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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 Fernandez, Fernando Pons, Jose Luis Martinez, Jose Luis Calleja
INTRODUCTION: The aim was to validate non-invasive methods to predict the presence of gastroesophageal varices (GEV) in patients with suspected compensated advanced chronic liver disease (cACLD). METHODS: We retrospectively reviewed clinical and radiological data collected prospectively between September 2013 and September 2015. We reviewed 442 consecutive patients with suspected cACLD measured by transient elastography (TE) and a gastroscopy. We evaluated platelets, spleen diameter, TE, LSPS (liver stiffness x spleen size /platelets), variceal risk index (VRI), Baveno VI strategy and Augustin algorithm...
March 11, 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...
February 3, 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...
November 18, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Anda Carmen Achim, Stefan Cristian Vesa, Eugen Dumitru
BACKGROUND: Diagnosis of portal hypertensive gastropathy (PHG) is based on endoscopic criteria. I-scan technology, a new technique of virtual chromoendoscopy, increases the diagnostic accuracy for lesions in the gastrointestinal tract. AIM: To establish the role of i-scan endoscopy in the diagnosis of PHG. METHOD: In this prospective study, endoscopic examination was conducted first by using white light and after that i-scan 1 and i-scan 2 technology in a group of 50 consecutive cirrhotic patients...
September 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
M Praktiknjo, C Meyer, C P Strassburg, J Trebicka
Recent non-cirrhotic and non-malignant splanchnic vein thrombosis is now defined as extrahepatic portal vein thrombosis with or without involvement of the mesenteric vein according to the Baveno VI consensus from 2015. An early diagnosis is often challenging due to unspecific symptoms with abdominal pain or diarrhea but extremely important because of the potential acute and chronic complications, such as mesenteric ischemia and portal hypertension; therefore, rapid treatment is crucial. We present two cases of severe splanchnic vein thrombosis, which were treated with catheter-directed local thrombolysis and thrombus aspiration...
January 2017: Der Internist
James B Maurice, Edgar Brodkin, Frances Arnold, Annalan Navaratnam, Heidi Paine, Sabrina Khawar, Ameet Dhar, David Patch, James O'Beirne, Raj Mookerjee, Massimo Pinzani, Emmanouil Tsochatzis, Rachel H Westbrook
BACKGROUND & AIMS: The Baveno VI guidelines propose that cirrhotic patients with a liver stiffness measurement (LSM) <20kPa and a platelet count >150,000/μl can avoid screening endoscopy as their combination is highly specific for excluding clinically significant varices. The aim of the study was to validate these criteria. METHODS: Transient elastography data was collected from two institutions from 2006-2015. Inclusion criteria were a LSM ⩾10kPa and an upper gastrointestinal endoscopy within 12months, with a diagnosis of compensated chronic liver disease...
November 2016: Journal of Hepatology
Mohammed N Quraishi, Faisal Khan, Dhiraj Tripathi
Variceal bleeding is a serious complication of portal hypertension with high morbidity and mortality. Advances in our understanding of screening and risk stratification along with evidence-based management strategies for acute variceal bleeding as well as primary and secondary prevention have improved overall outcomes in patients with portal hypertension. The guidelines recently published by the British Society of Gastroenterology (BSG) and Baveno 6 consensus have aimed to enhance the standard of care in the management of varices and their complications...
2016: Polskie Archiwum Medycyny Wewnętrznej
Lourdes Cabrera, Puneeta Tandon, Juan G Abraldes
The mortality rate in acute variceal haemorrhage remains high (around 15%). Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and prophylactic antibiotics. Effective resuscitation (haemostasis, volume management) is essential to prevent complications. Treatment failure is best managed by transjugular intrahepatic portosystemic shunt (TIPS). Balloon tamponade or specifically designed covered oesophageal stents can be used as a bridge to definitive therapy in unstable patients...
March 2, 2016: Gastroenterología y Hepatología
Reda Elwakil, Ashraf Mohammad Al Breedy, Hoda Hassan Abou Gabal
INTRODUCTION AND AIM: A few studies have shown that the degree of portal hypertensive gastropathy (PHG) and duodenopathy (PHD) has been worsening after the introduction of therapeutic endoscopic interventions. This study aimed to determine the impact of esophageal variceal eradication by endoscopic variceal ligation (EVL) on PHG and PHD using endoscopic and histopathologic assessment. METHODS: Fifty patients with esophageal varices for which EVL was indicated were included...
November 2016: Hepatology International
Andres Cardenas, Angela Mendez-Bocanegra
No abstract text is available yet for this article.
March 2016: Annals of Hepatology
Benjamin L Shneider, Jean de Ville de Goyet, Daniel H Leung, Anshu Srivastava, Simon C Ling, Mathieu Duché, Patrick McKiernan, Riccardo Superina, Robert H Squires, Jaime Bosch, Roberto Groszmann, Shiv K Sarin, Roberto de Franchis, George V Mazariegos
UNLABELLED: Approaches to the management of portal hypertension and variceal hemorrhage in pediatrics remain controversial, in large part because they are not well informed by rigorous clinical studies. Fundamental biological and clinical differences preclude automatic application of approaches used for adults to children. On April 11-12, 2015, experts in the field convened at the first Baveno Pediatric Satellite Meeting to discuss and explore current available evidence regarding indications for MesoRex bypass (MRB) in extrahepatic portal vein obstruction and the role of primary prophylaxis of variceal hemorrhage in children...
