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Disha Sharma, Rukaiya Bashir Hamidu, Gracia Viana Rodriguez, Andrew Canakis, Ahmed Chatila, Eric Goldberg
Postbanding ulcer bleeds (PBUBs) are an uncommon complication of variceal band ligation. They are often treated with proton pump inhibitors in addition to endoscopic interventions such as epinephrine injections, hemostatic clips, electrothermal cautery, or further band ligation. Over-the-scope clips are being increasingly used for the management of acute nonvariceal upper gastrointestinal bleeds, but their use in the management of PBUBs has been reported only once before. We present a 24-year-old man with alcohol-associated decompensated cirrhosis with recurrent PBUB, despite multiple endoscopic interventions, transjugular intrahepatic portosystemic shunt, and liver transplant, treated successfully with an Ovesco clip...
January 2024: ACG Case Reports Journal
#22
JOURNAL ARTICLE
Fawad Iqbal Janjua, Mahmood Ahmad, Salman Javed, Muhammad Qasim Zia, Ghulam Abbas, Naveed Aslam, Kamran Farooq, Muhammad Nabeel Shafqat
Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency that results in significant morbidity, mortality, and socioeconomic burden. Both types of cardio-fundal varices, gastro-esophageal varix 2 (GOV2) and isolated gastric varices type 1 (IGV1), can cause massive bleeding and often are difficult to treat compared to the other types of gastric varices. Endoscopic variceal band ligation (EVBL) is a less effective treatment modality for gastric varices than esophageal varices and is associated with high re-bleeding rates...
November 2023: Curēus
#23
REVIEW
Pierre Mayer, Aïna Venkatasamy, Thomas F Baumert, François Habersetzer, Patrick Pessaux, Antonio Saviano, Emanuele Felli
Left-sided or segmental portal hypertension (SPHT) is a rare entity, most often associated with pancreatic disease or antecedent pancreatic surgery. The starting point is splenic vein obstruction secondary to local inflammation or, less often, extrinsic compression. SPHT leads to splenomegaly and development of collateral porto-systemic venous circulation. SPHT should be suspected in patients with pancreatic history who present with episodic upper gastrointestinal bleeding and splenomegaly with normal liver function tests...
December 22, 2023: Journal of Visceral Surgery
#24
Kyung Kyu Lee, Jae Yong Park, Woo Sun Choi, Young Youn Cho
Duodenal varices are uncommon complications of portal hypertension. Although duodenal variceal bleeding is infrequent, it is a life-threatening condition with a high mortality rate. Non-surgical methods for duodenal variceal bleeding include endoscopic band ligation, endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and retrograde transvenous obliteration. On the other hand, an optimal treatment strategy for this rare condition has not been established. A 38-year-old male with a history of alcoholic liver cirrhosis presented with hematemesis...
December 25, 2023: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
#25
Liangchao Hao, Wei Cai, Zhaomu Zeng, Xiuchao Geng, Qiang Li, Hong Chen, Yuhao Zhang, Juan Ding
Chronic liver disease can cause an increase in portal sinus pressure, which may lead to rupture and bleeding of esophageal and gastric varices. Oesophageal variceal ligation, with use of sclerosing agent and tissue glue injection is commonly used in clinical practice to address oesophageal bleeding. A 58-year-old male patient with chronic liver disease was treated with oesophageal variceal ligation, sclerosing agent and tissue glue injection due to oesophageal and gastric variceal bleeding. After 2 days, the skin of the patient exhibited erythema to different degrees...
