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https://www.readbyqxmd.com/read/29214053/severe-carvedilol-toxicity-without-overdose-caution-in-cirrhosis
#1
Satish Maharaj, Karan Seegobin, Julio Perez-Downes, Belinda Bajric, Simone Chang, Pramod Reddy
Background: Carvedilol is used in the management of hypertension, ischemic heart disease, heart failure and most recently, portal hypertension. It has been associated with improved outcomes regarding variceal bleeding, hepatic decompensation and death when compared to propranolol and endoscopic band ligation. The main cause of portal hypertension is cirrhosis and therefore carvedilol is increasingly used in these patients. Due to its extensive hepatic metabolism, carvedilol is contraindicated in severe hepatic impairment...
2017: Clinical Hypertension
https://www.readbyqxmd.com/read/29209115/procedure-related-complications-in-gastric-variceal-obturation-with-tissue-glue
#2
Yun-Wei Guo, Hui-Biao Miao, Zhuo-Fu Wen, Jie-Ying Xuan, Hao-Xiong Zhou
AIM: To focus on procedure-related complications, evaluate their incidence, analyze the reasons and discuss the solutions. METHODS: Overall, 628 endoscopic gastric variceal obturation (EGVO) procedures (case-times) with NBC were performed in 519 patients in the Department of Endoscopy of the Third Affiliated Hospital of Sun Yat-Sen University from January 2011 to December 2016. The clinical data of patients and procedure-related complications of EGVO were retrospectively analyzed...
November 21, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/29186739/-french-comment-on-article-reprocessing-of-single-use-endoscopic-variceal-band-ligation-devices-a-pilot-study
#3
(no author information available yet)
No abstract text is available yet for this article.
December 2017: Endoscopy
https://www.readbyqxmd.com/read/29161702/favorable-effects-of-endoscopic-ligation-combined-with-drugs-on-rebleeding-and-mortality-in-cirrhotic-patients-a-network-meta-analysis
#4
Liang Shi, Xueping Zhang, Jianye Li, Xibo Bai
BACKGROUND: To assess the effects of combination therapies (endoscopic plus drug[s], drug combinations) on variceal/any-cause rebleeding and mortality among cirrhotic patients with one previous episode of variceal hemorrhage. SUMMARY: We searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies. We included 26 randomized controlled trials involving 2,536 adults using OR to measure the effects. Endoscopic variceal ligation (EVL) plus nadolol ranked first for reducing recurrent bleeds...
November 21, 2017: Digestive Diseases
https://www.readbyqxmd.com/read/29117668/outcomes-of-patients-treated-with-sengstaken-blakemore-tube-for-uncontrolled-variceal-hemorrhage
#5
Ja Yun Choi, Yun Won Jo, Sang Soo Lee, Wan Soo Kim, Hye Won Oh, Cha Young Kim, Eun Young Yun, Jin Joo Kim, Jae Min Lee, Hong Jun Kim, Hyun Jin Kim, Tae Hyo Kim, Woon Tae Jung, Ok Jae Lee, Rock Bum Kim
Background/Aims: The aim of this study was to investigate the mortality, bleeding control rate, and their associated predictors in patients treated with Sengstaken-Blakemore (SB) tube for uncontrolled variceal hemorrhage associated with hemodynamic instability or failure of endoscopic treatment. Methods: The clinical data of 66 consecutive patients with uncontrolled variceal hemorrhage treated with SB tube at Gyeongsang National University Hospital from October 2010 to October 2015 were retrospectively analyzed...
November 10, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29110128/endoscopic-treatments-for-portal-hypertension
#6
REVIEW
Gin-Ho Lo
Acute esophageal variceal hemorrhage is a dreaded complication of portal hypertension. Its management has evolved rapidly in recent years. Endoscopic therapy is often employed to arrest bleeding varices as well as to prevent early rebleeding. The combination of vasoconstrictor and endoscopic therapy is superior to vasoconstrictor or endoscopic therapy alone for control of acute esophageal variceal hemorrhage. After control of acute variceal bleeding, combination of banding ligation and beta-blockers is generally recommended to prevent variceal rebleeding...
November 7, 2017: Hepatology International
https://www.readbyqxmd.com/read/29099421/effects-of-atorvastatin-on-portal-hemodynamics-and-clinical-outcomes-in-patients-with-cirrhosis-with-portal-hypertension-a-proof-of-concept-study
#7
Saptarshi Bishnu, Sk M Ahammed, Avik Sarkar, Jabaranjan Hembram, Saswata Chatterjee, Kshaunish Das, Gopal K Dhali, Abhijit Chowdhury, Kausik Das
BACKGROUND AND AIM: Statins can modulate portal microvascular dynamics in patients with cirrhosis. We present data from a proof-of-concept study aimed at comparing combination of propranolol and atorvastatin versus propranolol alone in reducing portal pressure in patients with cirrhosis. PATIENTS AND METHODS: In this open-label proof-of-concept study, 23 consecutive patients with cirrhosis were randomized into group A (incremental dose propranolol, n=12) or group B (atorvastatin 20 mg daily with propranolol in incremental dose, n=11)...