April 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Tammy T Hshieh, Aung Kaung, Syed Hussain, Michael P Curry, Vinay Sundaram
BACKGROUND/AIMS: The international normalized ratio (INR) has not been validated as a predictor of bleeding risk in cirrhotics. The aim of this study was to determine whether elevation in the INR correlated with risk of esophageal variceal hemorrhage and whether correction of the INR prior to endoscopic therapy affects failure to control bleeding. PATIENTS AND METHODS: Patient records were retrospectively reviewed from January 1, 2000 to December 31, 2010. Cases were cirrhotics admitted to the hospital due to bleeding esophageal varices...
July 2015: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Pietro Lampertico, Federica Invernizzi, Mauro Viganò, Alessandro Loglio, Giampaolo Mangia, Floriana Facchetti, Massimo Primignani, Manol Jovani, Massimo Iavarone, Mirella Fraquelli, Giovanni Casazza, Roberto de Franchis, Massimo Colombo
BACKGROUND & AIMS: Esophageal varices (EV) are a marker of disease severity in compensated cirrhosis due to hepatitis B virus (HBV) which predicts also the risk of hepatocellular carcinoma (HCC), clinical decompensation and anticipated liver related death. The dynamics and prognostic significance of EV in patients under long-term HBV suppression by nucleos(t)ide analogs (NUC), are poorly known. METHODS: A standardized protocol (Baveno) including 414 upper gastrointestinal (GI) endoscopies was applied to 107 HBeAg-negative compensated cirrhotic patients (93% Child-Pugh A) during a median of 12 (range 2 to 17) years of NUC therapy...
November 2015: Journal of Hepatology
Roberto de Franchis
No abstract text is available yet for this article.
September 2015: Journal of Hepatology
Sudhagar Rengasamy, Sheik M Ali, Sarath C Sistla, Chandrasekharan P Lakshmi, Kottyen T Harichandra Kumar
BACKGROUND: Variceal bleeding is a medical emergency with 20% mortality at 6 weeks. The role of vasoactive agents in achieving hemostasis and preventing rebleeding has been well documented. The optimal duration of these agents has not been well established. There are no previous studies yielding the exact duration of octreotide to be administered to prevent rebleed and mortality from esophageal varices. The aim of this study is to evaluate the effect of combination therapy (octreotide and endoscopy), the exact duration of octreotide infusion, its cost-effectiveness, and the outcome in terms of rebleed and mortality...
April 2015: European Journal of Gastroenterology & Hepatology
Shahab Abid, Abdullah B Khalid, Safia Awan, Hasnain A Shah, Saeed Hamid, Wasim Jafri
INTRODUCTION: Variceal bleeding is a serious complication in patients with cirrhosis. Among the criteria that were proposed in Baveno conferences, the Adjusted Blood Requirement Index (ABRI) has not been validated prospectively in clinical practice. We therefore aim to evaluate the measurement of ABRI as a marker of failure to control bleeding and to evaluate the consistency of ABRI in relation to other criteria of failure to control variceal bleeding. PATIENTS AND METHODS: All patients with variceal bleeding who presented to Aga Khan University Hospital from January 2010 to December 2012 who were administered transfusion of packed red blood cells were included after obtaining informed consent...
March 2015: European Journal of Gastroenterology & Hepatology
Sun Young Ahn, Soo Young Park, Won Young Tak, Yu Rim Lee, Eun Jeong Kang, Jung Gil Park, Won Kee Lee, Kwan Lee, Young Oh Kweon
UNLABELLED: New definitions and criteria were released at the Baveno V consensus meeting. The purposes of this study were to verify Baveno V definitions and criteria for failure to control bleeding and to determine the usefulness of the combined use of the Adjusted Blood Requirement Index [ABRI: (number of blood units)/(final hematocrit-initial hematocrit)+0.01] with Baveno V criteria. In all, 246 consecutive liver cirrhosis patients with acute bleeding associated with portal hypertension were enrolled prospectively between January 2010 and October 2012...
March 2015: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Dominique Thabut, Marika Rudler, Nina Dib, Nicolas Carbonell, Philippe Mathurin, Faouzi Saliba, Alain Mallet, Julien Massard, Brigitte Bernard-Chabert, Frederic Oberti, Paul Cales, Jean-Louis Golmard, Christophe Bureau
UNLABELLED: The criteria for defining failure to control bleeding in cirrhosis patients were introduced at the Baveno II/III meetings and were widely used as endpoints in clinical trials. Because they lacked specificity, the Baveno IV criteria were proposed in 2005 and slightly modified in 2010 (Baveno V). These criteria included a new index for patients undergoing transfusion, called adjusted-blood-requirement-index (ABRI=number of blood units/(final-initial hematocrit+0.01)), with a cutoff value of 0...
March 2015: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Christos Triantos, Maria Kalafateli
Variceal bleeding is a life threatening situation with mortality rates of at least 20%. Prophylactic treatment with non-selective beta blockers (NSBBs) is recommended for patients with small varices that have not bled but with increased risk for bleeding. The recommended treatment strategies on primary prevention of variceal bleeding in patients with medium and large-sized varices are NSBBs or endoscopic band ligation. Nitrates, shunt surgery and sclerotherapy are not recommended in this setting. In this review, the most recent data on prevention of esophageal variceal bleeding are presented...
June 27, 2014: World Journal of Hepatology
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