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TIPS liver cirrhosis

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https://www.readbyqxmd.com/read/28602971/new-developments-in-hepatorenal-syndrome
#1
Ayse L Mindikoglu, Stephen C Pappas
Hepatorenal Syndrome (HRS) continues to be one of the major complications of decompensated cirrhosis leading to death in the absence of liver transplantation. Challenges in precisely evaluating renal function in the patient with cirrhosis remain due to the limitations of serum creatinine (Cr) alone in estimating glomerular filtration rate (GFR); current GFR estimating models appear to underestimate renal function. Newer models incorporating renal biomarkers, such as the Cr-Cystatin C GFR Equation for Cirrhosis appear to more accurately estimate true GFR...
June 7, 2017: Clinical Gastroenterology and Hepatology
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
#2
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/28501536/multicenter-external-validation-of-risk-stratification-criteria-for-patients-with-variceal-bleeding
#3
Irene Conejo, Maria Anna Guardascione, Puneeta Tandon, Alba Cachero, Josep Castellote, Juan G Abraldes, Lucio Amitrano, Joan Genescà, Salvador Augustin
BACKGROUND & AIMS: Early placement of a transjugular intrahepatic porto-systemic shunts (TIPS) is considered the treatment of choice for patients with acute variceal bleeding (AVB) and cirrhosis who have a high risk of death (Child-Pugh class B with active bleeding at endoscopy or Child-Pugh class C). It has been proposed that patients of Child-Pugh class B, even with active bleeding, should not be considered high risk. Alternative criteria have been proposed for identification of high-risk patients, such as Child-Pugh class C with plasma level of creatinine of 1 mg/dl or more (ChildC-C1) and a model for end-stage liver disease (MELD) score of 19 or more...
May 10, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28468013/translating-our-current-understanding-of-ascites-management-into-new-therapies-for-patients-with-cirrhosis-and-fluid-retention
#4
Elisa Pose, Andres Cardenas
Ascites is the most common complication associated with cirrhosis resulting in poor quality of life, high risk of development of other complications of cirrhosis, increased morbidity and mortality associated with surgical interventions, and poor long-term outcome. Patients with cirrhosis and a first onset of ascites, have a probability of survival of 85% during the first year and 56% at 5 years without liver transplantation. Ascites is caused due to increased renal sodium retention as a result of increased activity of the renin-angiotensin-aldosterone system in response to marked vasodilation of the splanchnic circulation...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28335998/point-shear-wave-elastography-to-evaluate-and-monitor-changing-portal-venous-pressure-in-patients-with-decompensated-cirrhosis
#5
Hao Han, Jian Yang, Yu-Zheng Zhuge, Ming Zhang, Min Wu
This study evaluated whether the stiffness of the liver and spleen, measured using the point shear wave elastography (pSWE) technique, correlates with portal venous pressure (PVP) and whether the result extends to estimate the diminishing change in PVP (ΔPVP) in patients with decompensated cirrhosis. We evaluated the data of 67 prospectively enrolled patients who underwent both transjugular intrahepatic portosystemic shunt (TIPS) and pSWE. The stiffness of liver and spleen were evaluated by measuring shear wave velocity (SWV) to determine the statistical correlation with PVP...
June 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28286557/covered-versus-bare-stents-for-transjugular-intrahepatic-portosystemic-shunt-an-updated-meta-analysis-of-randomized-controlled-trials
#6
Xingshun Qi, Yulong Tian, Wei Zhang, Zhiping Yang, Xiaozhong Guo
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment option for the management of portal hypertension in liver cirrhosis. Since the introduction of covered stents, shunt patency has been greatly improved. However, it remains uncertain about whether covered stents could improve survival. A meta-analysis of randomized controlled trials has been performed to compare the outcomes of covered versus bare stents for TIPS. METHODS: PubMed, EMBASE, and Cochrane Library databases were searched to identify the relevant randomized controlled trials...
January 2017: Therapeutic Advances in Gastroenterology
https://www.readbyqxmd.com/read/28228886/transjugular-intrahepatic-portosystemic-shunt-for-chylous-ascites-in-a-patient-with-recurrent-cirrhosis-following-liver-transplantation
#7
Jason T Salsamendi, Francisco J Gortes, Prasoon P Mohan, Ji Fan, Govindarajan Narayanan
Chylous ascites (CA) is the extravasation of lipid-rich lymphatic fluid into the peritoneal space following trauma or obstruction of the lymphatic system. Refractory cases of cirrhosis-related CA may be amendable to transjugular intrahepatic portosystemic shunting (TIPS). We present a case of TIPS in the setting of refractory CA secondary to cirrhosis of a transplanted liver graft. Following TIPS, the patient reported immediate improvement in abdominal pain and no longer requires paracentesis. Our case suggests TIPS to be a safe and effective treatment option for CA in liver transplant patients with cirrhosis...
