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Joohwan Bae, Dong Hyun Sinn, Wonseok Kang, Geum-Youn Gwak, Moon Seok Choi, Yong-Han Paik, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik
BACKGROUND AND AIMS: The Baveno VI and the expanded Baveno VI criteria were proposed to help identify patients who could safely avoid screening endoscopies for clinically significant varices among patients with compensated advanced chronic liver disease (cACLD). However, these criteria require cross-validation, especially in Asian populations where the etiologies of liver disease is different. METHODS: A total of 1,035 patients, including 282 patients with cACLD of different etiology, were analyzed...
March 1, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
R Schwarzer, D Kivaranovic, R Paternostro, M Mandorfer, T Reiberger, M Trauner, M Peck-Radosavljevic, A Ferlitsch
BACKGROUND: Sequential measurements of hepatic venous pressure gradient (HVPG) are used to assess the haemodynamic response to nonselective betablockers (NSBBs) in patients with portal hypertension. AIMS: To assess the rates of HVPG response to different doses of carvedilol. METHODS: Consecutive patients with cirrhosis undergoing HVPG-guided carvedilol therapy for primary prophylaxis of variceal bleeding between 08/2010 and 05/2015 were retrospectively included...
February 28, 2018: Alimentary Pharmacology & Therapeutics
Walter T McNicholas, Claudio L Bassetti, Luigi Ferini-Strambi, Jean Louis Pépin, Dirk Pevernagie, Johan Verbraecken, Winfried Randerath
No abstract text is available yet for this article.
February 7, 2018: Lancet Respiratory Medicine
Macarena Simón-Talero, Davide Roccarina, Javier Martínez, Katharina Lampichler, Anna Baiges, Gavin Low, Elba Llop, Michael Praktiknjo, Martin H Maurer, Alexander Zipprich, Michela Triolo, Guillaume Vangrinsven, Rita Garcia-Martinez, Annette Dam, Avik Majumdar, Carmen Picón, Daniel Toth, Anna Darnell, Juan G Abraldes, Marta Lopez, Guido Kukuk, Aleksander Krag, Rafael Bañares, Wim Laleman, Vincenzo La Mura, Cristina Ripoll, Annalisa Berzigotti, Jonel Trebicka, Jose Luis Calleja, Puneeta Tandon, Virginia Hernandez-Gea, Thomas Reiberger, Agustín Albillos, Emmanuel A Tsochatzis, Salvador Augustin, Joan Genescà, Sergi Quiroga, Dominic Yu, Mattias Mandorfer, Juan Carlos Garcia-Pagan, Claudia Berbel, Jose Ferrusquia, Michel Ble, Mari Angeles Garcia-Criado, Ernest Belmonte, Michael Ney, Cristina Margini, Stefania Casu, Giuseppe Murgia, Christiane Ludwig, Martin Rönsch, Dietrich Stoevesandt, Laura Carrion, Enrique Ramón Botella
BACKGROUND & AIMS: Spontaneous portosystemic shunts (SPSSs) have been associated with hepatic encephalopathy (HE). Little is known about their prevalence among patients with cirrhosis or clinical effects. We investigated the prevalence and characteristics of SPSSs in patients with cirrhosis and their outcomes. METHODS: We performed a retrospective study of 1729 patients with cirrhosis who underwent abdominal computed tomography or magnetic resonance imaging analysis from 2010 through 2015 at 14 centers in Canada and Europe...
January 20, 2018: Gastroenterology
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
Marika Rudler, Christophe Bureau, Nicolas Carbonell, Philippe Mathurin, Faouzi Saliba, Arianne Mallat, Julien Massard, Jean-Louis Golmard, Brigitte Bernard-Chabert, Nina Dib, Dominique Thabut
BACKGROUND & AIMS: Early TIPS placement must be considered in patients with Child-Pugh B and active bleeding at endoscopy or in patients with Child-Pugh C 10-13 and variceal bleeding. However, active bleeding at endoscopy is a subjective criterion. Moreover, a previous study has shown that a MELD-based score accurately predicted 6-week mortality and helped to stratify patients. Using a prospective series of patients included in a multicentre study before the era of early TIPS, we aimed (i) to identify factors associated with 6-week mortality, focusing on the prognostic value of active bleeding; and (ii) to assess whether a recalibrated MELD-based score accurately predicted 6-week mortality...