January 2024: Experimental and Therapeutic Medicine
#26
RANDOMIZED CONTROLLED TRIAL
Tsung-Chieh Yang, Wen-Chi Chen, Ming-Chih Hou, Ping-Hsien Chen, Pei-Chang Lee, Chung-Yu Chang, Hsiao-Sheng Lu, Yu-Jen Chen, Shao-Jung Hsu, Hui-Chun Huang, Jiing-Chyuan Luo, Yi-Hsiang Huang, Fa-Yauh Lee
OBJECTIVE: This randomised trial aimed to address whether endoscopic variceal ligation (EVL) or propranolol (PPL) is more effective at preventing initial oesophageal variceal bleeding (EVB) in patients with hepatocellular carcinoma (HCC). DESIGN: Patients with HCC and medium-to-large oesophageal varices (EVs) but without previous EVB were randomised to receive EVL (every 3-4 weeks until variceal eradication) or PPL (up to 320 mg daily) at a 1:1 ratio. Long-term follow-up data on EVB, other upper gastrointestinal bleeding (UGIB), non-bleeding liver decompensation, overall survival (OS) and adverse events (AEs) were analysed using competing risk regression...
March 7, 2024: Gut
#27
REVIEW
Càndid Villanueva, Victor Sapena, Gin-Ho Lo, Yeon Seok Seo, Hasnain Ali Shah, Virendra Singh, Dhiraj Tripathi, Michael Schepke, Cristian Gheorghe, Daniell Q Bonilha, Rome Jutabha, Huay-Min Wang, Susana G Rodrigues, Anna Brujats, Han Ah Lee, Zahid Azam, Pramod Kumar, Peter C Hayes, Tilman Sauerbruch, Wen-Chi Chen, Speranta Iacob, Ermelindo D Libera, Dennis M Jensen, Edilmar Alvarado, Ferran Torres, Jaume Bosch
BACKGROUND & AIMS: Non-selective β-blockers (NSBBs) and endoscopic variceal-ligation (EVL) have similar efficacy preventing first variceal bleeding. Compensated and decompensated cirrhosis are markedly different stages, which may impact treatment outcomes. We aimed to assess the efficacy of NSBBs vs EVL on survival in patients with high-risk varices without previous bleeding, stratifying risk according to compensated/decompensated stage of cirrhosis. METHODS: By systematic review, we identified RCTs comparing NSBBs vs EVL, in monotherapy or combined, for primary bleeding prevention...
February 2024: Alimentary Pharmacology & Therapeutics
#28
Jiayuan Ye, Yilian Xie, Yaojiang Xu, Nan Chen, Yifei Tu
Oxaliplatin has become a widely used agent in neoadjuvant chemotherapy for gastrointestinal tract tumors and is an integral part of the therapeutic approach for managing colorectal cancer recurrences and metastases, resulting in a more favorable prognosis for patients. Nevertheless, oxaliplatin can give rise to idiopathic non-cirrhotic portal hypertension (INCPH). The emergence of INCPH can disrupt tumor chemotherapy and incite persistent adverse reactions in later stages, significantly complicating clinical management...
2023: Frontiers in Medicine
#29
JOURNAL ARTICLE
Hwaseong Ryu, Tae Un Kim, Ki Tae Yoon, Young Mi Hong
BACKGROUND: Life-threatening bleeding following endoscopic variceal ligation (EVL) in patients with cirrhosis rarely can occur. The present study aimed to evaluate the performance of computed tomography (CT) in predicting the risk of early bleeding following EVL in cirrhotic patients. METHODS: We retrospectively investigated 285 cirrhotic patients who had undergone EVL. EVL was performed for prophylaxis or acute variceal bleeding. The patients were classified into 2 groups: early bleeding (< 14 days after EVL) and non-early bleeding...
November 24, 2023: BMC Gastroenterology
#30
JOURNAL ARTICLE
Sameh A Lashen, Mohammed M Shamseya, Ayman M Shamseya, Fahmy H Hablass
BACKGROUND: Up-to-date data about the role of acid suppression therapy e.g. proton-pump inhibitors; to reduce post-endoscopic variceal ligation (EVL) ulcer-bleeding are conflicting. Vonoprazan; a recently introduced potassium-competitor acid blocker, has not been studied to prevent post-EVL ulcer/bleeding. The aim was to evaluate the efficacy of vonoprazan vs. pantoprazole or non-acid suppression to prevent post-EVL ulcer/bleeding in portal hypertension patients. MATERIAL AND METHODS: We enrolled 275 portal hypertension patients undergoing EVL in a three-arm randomized, single-blind, controlled study...