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28226323/immune-complex-membranoproliferative-glomerulonephritis-associated-with-transjugular-intrahepatic-portosystemic-shunts-in-alcoholic-cirrhosis-two-case-reports
#8
Julio Hernández-Jaras, Jordi Espí-Reig, Rafael Alis, Ana-Maria García-Martínez, Diego Rodríguez-Ortega, Lourdes Roca-Argente, Jose-Luis Moll-Guillen
OBJECTIVE: To report on 2 patients with alcoholic cirrhosis who were treated with transjugular intrahepatic portosystemic shunt (TIPS) placement. CLINICAL PRESENTATION AND INTERVENTION: The 2 patients had a history of alcoholic cirrhosis, and TIPS surgery was performed on them. In both cases, 4 months after TIPS placement, proteinuria was observed along with histological alterations characteristic of immune complex membranoproliferative glomerulonephritis (MPGN)...
2017: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
https://www.readbyqxmd.com/read/28057091/-resting-state-functional-magnetic-resonance-study-of-brain-function-changes-after-tips-operation-in-patients-with-liver-cirrhosis
#9
C Liu, H B Wang, Y Q Yu, M Q Wang, G B Zhang, L Y Xu, J M Wu
Objective: To investigate the brain function changes in cirrhosis patients after transjugular intrahepatic portosystemic shunt (TIPS), resting-state functional MRI (rs-fMRI) performed and fractional amplitude of low frequency fluctuation (fALFF) was analyzed. Methods: From January 2014 to February 2016, a total of 96 cirrhotic patients from invasive technology department and infection department in the First Affiliated Hospital of Anhui Medical University were selected , the blood ammonia data of 96 cirrhotic patients with TIPS operation in four groups were collected after 1, 3, 6 and 12 month, and all subjects performed rs-fMRI scans...
December 20, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28052623/prevention-and-treatment-of-variceal-haemorrhage-in-2017
#10
REVIEW
Felix Brunner, Annalisa Berzigotti, Jaime Bosch
Variceal haemorrhage is a major complication of portal hypertension that still causes high mortality in patients with cirrhosis. Improved knowledge of the pathophysiology of portal hypertension has recently led to a more comprehensive approach to prevent all the complications of this condition. Thus, optimal treatment of portal hypertension requires a strategy that takes into account the clinical stage of the disease and all the major variables that affect the risk of progression to the next stage and death...
January 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27984174/emergency-tips-in-a-child-pugh-b-patient-when-does-the-window-of-opportunity-open-and-close
#11
REVIEW
Jonel Trebicka
Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis such as variceal bleeding and refractory ascites, but it also bears the risk of liver failure, overt hepatic encephalopathy (HE) and cardiac decompensation. Variceal bleeding may be controlled using endoscopic and medical treatment in patients with compensated cirrhosis; in decompensated patients, however, TIPS improves survival. Therefore, an early TIPS (within 72h or if later, still early after bleeding) might improve the survival of patients by preventing an inflammatory response and bacterial translocation...
October 29, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27977618/covered-tips-for-secondary-prophylaxis-of-variceal-bleeding-in-liver-cirrhosis-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#12
REVIEW
Xingshun Qi, Yulong Tian, Wei Zhang, Haitao Zhao, Guohong Han, Xiaozhong Guo
BACKGROUND: In the era of bare stents, transjugular intrahepatic portosystemic shunt (TIPS) is the second-line choice of therapy for the prevention of variceal rebleeding in liver cirrhosis. In the era of covered stents, the role of TIPS should be re-evaluated. AIM: The aim of the study was to compare the outcomes of covered TIPS versus the traditional first-line therapy (i.e, drug plus endoscopic therapy) for the prevention of variceal rebleeding in liver cirrhosis...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27923694/neuropsychiatric-performance-in-patients-with-cirrhosis-who-is-normal
#13
REVIEW
Sara Montagnese, Michele De Rui, Paolo Angeli, Piero Amodio
In patients with cirrhosis a normal neuropsychiatric performance has been traditionally defined by the absence of any degree of hepatic encephalopathy and/or the absence of psychometric or neurophysiological abnormalities, compared with data from the healthy population. As the understanding and management of end-stage liver disease continues to change, it is our impression that the concept of normal neuropsychiatric performance also needs updating. This review explores novel and more pragmatic interpretations of neuropsychiatric "normality" compared with top personal performance, in terms of risk of overt hepatic encephalopathy or brain failure and in relation with events such as liver transplantation, decompensation, acute-on-chronic liver failure and transjugular intrahepatic portosystemic shunt placement...
December 5, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27816756/sarcopenia-is-risk-factor-for-development-of-hepatic-encephalopathy-after-transjugular-intrahepatic-portosystemic-shunt-placement
#14
Silvia Nardelli, Barbara Lattanzi, Sabrina Torrisi, Francesca Greco, Alessio Farcomeni, Stefania Gioia, Manuela Merli, Oliviero Riggio
BACKGROUND & AIMS: Hepatic encephalopathy (HE) is an important complication in patients with cirrhosis who received transjugular intrahepatic portosystemic shunts (TIPS). We investigated whether a decrease in muscle mass was associated independently with the occurrence of HE after TIPS. METHODS: We performed a prospective study of 46 consecutive patients with cirrhosis (mean age, 58.6 ± 9.1 y; mean model for end-stage liver disease score, 11.3 ± 3.3; mean Child-Pugh score, 7...
