Gastric Varices In Patients Research Articles

Splenic Stiffness Measurement Combined With Liver Stiffness Measurement Compared With Baveno VII Criteria in Predicting the Presence of Oesophageal and Gastric Varices in Patients With Compensated Advanced Liver Cell Disease (cALCD).

Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) is being increasingly used as a screening tool to predict varices. Our aim was to test the utility of Baveno VII criteria and other combinations of LSM, platelet count (PC), and splenic stiffness measurement (SSM) to predict the presence of varices in a cohort of Sri Lankan patients with compensated advanced liver cell disease (cALCD). Consecutive patients with newly diagnosed Child-Pugh class A cALCD (non-viral, BMI<30) were recruited prospectively. They underwent gastroscopy. LSM and SSM were taken using vibration-controlled transient elastography (VCTE) (Echosens FibroScan 502 Touch; Echosens SA, Paris, France) by a single operator who was unaware of endoscopy findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of different Baveno VII criteria to predict the varices and different combinations of LSM, SSM, and PC were also explored. One hundred and seventy-four individuals were recruited. The mean age was 61.4 ((95% CI: 59.7-62.8) years. A total of 110 individuals were males, and 106 had varices. Our results indicated that the three Baveno VII criteria had sensitivities of 61%, 63%, and 42%, and specificities of 79%, 77%, and 87% to predict varices. SSM>30kPa alone and in combination with LSM>15kPa had sensitivities of 81 and 75%, specificities of 72 and 83%, PPVs of 82 and 87%, NPVs of 71% and 67%, and accuracies of 78 and 78%, respectively, to predict varices. Baveno VII criteria had a low sensitivity but high specificity in predicting the presence of varices. However, SSM>30kPa alone or in combination with LSM>15kPa had better sensitivity, specificity, PPV, NPV, and accuracy in predicting varices.

Long-Term Prognosis and Related Factors in Patients with Cirrhosis Treated with Balloon-Occluded Retrograde Transvenous Obliteration

Introduction: Balloon-occluded retrograde transvenous obliteration (BRTO) was developed as an effective treatment for gastric varices in patients with cirrhosis. Because liver fibrosis in these patients is assumed to be advanced, their prognosis is expected to be poor. In this study, we investigated the prognosis and characteristics of the patients. Methods: We enrolled 55 consecutive patients with liver cirrhosis treated with BRTO between 2009 and 2021 at our department. To evaluate factors related to variceal recurrence and long-term prognosis, survival analysis was performed on 45 patients, excluding those who died within 1 month, had an unknown prognosis, or whose treatments were converted to other treatments. Results: During a mean follow-up period of 2.3 years, esophageal varices recurred in 10 patients and could be treated endoscopically. Non-alcoholic steatohepatitis (NASH) was related to the variceal recurrence (hazard ratio [HR] = 4.27, 95% CI: 1.17–15.5, p = 0.028). The survival rate after the procedure at 1, 3, and 5 years was 94.2%, 74.0%, and 63.5%, respectively, and 10 patients died of hepatocellular carcinoma (n = 6), liver failure (n = 1), sepsis (n = 1), and unknown reasons (n = 2). The estimated glomerular filtration rate (eGFR) level was proved to be a significant poor prognostic factor (HR = 0.96, 95% CI: 0.93–0.99, p = 0.023). The comorbid hypertension (HTN) was the main cause of low eGFR, and HTN was also significantly related to survival (HR = 6.18, 95% CI: 1.57–24.3, p = 0.009). Most of the patients with HTN were treated with calcium channel blocker and/or angiotensin receptor blocker. Conclusion: The clinical course of patients with cirrhosis treated with BRTO was dependent on the metabolic factors including renal function, comorbid HTN, and NASH.

Gastric varices amongst patients with upper gastrointestinal bleeding

Background: The term "upper gastrointestinal bleeding" refers to bleeding from the gastrointestinal system that occurs above the Treitz ligament. It is one of the gastroenterological problems that is seen most often in clinical settings by gastroenterologists. Objective: To assess the frequency of gastric Varices amongst patients with upper gastrointestinal bleeding. Methodology: Our study was descriptive-cross sectional study, carried out at the Gastroenterology Department…….hospital Peshawar for duration of six months from August 2022 to January 2023. A careful upper-gastrointestinal endoscopy was carried out. Endoscopic findings of gastric varices in patients were recorded on a designed proforma for our research. All the documented data was analyzed by using 23. Results: In our current study a total of 120 patients were included. The male were 67 (55.83%) whereas female patients were 53 (44.17%). The mean age (SD) was 36 (9.11) years. The overall frequency of gastric varices amongst patients with gastrointestinal bleeding was 24 (20%). Conclusion: Our study concludes that frequency of gastric varices amongst patients with upper-gastrointestinal bleeding is very high. Multiple centre studies with large sample size should be conducted to get better results.

