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Lin LY, Zeng DW, Liu YR, Zhu YY, Huang LL. Diagnostic value of liver stiffness measurement combined with risk scores for esophagogastric variceal bleeding in patients with hepatitis B cirrhosis. Eur J Radiol 2024; 173:111385. [PMID: 38377895 DOI: 10.1016/j.ejrad.2024.111385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE To assess the predictive value of liver stiffness measurement (LSM) and three bleeding risk scoring systems for esophagogastric varices bleeding (EGVB) in patients with hepatitis B cirrhosis during hospitalization. METHODS In this study, 210 patients who had hepatitis B cirrhosis were selected as the subjects. They were categorized into two groups based on whether EGVB occurred during hospitalization: a bleeding group (70 cases) and a non-bleeding group (140 cases). Logistic regression was used to analyze the factors related to the occurrence of EGVB, and the diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve. RESULTS Significant differences were observed between the two groups in systolic blood pressure, platelet count, albumin, urea nitrogen, LSM, pre-endoscopic Rockall score (PRS), Glasgow-Blatchford score (GBS), and AIMS65 score (P < 0.05). The correlation analysis showed that LSM had significant positive relationship with PRS, GBS and AIMS65 score. Logistic regression analysis revealed that LSM and GBS score were independent risk factors for EGVB occurrence during hospitalization. ROC curve analysis showed that the combined prediction model of LSM and GBS score had the best prediction performance for EGVB occurrence, with an ROC curve area of 0.811, which was significantly better than the three risk scoring systems (P < 0.05), but similar to the predicted value of LSM (P = 0.335). CONCLUSIONS The combination of LSM and GBS score can significantly improve the predictive efficacy of EGVB occurrence in patients with hepatitis B cirrhosis during hospitalization, which has important clinical significance for patients' prognosis.
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Affiliation(s)
- Li-Yan Lin
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Da-Wu Zeng
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China; Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, Fujian Province, China
| | - Yu-Rui Liu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China; Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, Fujian Province, China
| | - Yue-Yong Zhu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China; Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, Fujian Province, China; Fujian Key Laboratory of Precision Medicine for Cancer, Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Ling-Ling Huang
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China; Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, Fujian Province, China.
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Sumida W, Tainaka T, Shirota C, Yokota K, Makita S, Okamoto M, Takimoto A, Yasui A, Takada S, Nakagawa Y, Kato D, Yokoyama S, Ishizu Y, Amano H, Guo Y, Hinoki A, Uchida H. Biochemical markers to predict the development of gastrointestinal bleeding and esophageal varices after portoenterostomy in biliary atresia. Pediatr Surg Int 2022; 38:1799-1805. [PMID: 36114864 DOI: 10.1007/s00383-022-05243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Gastrointestinal bleeding (GIB) due to esophageal varices (EV) is one of the factors that negatively impact native liver survival of patients with biliary atresia (BA). Gastrointestinal fibroscopy (GIF) is usually used to determine the presence of EVs; however, it requires general anesthesia. The aim of this study is to search for markers in blood tests obtained during routine check-ups that can predict the development of GIB. METHODS Data of patients with BA who underwent portoenterostomy at our hospital from 2014 to 2020 were retrospectively reviewed. The patients' data were assigned to three groups according to specific time points: Group B, which included data at GIB; Group NB-T, which included data at GIF and EV treatment; and Group NB-NT, which included data at GIF without treatment. The data in Group B were compared to those of other groups. RESULTS In our study, GIB occurred in 11 patients, and 12 cases and 8 cases were classified into Groups NB-NT and NB-T, respectively. Compared with the other groups, only ChE and M2BPGi in Group B showed statistically significant differences. CONCLUSIONS ChE and M2BPGi are useful for predicting GIB.
