variceal bleed control and has also been used extensively for secondary prophylaxis till variceal eradication is achieved. However, long-term follow-up beyond endoscopic eradication of esophageal varices (EEEV) indicates that there are numerous delayed bleed and non bleed sequelae of EHPVO, which merit surgery as a definitive procedure to decompress the hypertensive portal venous system...
June 14, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/28611971/diagnosis-and-management-of-hepatobiliary-complications-in-autosomal-recessive-polycystic-kidney-disease
#8
REVIEW
Andrew Wehrman, Alyssa Kriegermeier, Jessica Wen
Autosomal recessive polycystic kidney disease (ARPKD) is a congenital hepatorenal fibrocystic disease. The hepatic manifestations of ARPKD can range from asymptomatic to portal hypertension and massively dilated biliary system that results in liver transplantation. Hepatic complications of ARPKD typically present with signs of portal hypertension (splenomegaly and thrombocytopenia) or cholangitis. Liver disease in ARPKD does not always correlate with severity of renal disease. Management of ARPKD-related liver disease is largely treating specific symptoms, such as antibiotics for cholangitis or endoscopic treatment for variceal bleeding...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28599314/combination-therapy-versus-pharmacotherapy-endoscopic-variceal-ligation-or-the-transjugular-intrahepatic-portosystemic-shunt-alone-in-the-secondary-prevention-of-esophageal-variceal-bleeding-a-meta-analysis-of-randomized-controlled-trials
#9
Lu-Lu Lin, Shi-Ming Du, Yan Fu, Hui-Yun Gu, Lei Wang, Zhi-Yuan Jian, Xian-Feng Shen, Jie Luo, Chao Zhang
Patients with liver cirrhosis and variceal hemorrhage are at increased risk of rebleeding. We performed a meta-analysis toassess the clinical efficacy of combination therapy (pharmacotherapy and endoscopic variceal ligation (EVL)) compared with pharmacotherapy, EVL, or transjugular intrahepatic portosystemic shunt (TIPS) alone in the prevention of rebleeding and mortality. A literature search of MEDLINE, EMBASE, and the Cochrane Controlled Trials Register, up until November 2016, identified relevant randomized controlled trials...
May 24, 2017: Oncotarget
https://www.readbyqxmd.com/read/28594784/retrospective-study-to-compare-selective-decongestive-devascularization-and-gastrosplenic-shunt-versus-splenectomy-with-pericardial-devascularization-for-the-treatment-of-patients-with-esophagogastric-varices-due-to-cirrhotic-portal-hypertension
#10
Haili Bao, Qikuan He, Ninggao Dai, Ruifan Ye, Qiyu Zhang
BACKGROUND For patients with esophagogastric varices secondary to portal hypertension due to liver cirrhosis, portosystemic shunts and devascularization have become the most commonly used treatment methods. We have developed a novel surgical approach for the treatment of patients with cirrhotic portal hypertension, selective decongestive devascularization, and shunt of the gastrosplenic region (SDDS-GSR). This aim of this study was to compare the efficacy and safety of SDDS-GSR with splenectomy with pericardial devascularization (SPD)...
June 8, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28591243/platelet-count-squared-spleen-diameter-aspartate-aminotransferase-ratio-non-invasive-method-to-predict-esophageal-varices
#11
Ângelo Zambam de Mattos, Larissa Faraco Daros, Angelo Alves de Mattos
BACKGROUND: - Variceal bleeding has a high mortality among cirrhotics, and screening with endoscopy is indicated at the diagnosis of cirrhosis. Screening with endoscopy implies discomfort, risks and considerable costs. OBJECTIVE: - To evaluate platelet count squared/spleen diameter-aspartate aminotransferase ratio (PS/SA), as a non-invasive predictor of esophageal varices in cirrhotics. METHODS: - This cross-sectional study evaluated cirrhotics for PS/SA and presence of esophageal varices...