Nylon ring with titanium clip assists endoscopic cyanoacrylate injection for the treatment of GOV1-type gastric varices.

There is an estimated approximately 20 % chance of having gastric varices in patients with portal hypertension [1]. Gastric varices bleed less frequently than esophageal varices but are much more severe when they do occur. Therefore, effective treatment of such bleeding or prevention of rebleeding is vital. According to the Baveno VI Consensus Symposium, endoscopic injection of cyanoacrylate is the recommended treatment for hemostasis and prevention of rebleeding from gastric varices [2] (de Franchis and Baveno 2015). However, a number of serious adverse events has been reported including ectopic embolism, especially in bleeding patients with gastric varices and gastrorenal shunts (GOV2 or IGV1 varices) [3] [4]. As an alternative to endoscopic therapy guided by endoscopic ultrasound (EUS) and balloon-occluded retrograde transvenous obliteration, we hope to provide a new simple and effective method for the treatment of GOV1 gastric varices. By using nylon rings and clips we attempted to completely block blood flow to the gastric varices before injecting cyanoacrylate into the gastric varices. This method can effectively reduce the risk of ectopic embolism in GOV1 gastric varices and reduce the dosage of cyanoacrylate.

Platelet Spleen Index is a Noninvasive Technique to Detect Esophageal Varices in Cirrhotics

Background: noninvasive esophageal parameters may prevent the need for an esophagogastroduodenoscopy. Liver cirrhosis patients may benefit from the PC/SD ratio and the platelet count to spleen diameter (PC/SD) ratio, both of which are noninvasive yet useful indicators of liver cirrhosis progression. Objective: This study aimed to evaluate the diagnostic accuracy of the platelet spleen index for the diagnosis of gastric varices in patients with cirrhosis, using esophagogastroduodenoscopy as the reference standard. Methodology: A-Cross-sectional descriptive validation The study was conducted over the course of three months, from October, 2019 to December 2019. At the Gastroenterology A tertiary care hospital. The study comprised 90 participants. In addition to the requisite blood tests, abdominal ultrasonography was used to evaluate the size of the spleen. TYPE SIZE The sensitivity is 83%, the specificity is 66%, and the accuracy is 83% Variations were found in 24% of cirrhotic individuals. Cirrhosis was defined in accordance with the operational definition. Patients' blood samples were collected at the hospital laboratory for a complete blood count, abdominal ultrasound was performed in the Radiology department, and upper GI endoscopy was performed in the endoscopic suite for screeningpurposes. Results: With reverence to study the ages of the study's patients varied from 55.0 to 89.8. Ninety patients (44.7%) were women, while the remaining 48 (55.3%) were males. Hepatitis C was the most common diagnosis (almost 50%), followed by hepatitis B, cryptogenic cirrhosis, and Wilson's disease. Hepatitis A and B accounted for the remaining cases. (1.2% of the total). There were three distinct severity levels for esophageal varices. 12 patients (14.2%), 23 patients (27.7%), 32 patients (37.7%), and 38 esophageal varies (21.8%). Out of the total 90, 69.5% were determined to be in Child's Pugh stage A, 24.9% in stage B, and 4.7% in grade C. In a two-by-two table, we calculated the likelihood ratio (sensitivity plus specificity plus positive and negative predictive values) of the platelet spleen index for the diagnosis of gastro esophageal varices, and it came out to 78%. A ROC curve was also generated. The patients were stratified according to their age, gender, the cause of their cirrhosis, and the severity of their condition. Practical implications: This study will provide data to the health care workers to use non-invasive technique to lower procedure costs and associated complications to detect Esophageal varices in cirrhotics Conclusion: It is possible that the amount of unnecessary esophagogastroduodenoscopies may be reduced if a noninvasive method for diagnosing gastroesophageal varices were widely used. keywords: Esophageal varies, Cirrhosis, Platelet spleen index, Non invasive method, esophagogastroduodenoscopy

Our Experience in the Treatment of Bleeding From Esophageal and Gastric Varices in Patients With Hepatic Cirrhosis

An analysis of the results of conservative and surgical treatment of bleeding from esophageal and gastric varices in patients with hepatic cirrhosis over a 10-year period is presented. The results obtained indicate unsatisfactory results of conservative treatment due to the use of expectant conservative tactics, low surgical activity in relation to the treatment and prevention of esophageal-gastric bleeding. Early performance of surgical interventions according to the proposed combined method allows to improve the results of treatment in patients with sub- and decompensated stages of hepatic cirrhosis.