2023: Journal of Clinical and Experimental Hepatology
#31
JOURNAL ARTICLE
Lorenz Balcar, Mattias Mandorfer, Virginia Hernández-Gea, Bogdan Procopet, Elias Laurin Meyer, Álvaro Giráldez, Lucio Amitrano, Candid Villanueva, Dominique Thabut, Luis Ibáñez Samaniego, Gilberto Silva-Junior, Javier Martinez, Joan Genescà, Christophe Bureau, Jonel Trebicka, Elba Llop Herrera, Wim Laleman, José María Palazón Azorín, Jose Castellote Alonso, Lise Lotte Gluud, Carlos Noronha Ferreira, Nuria Cañete, Manuel Rodríguez, Arnulf Ferlitsch, Jose Luis Mundi, Henning Grønbæk, Manuel Nicolas Hernandez Guerra, Romano Sassatelli, Alessandra Dell'Era, Marco Senzolo, Juan Gonzalez Abraldes, Manuel Romero-Gómez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Massimo Primignani, Aleksander Krag, Frederik Nevens, Jose Luis Calleja, Christian Jansen, María Vega Catalina, Agustín Albillos, Marika Rudler, Edilmar Alvarado Tapias, Maria Anna Guardascione, Marcel Tantau, Rémy Schwarzer, Thomas Reiberger, Stig Borbjerg Laursen, Marta Lopez-Gomez, Alba Cachero, Alberto Ferrarese, Cristina Ripoll, Vincenzo La Mura, Jaime Bosch, Juan Carlos García-Pagán
BACKGROUND & AIMS: Pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for high-risk acute variceal bleeding (AVB; i.e., Child-Turcotte-Pugh [CTP] B8-9+active bleeding/C10-13). Nevertheless, some 'non-high-risk' patients have poor outcomes despite the combination of non-selective beta-blockers and endoscopic variceal ligation for secondary prophylaxis. We investigated prognostic factors for re-bleeding and mortality in 'non-high-risk' AVB to identify subgroups who may benefit from more potent treatments (i...
January 2024: Journal of Hepatology
#32
JOURNAL ARTICLE
Rui Cao, Xiangyu Lu, Yilei Wu, Siyu Li, Jun Gong
Background/Aims: To compare laparoscopic splenectomy and esophagogastric devascularization (LSED) with endoscopic variceal ligation (EVL) plus laparoscopic splenectomy (LS) in treating esophagogastric variceal bleeding (EGVB) caused by portal hypertension (PH). Methods: Between January 2015 and May 2022, 87 patients with PH caused by hepatitis B cirrhosis were included in the retrospective study (34 in LSED versus 53 in EVL + LS). Results: The clinical features of both groups were well-matched ( P > ...
November 2023: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
#33
REVIEW
Ahram Han, Seung-Kee Min
Atypical variceal bleeding, which primarily stems from extrahepatic portal vein obstruction (EHPVO), is a severe complication of pancreatic hepatobiliary surgery. This review provides insights into this condition's incidence, diagnosis, and management strategies. The treatment modalities for atypical variceal bleeding resulting from EHPVO range from endoscopic intervention to surgical procedures, including direct variceal ligation and shunt surgery. Here, we discuss the efficacy and potential limitations of each treatment approach...
September 4, 2023: Vascular Specialist International
#34
RANDOMIZED CONTROLLED TRIAL
Xiaoze Wang, Guofeng Liu, Junchao Wu, Xue Xiao, Yuling Yan, Yuxin Guo, Jinlin Yang, Xiao Li, Yazhou He, Li Yang, Xuefeng Luo
Background Some studies have shown that transjugular intrahepatic portosystemic shunt (TIPS) placement within 72 hours of admission improves survival in patients at high risk who present with acute variceal bleeding. However, the role of small-diameter covered TIPS in the secondary prophylaxis of variceal bleeding is still debatable. Purpose To compare the efficacy of 8-mm TIPS and endoscopic variceal ligation (EVL) plus propranolol in the prevention of variceal rebleeding among participants with advanced cirrhosis...