March 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Dominique Thabut, Arnaud Pauwels, Nicolas Carbonell, Andre Jean Remy, Pierre Nahon, Xavier Causse, Jean-Paul Cervoni, Jean-François Cadranel, Isabelle Archambeaud, Slim Bramli, Florent Ehrhard, Philippe Ah-Soune, Florian Rostain, Alexandre Pariente, Julien Vergniol, Jean-Pierre Dupuychaffray, Anne-Laure Pelletier, Florence Skinazi, Anne Guillygomarc'h, René-Louis Vitte, Jean Henrion, Stéphanie Combet, Marika Rudler, Christophe Bureau
BACKGROUND: The Baveno VI consensus meeting concluded that an early TIPS must be considered in high-risk cirrhotic patients presenting with variceal bleeding (VB) (Child B + active bleeding at endoscopy or Child C10-13 patients). Whether this therapeutic approach is feasible in a real-life setting remains unclear. AIMS: To determine (1) the proportion of patients eligible for early-TIPS among cirrhotic patients with VB, (2) the proportion of these patients who underwent early-TIPS placement and the main reasons for discarding TIPS, and (3) the outcomes of patients who experienced early-TIPS placement in a large, national, prospective, multicentre audit including academic and non-academic centres...
September 13, 2017: Journal of Hepatology
Etienne Pateu, Frédéric Oberti, Paul Calès
Here, we review recent improvements made to different noninvasive tests used for the diagnosis of esophageal varices (EV) in the light of the recent Baveno VI recommendation and with an emphasis on clinical application. Like for fibrosis tests, these noninvasive EV tests can be classified as direct markers when they provide a visualization of EV (including all imaging procedures like endoscopy or radiology) and as indirect markers when they do not (blood markers or elastometry). Clinical descriptors expressed as percentages, especially the spared endoscopy rate and the missed high-risk esophageal varices (HREV) rate, are more eloquent in this setting than classical statistical descriptors like accuracy...
September 1, 2017: Clinics and Research in Hepatology and Gastroenterology
Davide Roccarina, Matteo Rosselli, Joan Genesca, Emmanuel A Tsochatzis
The gold standard to assess the presence and severity of portal hypertension remains the hepatic vein pressure gradient, however the recent development of non-invasive assessment using elastography techniques offers valuable alternatives. In this review, we discuss the diagnostic accuracy and utility of such techniques in patients with portal hypertension due to cirrhosis. Areas covered: A literature search focused on liver and spleen stiffness measurement with different elastographic techniques for the assessment of the presence and severity of portal hypertension and oesophageal varices in people with chronic liver disease...
September 12, 2017: Expert Review of Gastroenterology & Hepatology
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
Mafalda Sousa, Sónia Fernandes, Luísa Proença, Ana Paula Silva, Sónia Leite, Joana Silva, Ana Ponte, Jaime Rodrigues, João Carlos Silva, João Carvalho
BACKGROUND AND AIMS: According to the Baveno VI consensus, patients with liver stiffness < 20 kPa and a platelet count > 150,000 ul have very low risk of clinically significant varices and do not need a screening endoscopy. The aim of this study was to evaluate non-invasive methods as predictors of esophageal varices according to the Baveno VI recommendations, in real life clinical practice. METHODS: Retrospective evaluation of patients with chronic liver disease who underwent transient elastography between January 2013 and December 2015...
October 2017: Revista Española de Enfermedades Digestivas
Salvador Augustin, Mònica Pons, James B Maurice, Christophe Bureau, Horia Stefanescu, Michel Ney, Hélène Blasco, Bogdan Procopet, Emmanuel Tsochatzis, Rachel H Westbrook, Jaime Bosch, Annalisa Berzigotti, Juan G Abraldes, Joan Genescà
Patients with compensated advanced chronic liver disease (cACLD) can safely avoid screening endoscopy with a platelet count >150 × 109 cells/L and a liver stiffness measurement (LSM) <20 kPa (Baveno VI criteria). However, the total number of avoided endoscopies using this rule is relatively low. We aimed at expanding the Baveno VI criteria and validating them in additional cohorts. Patients from the Anticipate cohort (499 patients with cACLD of different etiologies) were used to study the performance of different thresholds of platelets and LSM for the identification of patients at very low risk (<5%) of having varices needing treatment (VNT)...
December 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Elliot B Tapper, Jennifer Friderici, Zachary A Borman, Jacob Alexander, Alan Bonder, Nabiha Nuruzzaman, Sheryl Ramdass, Rony Ghaoui
GOALS: To determine the rate of and outcomes associated with guideline adherence in the care of acute variceal hemorrhage (AVH). BACKGROUND: Four major elements of high-quality care for AVH defined by the Baveno consensus (VI) include timely endoscopy (≤12 h), antibiotics, and somatostatin analogs before endoscopy and band ligation as primary therapy for esophageal varices. STUDY: We retrospectively evaluated 239 consecutive admissions of 211 patients with AVH admitted to 2 centers in Massachusetts from 2010 to 2015...
February 2018: Journal of Clinical Gastroenterology
Paul Calès, Sylvie Sacher-Huvelin, Dominique Valla, Christophe Bureau, Anne Olivier, Frédéric Oberti, Jérôme Boursier, Jean Paul Galmiche
BACKGROUND & AIMS: Large esophageal varice (LEV) screening is recommended in cirrhosis. We performed a prospective study to improve non-invasive LEV screening. DESIGN: 287 patients with cirrhosis had upper gastrointestinal endoscopy (LEV reference), esophageal capsule endoscopy (ECE), liver elastography and blood marker analyses. CirrhoMeter (cirrhosis blood test), the most accurate non-invasive LEV test, was segmented for cirrhosis (reference comparator) or LEV...