May 25, 2017: Arquivos de Gastroenterologia
https://www.readbyqxmd.com/read/28585310/direct-acting-antivirals-for-chronic-hepatitis-c
#12
REVIEW
Janus C Jakobsen, Emil Eik Nielsen, Joshua Feinberg, Kiran Kumar Katakam, Kristina Fobian, Goran Hauser, Goran Poropat, Snezana Djurisic, Karl Heinz Weiss, Milica Bjelakovic, Goran Bjelakovic, Sarah Louise Klingenberg, Jian Ping Liu, Dimitrinka Nikolova, Ronald L Koretz, Christian Gluud
BACKGROUND: Millions of people worldwide suffer from hepatitis C, which can lead to severe liver disease, liver cancer, and death. Direct-acting antivirals (DAAs) are relatively new and expensive interventions for chronic hepatitis C, and preliminary results suggest that DAAs may eradicate hepatitis C virus (HCV) from the blood (sustained virological response). However, it is still questionable if eradication of hepatitis C virus in the blood eliminates hepatitis C in the body, and improves survival and leads to fewer complications...
June 6, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28580075/role-of-vasopressin-in-current-anesthetic-practice
#13
REVIEW
Keun Suk Park, Kyung Yeon Yoo
Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V1 receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP ('relative vasopressin deficiency') and supersensitivity to exogenously-administered AVP...
June 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28576121/proximal-spleno-renal-shunt-with-retro-aortic-left-renal-vein-in-a-patient-with-extra-hepatic-portal-vein-obstruction-first-case-report
#14
Sundeep Jain, Mukesh Kalla, Adil Suleman, Alok Verma
BACKGROUND: Presence of retro-aortic left renal vein poses special challenge in creating spleno-renal shunt potentially increasing the chance of shunt failure. The technical feasibility and successful outcome of splenectomy with proximal spleno-renal shunt (PSRS) with retro-aortic left renal vein is presented for the first time. The patient was treated for portal hypertension and hypersplenism due to idiopathic extra-hepatic portal vein obstruction. CASE PRESENTATION: A twenty year old male suffering from idiopathic extra-hepatic portal vein obstruction presented with bleeding esophageal varices, portal hypertensive gastropathy, asymptomatic portal biliopathy and symptomatic hypersplenism...
June 2, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28567454/distal-pancreatectomy-with-splenorenal-shunt-to-preserve-spleen-in-a-cirrhotic-patient
#15
Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Marco Colasanti, Edoardo de Werra, Pasquale Lepiane
At pancreatic ductal adenocarcinoma is an aggressive malignancy with a high recurrence rate. Due to its high potentials of local invasion and distant metastasis, surgical resection is the only means for possible long-term survival. Surgical treatment comprises a distal pancreatectomy with or without splenectomy. Surgery has been conventionally contraindicated for patients with cirrhosis and portal vein hepato-biliary hypertension. Splenorenal shunt was first described by Warren and colleagues, to prevent death from bleeding esophageal varices in a patient with a patent portal vein hypertension...