November 2, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29064029/the-portal-hypertension-syndrome-etiology-classification-relevance-and-animal-models
#8
REVIEW
Jaime Bosch, Yasuko Iwakiri
BACKGROUND: Portal hypertension is a key complication of portal hypertension, which is responsible for the development of varices, ascites, bleeding, and hepatic encephalopathy, which, in turn, cause a high mortality and requirement for liver transplantation. AIM: This review deals with the present day state-of-the-art preventative treatments of portal hypertension in cirrhosis according to disease stage. Two main disease stages are considered, compensated and decompensated cirrhosis, the first having good prognosis and being mostly asymptomatic, and the second being heralded by the appearance of bleeding or non-bleeding complications of portal hypertension...
October 24, 2017: Hepatology International
https://www.readbyqxmd.com/read/29033774/hemothorax-following-uncomplicated-endoscopic-variceal-sclerotherapy-and-ligation-for-esophageal-varices
#9
Tomoko Ochiai, Yukiomi Nakade, Rena Kitano, Shunsuke Kato, Kazumasa Sakamoto, Tadahisa Inoue, Yuji Kobayashi, Norimitsu Ishii, Tomohiko Ohashi, Yoshio Sumida, Kiyoaki Ito, Haruhisa Nakao, Chihiro Furuta, Motoki Yano, Masashi Yoneda
Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures...
September 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28970710/transient-elastography-fibroscan-in-patients-with-non-cirrhotic-portal-fibrosis
#10
Praveen Sharma, Rachit Agarwal, Shashi Dhawan, Naresh Bansal, Vikas Singla, Ashish Kumar, Anil Arora
BACKGROUND: Non-cirrhotic portal hypertension (NCPH) is a common cause of variceal bleed in developing countries. Transient elastography (TE) using Fibroscan is a useful technique for evaluation of fibrosis in patients with liver disease. There is a paucity of studies evaluating TE in patients with Non-cirrhotic portal fibrosis (NCPF) and none in Asian population. Aim of this study was to evaluate role of TE in NCPF. METHODS: Retrospective data of consecutive patients of NCPF as per Asian pacific association for the study of liver (APASL) guidelines were noted...
September 2017: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/28970291/covered-tips-versus-endoscopic-band-ligation-plus-propranolol-for-the-prevention-of-variceal-rebleeding-in-cirrhotic-patients-with-portal-vein-thrombosis-a-randomised-controlled-trial
#11
Yong Lv, Xingshun Qi, Chuangye He, Zhengyu Wang, Zhanxin Yin, Jing Niu, Wengang Guo, Wei Bai, Hongbo Zhang, Huahong Xie, Liping Yao, Jianhong Wang, Tao Li, Qiuhe Wang, Hui Chen, Haibo Liu, Enxing Wang, Dongdong Xia, Bohan Luo, Xiaomei Li, Jie Yuan, Na Han, Ying Zhu, Jielai Xia, Hongwei Cai, Zhiping Yang, Kaichun Wu, Daiming Fan, Guohong Han
OBJECTIVE: Limited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol for the prevention of variceal rebleeding among patients with cirrhosis and PVT. DESIGN: Consecutive cirrhotic patients (94% Child-Pugh class A or B) with PVT who had variceal bleeding in the past 6 weeks were randomly assigned to TIPS group (n=24) or EBL plus propranolol group (EBL+drug, n=25), respectively...
September 28, 2017: Gut
https://www.readbyqxmd.com/read/28966686/sevoflurane-may-be-more-beneficial-than-propofol-in-patients-receiving-endoscopic-variceal-ligation-and-endoscopic-variceal-sclerotherapy-a-randomized-double-blind-study
#12
Linghua Tang, Huimin Liu, Yang Wu, Mei Li, Wei Li, Meng Jiang, Jiabao Hou, Ying Jiang, Zhongyuan Xia, Qingtao Meng
The aim of the present study was to evaluate the safety and efficacy of various general anesthesia regimens during endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS). A total of 123 patients with American Society of Anesthesiologists physical status III and IV, aged 40-70 years, undergoing general anesthesia for EVL and EVS were randomly divided into two groups: Sevoflurane anesthesia (group S; n=60) and propofol anesthesia (group P; n=60). Vital signs, particularly heart rate (HR) and mean arterial pressure (MAP), were monitored...
October 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28915680/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
#13
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...
August 22, 2017: Oncotarget
https://www.readbyqxmd.com/read/28874418/therapeutic-endoscopy-related-gi-bleeding-and-thromboembolic-events-in-patients-using-warfarin-or-direct-oral-anticoagulants-results-from-a-large-nationwide-database-analysis
#14
Naoyoshi Nagata, Hideo Yasunaga, Hiroki Matsui, Kiyohide Fushimi, Kazuhiro Watanabe, Junichi Akiyama, Naomi Uemura, Ryota Niikura
OBJECTIVE: To compare the risks of postendoscopy outcomes associated with warfarin with direct oral anticoagulants (DOACs), taking into account heparin bridging and various types of endoscopic procedures. DESIGN: Using the Japanese Diagnosis Procedure Combination database, we identified 16 977 patients who underwent 13 types of high-risk endoscopic procedures and took preoperative warfarin or DOACs from 2014 to 2015. One-to-one propensity score matching was performed to compare postendoscopy GI bleeding and thromboembolism between the warfarin and DOAC groups...