June 16, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
Agustín Albillos, Javier Zamora, Javier Martínez, David Arroyo, Irfan Ahmad, Joaquin De-la-Peña, Juan-Carlos Garcia-Pagán, Gin-Ho Lo, Shiv Sarin, Barjesh Sharma, Juan G Abraldes, Jaime Bosch, Guadalupe Garcia-Tsao
Endoscopic variceal ligation plus beta-blockers (EVL+BB) is currently recommended for variceal rebleeding prophylaxis, a recommendation that extends to all patients with cirrhosis with previous variceal bleeding irrespective of prognostic stage. Individualizing patient care is relevant, and in published studies on variceal rebleeding prophylaxis, there is a lack of information regarding response to therapy by prognostic stage. This study aimed at comparing EVL plus BB with monotherapy (EVL or BB) on all-source rebleeding and mortality in patients with cirrhosis and previous variceal bleeding stratified by cirrhosis severity (Child A versus B/C) by means of individual time-to-event patient data meta-analysis from randomized controlled trials...
October 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Carlos Moctezuma Velázquez, Juan G Abraldes
A major complication of portal hypertension in patients with cirrhosis is the development of esophageal varices with the associated risk of variceal bleeding. Hence, the Baveno consensus on portal hypertension in its first five editions had recommended surveillance with periodic upper endoscopies in these patients to identify in a timely fashion the development of esophageal varices and initiate a primary prophylaxis strategy in those at a high risk of bleeding. For the first time, the Sixth Baveno Consensus on Portal Hypertension (Baveno VI) recommended using non-invasive tools to rule out the presence of varices with a high risk of bleeding...
May 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Jonathan Chung-Fai Leung, Thomson Chi-Wang Loong, James Pang, Jeremy Lok Wei, Vincent Wai-Sun Wong
Portal hypertension is the central driver of complications in patients with chronic liver diseases and cirrhosis. The diagnosis of portal hypertension has important prognostic and clinical implications. In particular, screening for varices in patients with portal hypertension can effectively reduce the morbidity and mortality of variceal bleeding. In this article, we review the invasive and non-invasive methods to assess portal hypertension. Hepatic venous pressure gradient remains the gold standard to measure portal pressure but is invasive and seldom performed outside expert centers and research settings...
March 30, 2017: Hepatology International
Elba Llop, Marta Lopez, Juan de la Revilla, Natalia Fernandez, Maria Trapero, Marta Hernandez, Carlos Fernández-Carrillo, Fernando Pons, Jose Luis Martinez, Jose Luis Calleja
BACKGROUND AND AIM: The aim was to validate noninvasive methods to predict the presence of gastroesophageal varices (GEV) in patients with suspected compensated advanced chronic liver disease. METHODS: We retrospectively reviewed clinical and radiological data collected prospectively between September 2013 and September 2015. We reviewed 442 consecutive patients with suspected compensated advanced chronic liver disease measured by transient elastography (TE) and a gastroscopy...
November 2017: Journal of Gastroenterology and Hepatology
Parastoo Jangouk, Laura Turco, Ana De Oliveira, Filippo Schepis, Erica Villa, Guadalupe Garcia-Tsao
BACKGROUND: Guidelines recommend variceal screening in patients with cirrhosis to identify varices at high risk of bleeding requiring primary prophylaxis. Non-invasive criteria to rule out high-risk varices will avoid unnecessary endoscopies. Recent Baveno VI criteria define patients with compensated cirrhosis in whom endoscopy can be avoided as those with a liver stiffness by transient elastography <20 kPa and a platelet count >150 000/mm(3.) AIMS: To validate Baveno criteria in two cohorts with a different prevalence of high-risk varices and to determine whether alternate parameters not including liver stiffness would be equal/more accurate in ruling out high-risk varices...
August 2017: Liver International: Official Journal of the International Association for the Study of the Liver
Astrid Marot, Eric Trépo, Christopher Doerig, Alain Schoepfer, Christophe Moreno, Pierre Deltenre
BACKGROUND & AIMS: The 2015 Baveno VI guidelines recommend against performing upper gastrointestinal endoscopy in patients with compensated cirrhosis who have a liver stiffness <20 kPa and a platelet count >150 000/mm³ because of a low prevalence of varices at risk of bleeding in this population. The aim was to synthesize the available evidence on the usefulness of the combined use of liver stiffness and platelet count to identify patients without oesophageal varices. METHODS: Meta-analysis of trials evaluating the usefulness of a given cut-off for liver stiffness and platelet count to rule out the presence of oesophageal varices...
May 2017: Liver International: Official Journal of the International Association for the Study of the Liver
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