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Affiliation(s)
- Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Toho University Omori Hospital, Tokyo, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuki Yokota
- Department of Gastrointestinal and Pediatric Surgery, Mie University, Tsu, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Efficacy and Safety of Endoscopic Primary Prophylaxis of Bleeding in Children With High-Risk Gastroesophageal Varices. J Pediatr Gastroenterol Nutr 2022; 75:491-496. [PMID: 35706101 DOI: 10.1097/mpg.0000000000003529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Primary prophylaxis of bleeding is debated in children with gastroesophageal varices; one of the reasons is the limited number of studies concerning its efficacy and safety. We report our experience with endoscopic primary prophylaxis. METHODS From 2006 to 2019, 145 children (median age, 3.5 years; cirrhosis, n = 116) with high-risk gastroesophageal varices underwent primary prophylaxis (banding, n = 114; sclerotherapy n = 31, primarily in smaller children). RESULTS We observed the eradication of varices in 93% of children after a mean of 6 months, at least one recurrence of varices in 45% after eradication, and gastrointestinal bleeding in 17% of children. Irrespective of the cause of portal hypertension, grade 3 esophageal varices, presence of gastric varices along the cardia and a lower composite score of endoscopic severity were associated with a worse probability of eradication, a longer time to eradication and a lower risk of a first recurrence and of bleeding following the procedure, respectively. Ten-year probabilities of overall survival and of bleeding-free survival were 95% and 75%, respectively. CONCLUSIONS Endoscopic primary prophylaxis of variceal bleeding is reasonably effective and safe in children with high-risk gastroesophageal varices. Worse results are observed in children with more advanced endoscopic features. This pleads for endoscopic screening in children with portal hypertension and early detection of varices warranting primary prophylaxis.
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A Model for Early Endoscopic Detection of High-Risk Gastroesophageal Varices in Children With Biliary Atresia. J Pediatr Gastroenterol Nutr 2022; 74:643-650. [PMID: 34984987 DOI: 10.1097/mpg.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE In children with biliary atresia and portal hypertension, progression to gastroesophageal varices carrying a risk of bleeding depends on age, total serum bilirubin concentration and initial endoscopic features. We report an attempt to use these factors for early detection of high-risk varices (HRVs). METHODS Based on different combinations of these factors, a model was set to estimate the probabilities of emergence of HRVs at various time intervals. A 10% probability was chosen to set the date of the next endoscopy in children who did not display HRVs initially. A total of 113 children without HRVs who underwent their first endoscopy before age 8 in 2013-2020 were included. A comparison was made with children seen during the period 1990-2012 when this model was not used. RESULTS In all, 65 of the 113 children underwent one to five additional endoscopies at dates set according to the model. The emergence of HRVs was recorded in 22 children after a mean interval of 14 months and was managed by endoscopic primary prophylaxis in all but one who underwent liver transplantation. Three other children bled before the next planned endoscopy. Compared with 175 children of the same age ranges without HRVs in the period 1990-2012, the use of the model was associated with a faster detection of HRVs with a lower number of endoscopic procedures (P = 0.0022 and P = 0.023, respectively). CONCLUSION The results suggest that the model reported may be a useful tool for the early detection of HRVs to allow primary prophylaxis of bleeding.
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Bello FPS, Cardoso S, Tannuri AC, Preto-Zamperlini M, Schvartsman C, Farhat SCL. Acute upper gastrointestinal bleeding due to portal hypertension in children: What is the best timing of endoscopy? Dig Liver Dis 2022; 54:63-68. [PMID: 34625365 DOI: 10.1016/j.dld.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare initial clinical/laboratory parameters and outcomes of mortality/rebleeding of endoscopy performed <12 h(early UGIE) versus endoscopy performed after 12-24h(late UGIE) of ED admission in children with acute upper gastrointestinal bleeding(AUGIB) due to portal hypertension. METHODS This is a retrospective cohort study. From January 2010 to July 2017, medical records of all children admitted to a tertiary care hospital with AUGIB due to portal hypertension were reviewed until 60 days after ED admission. RESULTS A total of 98 ED admissions occurred from 73 patients. Rebleeding was identified in 8/98(8%) episodes, and 9 deaths were observed. UGIE was performed in 92(94%) episodes, and 53(58%) of them occurred within 12 h of ED admission. Episodes with early UGIE and late UGIE were similar in terms of history/complaints/laboratory data at admission, chronic liver disease associated, AUGIB duration, and initial management. No statistically significant associations were found between early UGIE and the outcomes of death/rebleeding and prevalence of endoscopic hemostatic treatment (band ligation or sclerotherapy) compared to late UGIE. In the multivariable logistic regression model, the endoscopic hemostatic treatment showed a negative association with early UGIE(OR=0.33;95%CI=0.1-0.9;p = 0.04). CONCLUSIONS This study suggests that in pediatric patients with AUGIB and portal hypertension, UGIE may be performed after 12-24 h without harm to the patient, facilitating better initial clinical stabilization/treatment and optimization of resources.