May 2017: Annals of Hepato-Biliary-Pancreatic Surgery
https://www.readbyqxmd.com/read/28566595/gastroesophageal-variceal-bleeding-successfully-controlled-by-partial-splenic-embolization
#16
Takayuki Kogure, Jun Inoue, Eiji Kakazu, Masashi Ninomiya, Tooru Shimosegawa
A 53-year-old male patient with a history of hepatocellular carcinoma developed gastroesophageal varices refractory to endoscopic injection sclerotherapy (EIS). He required EIS six times in 2 years for recurring variceal bleeding. After hepatic resection, he developed massive splenomegaly. Partial splenic embolization (PSE) was performed to reduce the portal pressure. Varices and variceal bleeding were not detected during 13-year follow up, until the patient died of hepatocellular carcinoma. This is a unique case of gastroesophageal varices controlled by PSE and improved portal hypertension...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28565796/hemodynamic-effects-of-renin-angiotensin-aldosterone-inhibitor-and-%C3%AE-blocker-combination-therapy-vs-%C3%AE-blocker-monotherapy-for-portal-hypertension-in-cirrhosis-a-meta-analysis
#17
Jianrong Wang, Wenxia Lu, Jingjing Li, Rong Zhang, Yuqing Zhou, Qin Yin, Yuanyuan Zheng, Fan Wang, Yujing Xia, Kan Chen, Sainan Li, Tong Liu, Jie Lu, Yingqun Zhou, Chuan-Yong Guo
β-blockers are commonly used for the treatment of acute variceal bleeding in cirrhosis. Renin-angiotensin-aldosterone antagonists (angiotensin I-converting enzyme inhibitors, angiotensin receptor blockers and aldosterone antagonists) are potential therapies for portal hypertension. Several studies have compared the renin-angiotensin-aldosterone system (RAAS) inhibitor and β-blocker combination therapy vs. β-blocker monotherapy, with inconsistent results. The aim of the present study was to assess the efficacy of the RAAS inhibitor and β-blocker combination therapy vs...
May 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28564642/effectiveness-of-endoscopic-hemostasis-with-soft-coagulation-for-non-variceal-upper-gastrointestinal-bleeding-over-a-12-year-period
#18
Daisuke Yamaguchi, Yasuhisa Sakata, Hisako Yoshida, Naoko E Furukawa, Nanae Tsuruoka, Toru Higuchi, Akira Watanabe, Ryo Shimoda, Seiji Tsunada, Ryuichi Iwakiri, Kazuma Fujimoto
BACKGROUND/AIMS: In this study, investigations were carried out to ascertain whether soft coagulation hemostasis for non-variceal upper gastrointestinal bleeding (UGIB) has ever been performed in a time-dependent manner. METHODS: Medical records of 502 patients who had undergone emergency endoscopic hemostasis for non-variceal UGIB from 2003 to 2014 were checked and the modalities were used to achieve hemostasis compared between the first period from 2003 to 2008 (197 patients) and the second period from 2009 to 2014 (305 patients)...
June 1, 2017: Digestion
https://www.readbyqxmd.com/read/28556269/cervical-varices-an-unusual-source-of-first-trimester-hemorrhage
#19
Joseph R Wax, Angelina Cartin, Christian Litton, Kelley Conroy, Michael G Pinette
Endocervical varices are a rare cause of obstetrical hemorrhage. Usually presenting in the second and third trimesters, bleeding varices often require pregnancy termination or indicated preterm birth via cesarean delivery. Our patient experienced variceal hemorrhage at 12 weeks' gestation in a dichorionic twin pregnancy conceived through in vitro fertilization. A low-lying placenta resolved at 19 weeks followed by variceal regression at 22 weeks' gestation. Endocervical varices causing first-trimester hemorrhage may regress with resolution of a coexisting low placental implantation, permitting planned vaginal delivery, despite progressive hemodynamic changes of pregnancy...
May 29, 2017: Journal of Clinical Ultrasound: JCU
https://www.readbyqxmd.com/read/28550512/duplex-ultrasound-versus-clinical-surveillance-in-the-prediction-of-tips-malfunction-placed-for-refractory-ascites-is-ultrasound-surveillance-useful
#20
Shamar Young, Patrick Scanlon, Prashant Sherestha, Jafar Golzarian, Tina Sanghvi
PURPOSE: Since the advent of expanded polytetrafluoroethylene-covered stents and the improved patency they confer for transjugular intrahepatic portosystemic shunt (TIPS), the need to perform ultrasound surveillance has been debated. Prior reports have failed to separately evaluate patients who had TIPS placed for refractory ascites and variceal bleeding. The difference in morbidity from TIPS malfunction between these cohorts argues for distinction between the two. This retrospective review aims to determine whether Duplex ultrasound or return of symptoms more accurately predicts TIPS dysfunction...
May 26, 2017: Cardiovascular and Interventional Radiology
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