September 5, 2017: Gut
https://www.readbyqxmd.com/read/28869158/re-bleeding-rates-and-survival-after-early-transjugular-intrahepatic-portosystemic-shunt-tips-in-clinical-practice
#15
Theresa Bucsics, Maria Schoder, Nicolas Goeschl, Philipp Schwabl, Mattias Mandorfer, Magdalena Diermayr, Maria Feldner, Florian Riedl, David Bauer, Bernhard Angermayr, Manfred Cejna, Arnulf Ferlitsch, Wolfgang Sieghart, Michael Trauner, Markus Peck-Radosavljevic, Josef Karner, Franz Karnel, Thomas Reiberger
BACKGROUND: Early implantation (<72h) of a transjugular intrahepatic portosystemic shunt (TIPS) after acute variceal bleeding (AVB) improves survival in highly selected patients. METHODS: We retrospectively assessed bleeding control and survival of unselected cirrhotic patients undergoing early TIPS implantation within 72h. We compared the outcomes to patients meeting early TIPS criteria but receiving late TIPS within 3-28days after AVB and endoscopic/medical treatment...
August 8, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28852523/variceal-bleeding-in-cirrhotic-patients
#16
REVIEW
Maxime Mallet, Marika Rudler, Dominique Thabut
Variceal bleeding is one of the major causes of death in cirrhotic patients. The management during the acute phase and the secondary prophylaxis is well defined. Recent recommendations (2015 Baveno VI expert consensus) are available and should be followed for an optimal management, which must be performed as an emergency in a liver or general intensive-care unit. It is based on the early administration of a vasoactive drug (before endoscopy), an antibiotic prophylaxis and a restrictive transfusion strategy (hemoglobin target of 7 g/dL)...
August 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28801510/therapeutic-options-for-bleeding-oesophageal-varices-cyanoacrylate-and-balloon-occluded-retrograde-obliteration-brto
#17
Helena L Frischtak, Jessica P Davis, Neeral L Shah
A 56-year-old male with cirrhosis presented with acute bleeding from cardiofundal gastroesophageal varices (GOV) and was treated with endoscopic cyanoacrylate glue. Glue therapy achieved stabilisation of the patient in the emergent setting. Three months later, the patient suffered rebleeding. At that time, he underwent retreatment with balloon-occluded retrograde obliteration (BRTO), with no recurrence at a follow-up of 14 months.Available treatments for bleeding GOV include methods to (a) directly obstruct the varices (endoscopic variceal ligation , sclerotherapy and cyanoacrylate glue, BRTO) or to (b) decrease portal pressure (surgical portacaval shunts; transportal intrahepatic portosystemic shunt)...
August 11, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28767684/application-of-chronic-liver-failure-sequential-organ-failure-assessment-score-for-the-predication-of-mortality-after-esophageal-variceal-hemorrhage-post-endoscopic-ligation
#18
Ming-Wun Wong, Ming-Jen Chen, Huan-Lin Chen, Yu-Chi Kuo, I-Tsung Lin, Chia-Hsien Wu, Yuan-Kai Lee, Chun-Han Cheng, Ming-Jong Bair
BACKGROUND: Esophageal variceal hemorrhage (EVH) is one of the high mortality complications in cirrhotic patients. Endoscopic variceal ligation (EVL) is currently the standard therapy for EVH. However, some patients have expired during hospitalization or survived shortly after management. AIM: To evaluate hospital and 6-week mortality by receiver operating characteristic (ROC) curve of chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score compared to a model for end-stage liver disease (MELD) score and Child-Turcotte-Pugh (CTP) class...
2017: PloS One
https://www.readbyqxmd.com/read/28753701/reprocessing-of-single-use-endoscopic-variceal-band-ligation-devices-a-pilot-study
#19
Kavel Visrodia, Abdul Haseeb, Yuri Hanada, Kelly M Pennington, Magdalen Clemens, Paul J Pearce, Pritish K Tosh, Bret T Petersen, Mark D Topazian
Background and study aims The preferred management of bleeding esophageal varices includes endoscopic band ligation. Endoscopic ligation devices (ELDs) are expensive and designed for single use, limiting their uptake in developing countries. We aimed to assess the efficacy of reprocessing ELDs using terminal microbial cultures and adenosine triphosphate (ATP) testing. Materials and methods ELDs were recovered after clinical use and their components (cap, handle, and cord) were subjected to reprocessing...
July 28, 2017: Endoscopy
https://www.readbyqxmd.com/read/28746314/outcome-of-endoscopic-variceal-band-ligation
#20
B Shrestha, S Kc, S Chaudhary, B K Basnet, A K Mandal, N S Poudyal
INTRODUCTION: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices. METHODS: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017...
April 2017: JNMA; Journal of the Nepal Medical Association
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