November 2, 2016: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27723988/-late-complications-of-liver-cirrhosis-management-of-gastrointestinal-bleeding-in-the-presence-of-portal-hypertension
#15
Václav Hejda
Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality...
December 0: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/27706896/the-soluble-mannose-receptor-is-released-from-the-liver-in-cirrhotic-patients-but-is-not-associated-with-bacterial-translocation
#16
Tea L Laursen, Sidsel Rødgaard-Hansen, Holger J Møller, Christian Mortensen, Stine Karlsen, Dennis T Nielsen, Susanne Frevert, Jens O Clemmesen, Søren Møller, Jørgen S Jensen, Flemming Bendtsen, Henning Grønbaek
BACKGROUND & AIMS: Intestinal bacterial translocation is involved in activation of liver macrophages in cirrhotic patients. Macrophages play a key role in liver inflammation and are involved in the pathogenesis of cirrhosis and complications. Bacterial translocation may be determined by presence of bacterial DNA and macrophage activation, by the soluble mannose receptor. We hypothesize that the soluble mannose receptor is released from hepatic macrophages in cirrhosis and associated with bacterial DNA, portal pressure and complications...
April 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27706547/-percutaneous-paraumbilical-embolization-of-bleeding-rectal-varices-due-to-portal-hypertension
#17
Tina Stuber, Bernd Schmitz, Hans Jürgen Brambs
Introduction Portal hypertension may lead to severe esophageal or rectal variceal bleeding. Case report We present a case of a 67-year-old patient presenting with recurrent rectal variceal bleeding who was non-responsive to endoscopic treatment. We are reporting on an interventional therapeutic approach found in interdisciplinary consensus. Discussion Endoscopy, surgery or TIPS (transjugular intrahepatic portosystemic shunt) can be performed in patients with gastrointestinal bleeding due to portal hypertension in liver cirrhosis...
June 2017: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/27706545/rescue-therapy-of-a-refractory-rectal-variceal-bleeding-in%C3%A2-a-cirrhotic-patient-by-linton-nachlas-tube-and-tips-implantation-in-combination-with-variceal-embolization
#18
Matthias Buechter, Jens M Theysohn, Alisan Kahraman, Paul Manka, Guido Gerken, Ali Canbay, Alexander Dechêne
Background Transjugular intrahepatic portosystemic shunt (TIPS) is considered the gold standard for treatment of gastrointestinal variceal bleeding refractory to endoscopic therapy in patients with portal hypertension. Clinically relevant hemorrhage from rectal varices is less frequent than from other sources, and the therapeutic role of TIPS is still ambiguous. Case report A 57-year-old female patient was referred to us in December 2015 with severe signs of decompensated alcohol-induced liver cirrhosis...
January 2017: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/27695164/safety-and-efficacy-of-2-octyl-cyanoacrylate-in-the-management-of-patients-with-gastric-and-duodenal-varices-who-are-not-candidates-for-transjugular-intrahepatic-portosystemic-shunts
#19
Luis Lizardo-Sanchez, James Burdick, James F Trotter
Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension and cirrhosis. Options are limited for patients who are not candidates for transjugular intrahepatic portosystemic shunts (TIPS). Cyanoacrylate injections have been reported to be efficacious in previous case series. The aim of this retrospective study was to report our single-center experience with the safety and efficacy of 2-octyl-cyanoacrylate in patients who were not TIPS candidates. Electronic medical records were reviewed for 16 patients who underwent a total of 18 esophagogastroduodenoscopies for acute gastric or duodenal variceal bleeding and secondary prophylaxis of gastric varices; 14 patients had cirrhosis with an average Model for End-Stage Liver Disease score of 16, and 2 patients had noncirrhotic portal hypertension...
October 2016: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/27663604/transjugular-intrahepatic-portosystemic-shunts-with-covered-stents-increase-transplant-free-survival-of-patients-with-cirrhosis-and-recurrent-ascites
#20
RANDOMIZED CONTROLLED TRIAL
Christophe Bureau, Dominique Thabut, Frédéric Oberti, Sébastien Dharancy, Nicolas Carbonell, Antoine Bouvier, Philippe Mathurin, Philippe Otal, Pauline Cabarrou, Jean Marie Péron, Jean Pierre Vinel
BACKGROUND & AIMS: There is controversy over the ability of transjugular intrahepatic portosystemic shunts (TIPS) to increase survival times of patients with cirrhosis and refractory ascites. The high rate of shunt dysfunction with the use of uncovered stents counteracts the benefits of TIPS. We performed a randomized controlled trial to determine the effects of TIPS with stents covered with polytetrafluoroethylene in these patients. METHODS: We performed a prospective study of 62 patients with cirrhosis and at least 2 large-volume paracenteses within a period of at least 3 weeks; the study was performed at 4 tertiary care centers in France from August 2005 through December 2012...
January 2017: Gastroenterology
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