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Affiliation(s)
| | - Silvia Cardoso
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Endoscopy Unit, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Pediatric Surgery Unit Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ana Cristina Tannuri
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Marcela Preto-Zamperlini
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Cláudio Schvartsman
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Sylvia Costa Lima Farhat
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil.
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Non-invasive Predictors of Esophageal Varices With a High Risk of Bleeding in Pediatric Cirrhotic Patients. J Pediatr Gastroenterol Nutr 2021; 72:802-806. [PMID: 33399326 DOI: 10.1097/mpg.0000000000003039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate non-invasive predictive factors of varices with a high risk of bleeding in pediatric cirrhotic patients. METHODS This retrospective, cross-sectional study included data from 158 children with cirrhosis, median age of 5.38 years (interquartile [IQ] 2.08-11.52 years), and no history of upper gastrointestinal bleeding. Patients underwent an endoscopy to screen for esophageal varices. Varices with a high risk of bleeding were defined as those with a medium to large caliber, presence of red spots, or the presence of gastric varices and identified as high-risk varices (HRV). Laboratory and clinical factors were evaluated as possible predictors of HRV. RESULTS HRV were detected in 30 children (19%) after the first endoscopy. In the multivariate analysis, only the risk score (RS), as described by Park et al, and the aspartate aminotransferase-to-platelet ratio index (APRi) were predictive of HRV. The best non-invasive predictor of HRV was the RS with an area under the receiver operating characteristic curve of 0.764. When used a cut-off point of -1.2, the sensitivity of the RS was 90% and specificity was 53%. The use of RS or APRi correctly identified 96% of children with HRV. CONCLUSIONS The described predictors allow the correct identification of patients with HRV. The association of RS >-1.2 or APRi >1.4 has a good sensitivity to identify HRV and to prevent unnecessary endoscopy in about one-third of children with no HRV.
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Razek AAKA, Hafez MM, Mahmoud W, Ismail AR, Ali KM, Barakat TE. Diffusion tensor imaging of the spleen in prediction and grading of esophageal varices in cirrhotic children with portal hypertension. Jpn J Radiol 2021; 39:907-913. [PMID: 33914254 DOI: 10.1007/s11604-021-01123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess diffusion tensor imaging (DTI) of spleen in prediction and grading of esophageal varices (OV) in cirrhotic children. METHODS This prospective study was conducted upon 30 children with cirrhotic children with OV and 10 age-gender matched controls that underwent DTI of abdomen. Mean diffusivity (MD) and fractional anisotropy (FA) of spleen were calculated and matched with the grading of OV at endoscopy and laboratory biomarkers of portal hypertension. RESULTS Mean ADC of spleen in patient was significantly different (p = 0.001) from that of controls by both reviewers respectively. The cutoff ADC measurement of the spleen used for prediction of OV was ≥ 0.75 and ≥ 0.76 × 10-3mm2/s with AUC was 0.993 and 0.997 for both reviewers respectively. The FA of the spleen in patient was different (p = 0.01) from of controls of both reviewers respectively. Cutoff FA of spleen used for prediction of OV was ≤ 0.35 and ≤ 0.36 for both observers respectively. ADC and FA of spleen was correlated with platelets count (r = - 0.713, 0.392; p = 0.001, 0.012) and prothrombin time (r = 0.518, - 0.380; p = 0.001, 0.016). CONCLUSION DTI metrics of spleen can predict and grade OV and correlated with laboratory biomarkers of portal hypertension.