Results of Surgical Treatment of Bleeding From Esophageal and Gastric Varices in Patients With Hepatic Cirrhosis

The article presents the results of surgical treatment of bleeding from esophageal and gastric varices in patients with sub- and decompensated hepatic cirrhosis. The study included 62 patients. The average age was 46.7±15.2 years. The vast majority of patients had clinical signs of severe hepatic failure in accordance with the Child-Pugh criteria (class B — 24, class C — 38 patients). Among the patients, two groups were identified. In the control group, 20 patients underwent suturing of varicose veins (operation by M. D. Patsiora) due to the failure of conservative treatment. In the main group, 42 patients were operated on in a combined way in the early stages from the moment of admission. The results obtained indicated an increase in the survival rate of patients in the stage of sub- and decompensation, operated on in the early stages and by the proposed combined method.

Dynamic Changes and Nomogram Prediction for Sinistral Portal Hypertension in Moderate and Severe Acute Pancreatitis.

ObjectivesTo investigate the dynamic changes in gastric varices in patients with acute pancreatitis (AP) and to develop a novel nomogram for the early prediction of sinistral portal hypertension (SPH).MethodsThis was a retrospective, case-control study with an analysis of the quantitative, dynamic computed tomography imaging results of SPH in patients with moderate and severe AP with a long-term follow-up. Multivariate logistic regression analysis and nomogram were employed.ResultsThe SPH group (n = 94) and non-SPH group (n = 94) were matched. The dynamic changes showed an increasing trend in the diameter of gastric fundus, short gastric, gastric coronary, and gastroepiploic veins, which did not recover during the one-year follow-up. Multivariate analysis showed that male (adjusted odds ratio (adjOR), 8.71; 95% confidence interval (CI), 2.86–26.53; P < 0.001), body mass index ≥27.5 kg/m2 (adjOR, 5.49; 95% CI, 1.85–16.29; P = 0.002), prothrombin time ≥12.6 s (adjOR, 2.82; 95% CI, 1.11–7.17; P = 0.03), and the patency of splenic vein [stenosis (adjOR, 8.48; 95% CI, 2.13–33.71; P = 0.002), and occlusion (adjOR, 34.57; 95% CI, 10.87–110.00; P < 0.001)] were independently associated with the development of SPH. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.92 (95% CI, 0.87–0.95).ConclusionThe dynamic changes in varices in SPH are long-term and slowly progressing. Males and obese patients with abnormal splenic veins and coagulopathies are at high risk for developing SPH. A simple nomogram tool helps in the early, accurate prediction of SPH.

Prediction model of high risk esophageal and gastric varices in patients with compensated hepatitis B cirrhosis: A case-control study

Prediction model of high risk esophageal and gastric varices in patients with compensated hepatitis B cirrhosis: A case-control study

Left Gastric Vein Width Is an Important Risk Factor for Exacerbation of Esophageal Varices Post Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices in Cirrhotic Patients.