August 2023: Radiology
#35
EDITORIAL
Klemens H Barth
No abstract text is available yet for this article.
August 2023: Radiology
#36
JOURNAL ARTICLE
Irene Diéguez Hernández-Vaquero, Anna Domènech Tàrrega, Adrià Costa-Roig, Miguel Couselo Jerez, Juan José Vila Carbó
INTRODUCTION: Portal vein thrombosis (PVT) is the most frequent cause of portal hypertension in paediatric population. Baveno VI Consensus considers endoscopic variceal ligation as the second therapeutic option after meso-Rex bypass (surgical shunt). AIM: Analyse the diagnostic profitability of non-invasive scales in order to predict the risk of oesophageal varices (OV) in children with PVT. MATERIAL AND METHODS: Descriptive retrospective study where every upper gastrointestinal endoscopy (UGE) carried on patients <15 years old with non-cirrhotic PVT were included...
August 9, 2023: Gastroenterología y Hepatología
#37
JOURNAL ARTICLE
Tetsuya Shimizu, Masato Yoshioka, Akira Matsushita, Junji Ueda, Mampei Kawashima, Takashi Ono, Youichi Kawano, Hiroshi Yoshida
Extrahepatic portal vein obstruction (EHPVO) is a very rare disease-causing portal hypertension. Myeloproliferative neoplasm (MPN) including essential thrombocythemia (ET) is reported as a risk factor for EHPVO due to underlying persistent thrombophilia.A Japanese woman in her 40s was referred to our hospital with a one-month history of gastric variceal bleeding due to EHPVO. Laboratory investigation demonstrated thrombocytosis despite portal hypertension. She had a mutation of clonal marker JAK2V617F with EHPVO, which prompted us to consult a hematologist...
August 8, 2023: Journal of Nippon Medical School
#38
JOURNAL ARTICLE
Wen-Chi Chen, Tsung-Chieh Yang, Pei-Chang Lee, Yen-Po Wang, Ming-Chih Hou, Fa-Yauh Lee
INTRODUCTION: Endoscopic variceal ligation (EVL) plus nonselective β-blockers (NSBB) is the standard of care for secondary prophylaxis of esophageal variceal bleeding (EVB). This trial aimed to compare the rebleeding rates between EVL plus NSBB till eradication of esophageal varices (EEV) and EVL plus long-term NSBB. METHODS: After control of acute EVB, patients with cirrhosis were randomized into 2 groups, with group A patients receiving EVL plus propranolol till EEV, while group B patients received standard of care with continuation of propranolol...
September 11, 2023: American Journal of Gastroenterology
#39
RANDOMIZED CONTROLLED TRIAL
Le Zhang, Lu Li, Jun Wang, Can Zhao, Erxian Zhao, Yanrong Li, Yunqi Lv
Various airway techniques have been used in endoscopic esophageal variceal ligation (EVL). In this respect, Jcerity endoscoper airway (JEA) is a novel laryngeal mask airway that is designed for use in gastrointestinal endoscopy. In the present study, 164 patients who underwent EVL were randomly divided into JEA group or endotracheal tube (ETT) group (ratio: 1:1). Success rate of endoscopic procedure, endoscope insertion time, procedure duration, recovery time, airway technique extubation time, anesthesia costs, hospital stay duration, complications, and hemodynamic parameters were recorded...
July 22, 2023: Scientific Reports
#40
JOURNAL ARTICLE
David Schneider, Vladimír Kojecký
Variceal bleeding belongs to the one of the complications of portal hypertension and is a life-threatening condition. A transjugular intrahepatic portosystemic shunt (TIPS) is indicated in case of failure of the pharmacological and endoscopic therapy, even if it is associated with complications. Stent migration to the heart, is a rare event which may cause perforation of the right cardiac chambers or damage to the tricuspid valve. However, it may not be a problem in some cases. There are two approaches to extraction - percutaneous or surgical...
2023: Vnitr̆ní Lékar̆ství
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