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Affiliation(s)
| | - Mona Mohamed Hafez
- Cardiology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Walaa Mahmoud
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 13551, Egypt
| | - Ahmed Ramadan Ismail
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tarek Elsayed Barakat
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Samanta T, Biswas K, Ghosh S, Gupta MK, Basu R, Purkait R, Naskar A, Butta S, Das D, Ganguly S. Validation of Revised Baveno VI Criteria for Screening of Varices Needing Treatment in Children with Cirrhosis. Clin Exp Gastroenterol 2020; 13:503-509. [PMID: 33177858 PMCID: PMC7652065 DOI: 10.2147/ceg.s276182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
Background Baveno VI criteria for screening varices needing treatment (VNT) have not yet been validated in an exclusive pediatric and adolescent set of the population, in whom baseline parameters differ in relation to adults. Therefore, our primary objective was to validate Baveno VI and its expanded form in children below 18 years of age. The secondary aim was to elicit whether any revision of the above criteria with a target of not missing more than 5% VNT could be more accurate for this age group. Materials and Methods The work was carried out in two medical institutes, over a span of 3 years. Consecutively enrolled patients below 18 years of age, with compensated cirrhosis confirmed by liver biopsy, were evaluated for related blood parameters, transient elastography (TE) and esophagogastroduodenoscopy. Results Out of the 33 recruited patients, five (15.15%) met the criteria for VNT. The sensitivity, specificity, PPV and NPV of Baveno VI and Expanded Baveno VI were observed as 60%, 92.3%, 60% and 92.3%, and 20%, 100%, 100% and 88%, respectively. We found that the Revised Baveno VI criteria with TE <19 kPa and platelet count of >175×109 cells/L, with sensitivity 100%, specificity 79%, PPV 45%, NPV 100% and accuracy of 82%, are more appropriate for this age group. Conclusion We propose that further multicentrer studies with a larger sample size should be conducted before incorporating Revised Baveno VI criteria for high-risk varices in patients below 18 years in future guidelines.
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Affiliation(s)
- Tryambak Samanta
- Department of Medical Gastroenterology, Medical College, Kolkata 73, India
| | - Kalidas Biswas
- Department of Medical Gastroenterology, Medical College, Kolkata 73, India
| | - Saubhik Ghosh
- Department of Medical Gastroenterology, Medical College, Kolkata 73, India
| | - Manoj Kumar Gupta
- Department of Medical Gastroenterology, Medical College, Kolkata 73, India
| | - Rajarshi Basu
- Department of Pediatrics, Nil Ratan Sircar Medical College, Kolkata 14, India
| | - Radheshyam Purkait
- Department of Pediatrics, Nil Ratan Sircar Medical College, Kolkata 14, India
| | - Abhisek Naskar
- Department of Pediatrics, Nil Ratan Sircar Medical College, Kolkata 14, India
| | - Shristi Butta
- Department of Pathology, Nil Ratan Sircar Medical College, Kolkata 14, India
| | - Debasis Das
- Department of Community Medicine, Medical College, Kolkata 73, India
| | - Sutapa Ganguly
- Department of Pediatrics, KPC Medical College, Kolkata, India
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Oliveira APPD, Ferreira AR, Fagundes EDT, Queiroz TCN, Carvalho SD, Neto JAF, Bittencourt PFS. Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Oliveira APPD, Ferreira AR, Fagundes EDT, Queiroz TCN, Carvalho SD, Neto JAF, Bittencourt PFS. Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction. J Pediatr (Rio J) 2020; 96:755-762. [PMID: 31666182 PMCID: PMC9432056 DOI: 10.1016/j.jped.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate factors associated with upper digestive hemorrhage and primary and secondary endoscopic prophylaxis outcomes in children with extrahepatic portal vein obstruction. METHODS This observational and prospective study included 72 children with extrahepatic portal vein obstruction who were followed from 2005 to 2017. Risk factors associated with upper digestive hemorrhage and the results of primary and secondary prophylaxis of these patients were evaluated. RESULTS Fifty patients (69.4%) had one or more episodes of bleeding during follow-up, with a median age at first hemorrhage of 4.81 years. The multivariate analysis showed that medium- to large-caliber esophageal varices were associated with an 18-fold risk of upper digestive hemorrhage (95% CI: 4.33-74.76; p < 0.0001). Primary prophylaxis was administered to 14 patients, with eradication in 85.7%; however, 14.3% of these patients had hemorrhages during the follow-up period and 41.7% had a relapse of varices. Secondary prophylaxis was administered to 41 patients. Esophageal varices were eradicated in 90.2% of patients. There were relapse and re-bleeding of esophageal varices in 45.9% and 34.1% of the children, respectively. CONCLUSION Primary and secondary endoscopic prophylaxes showed high rates of esophageal varix eradication, but with significant relapses. Eradication of esophageal varices cannot definitively prevent recurrent upper digestive hemorrhage, since bleeding from alternate sites can occur. Medium- and large-caliber esophageal varices were associated with upper digestive hemorrhage in patients with extrahepatic portal vein obstruction. To the best of the authors' knowledge, this study is the first to evaluate bleeding risk factors in children with extrahepatic portal vein obstruction.
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Affiliation(s)
- Ana Paula Pereira de Oliveira
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Departamento de Pediatria, Grupo de Gastroenterologia Pediátrica, Belo Horizonte, MG, Brazil.
| | - Alexandre Rodrigues Ferreira
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Departamento de Pediatria, Grupo de Gastroenterologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Eleonora Druve Tavares Fagundes
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Departamento de Pediatria, Grupo de Gastroenterologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Thaís Costa Nascentes Queiroz
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Departamento de Pediatria, Grupo de Gastroenterologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Simone Diniz Carvalho
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Departamento de Pediatria, Grupo de Gastroenterologia Pediátrica, Belo Horizonte, MG, Brazil
| | - José Andrade Franco Neto
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Departamento de Pediatria, Grupo de Gastroenterologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Paulo Fernando Souto Bittencourt
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Departamento de Pediatria, Grupo de Gastroenterologia Pediátrica, Belo Horizonte, MG, Brazil
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Clinical effect of single covered stent and double covered stent on TIPS in the treatment of hemorrhage due to rupture of esophageal and gastric varices in cirrhosis and its influence on immune function. Exp Ther Med 2019; 18:4259-4264. [PMID: 31772628 PMCID: PMC6861876 DOI: 10.3892/etm.2019.8106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/02/2019] [Indexed: 11/05/2022] Open
Abstract
Clinical effect of single covered stent and double covered stent in transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of hemorrhage due to rupture of esophageal and gastric varices in cirrhosis and its influence on the immune function of patients was investigated. Altogether 124 patients with liver cirrhosis and esophageal and gastric varices bleeding who were admitted to the First People's Hospital of Neijiang from February 2012 to April 2016 were selected as research objects and divided into group A and B. Group A (65 cases) was treated with simple covered stent, and group B (59 cases) was treated with double covered stent simulating Viatorr technique. The therapeutic effect of the two groups after operation was observed. The changes of portal vein pressure before and after treatment and the changes of esophageal and gastric varices after operation were observed. The levels of peripheral blood T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) were detected by flow cytometry. The therapeutic effect of group B was higher than that of group A (P>0.05). The postoperative portal vein pressure in group B was significantly lower than that in group A (P<0.05). The disappearance rate and overall effective rate of varicose veins in group B were better than those in group A (P>0.05). After three days of treatment, the levels of CD3+, CD4+, CD4+/CD8+ in the peripheral blood of group B were higher than those of group A (P>0.05), while the decline rate of CD3+, CD4+, CD4+/CD8+ in the peripheral blood of group B was higher than that of group A after seven days of treatment. Double-stent simulated Viatorr has a higher effective rate, has a certain improvement on the immune function of patients, and the survival rate is also higher than that of single covered stent, which is worthy of clinical application and promotion.
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