Background and Objectives: Balloon-occluded retrograde transvenous obliteration (BRTO) could be currently one of the best therapies for patients with gastric varices. This study examined the exacerbation rates for esophageal varices following BRTO for gastric varices in patients with hepatic cirrhosis. Materials and Methods: We enrolled 91 cirrhotic patients who underwent BRTO for gastric varices. In total, 50 patients were examined for exacerbation rates of esophageal varices following BRTO. Esophageal varices and their associated exacerbation were evaluated by upper gastrointestinal endoscopy. Patients were allocated into two groups according to the main inflow tract for gastric varices: (1) 37 patients in the left gastric vein (LGV) group with an LGV width of more than 3.55 mm, and (2) 13 patients in the non-LGV group who had short gastric vein or posterior gastric vein. Moreover, treatment outcomes were retrospectively analyzed. Results: LGV width (p < 0.01) was the major risk factor for the deterioration of esophageal varices post BRTO. In addition, LGV was the most common inflow tract, and the LGV group contained 74% (37/50) of patients. The exacerbation rates of esophageal varices at 1, 2, 3, and 4 years post BRTO were 40%, 62%, 65%, and 68%, respectively. The comparison of the exacerbation rates for esophageal varices following BRTO according to inflow tract showed that the exacerbation rates were significantly higher in the LGV group than those of the non-LGV group (p = 0.03). In more than half of the subjects, LGV was the main inflow tract for gastric varices, and this group experienced more frequent exacerbations of esophageal varices following BRTO compared to patients with different inflow tract sources. Conclusion: Careful attention should be paid to the LGV width when BRTO is performed for gastric varices.

Frequency of Gastric Varices in patients presenting with upper gastrointestinal bleed

Aim: To establish the frequency of gastric varices in patients presenting with upper GI bleed. Study design: Descriptive cross sectional study. Place and duration of study: Department of Gastroenterology, Hayatabad Medical Complex, Peshawar from 11th May 2018 to 11th November 2018. Methodology: Ninety three patients with upper GI bleed were enrolled. After brief history and clinical evaluation, prompt resuscitation was done. Patient underwent a careful upper GI endoscopic evaluation after initial resuscitation. All endoscopic procedures were carried out by a single gastroenterologist of at least assistant professor level to detect gastric varices. All the information’s collected were recorded Results: The mean age was 37±12.2 years. Fifty four percent patients were male while 46% patients were female. Twenty two percent patients had gastric varices while 78% patients didn’t had gastric varices. Conclusion: The frequency of gastric varices was 22% in patients presenting with upper gastrointestinal bleed. Key words: Gastric varices, Upper, Gastrointestinal bleed

ASSESSMENT OF PLATELET COUNT AND DOPPLER ULTRASOUND ON HEPATIC AND SPLENIC VENOUSSYSTEM AS NON-INVASIVE PREDICTORS OF GASTRIC VARICES IN PATIENTS WITH LIVER CIRRHOSIS

Background: Gastric varices are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Objective: To assess platelet count and doppler ultrasound on hepatic and splenic venous system as non-invasive predictors of gastric varices in patients with liver cirrhosis with no history of previous endoscopic or surgical intervention for portal hypertension. Patients and Methods: An observational case control study was accomplished at Al-Azhar University Hospitals, Hepatogastroenterology and infectious diseases Departments, at Cairo from September 2018 to December 2019. One hundred and twenty patients with liver cirrhosis without past history of previous endoscopic or surgical intervention for portal hypertension were selected, and divided into three equal main groups:Group A: Cirrhotic patients without varices, Group B: Cirrhotic patients with esophageal varices only, and Group C: Cirrhotic patients with gastric varices, which divided into two subgroups: Group Ca:Six patients with isolated gastric varices and Group Cb:Thirty four patients with gastroesophageal varices. All patients were subjected to upper gastrointestinal endoscopy,complete blood picture (CBC) and abdominal Doppler ultrasonography study on hepatic and splenic venous systems. Results: Group Cb recorded the highest values of splenic size (P<0.001), ascites (p=0.006), portal vein diameter (P<0.001) and collaterals (P<0.001) compared to other groups. Group Ca recorded the lowest values of the mean portal vein flow velocity (MPVV)(p < 0.001), the mean splenic vein flow velocity(M.SVV) (P=0.026), and recorded the highest values of portal vein congestion index (P.CI) (P<0.001), portal vein thrombosis (PVT)(P<0.001), the mean values of the splenic vein diameter (P<0.001), cross sectional area of splenic vein (p < 0.001), splenic vein congestion index(S.CI) (p < 0.001), as well as abnormal blood direction in splenic vein(P=0.019) compared to other groups. Also, portal vein cross sectional area and the Child-Turcotte-Pugh score class “C” showed statistically significant difference (p < 0.001) between group A which recorded the lowest value compared to group B which recorded the highest value. Also, platelet count recorded no statistically significant difference between the four groups. Conclusion: Doppler ultrasound can be an easy, cheap and safe predictor of gastric varices, while platelet count has no any significance in predicting of gastric varices.

Prognostic Nomogram model for the efficacy of endoscopic treatment in gastric varices caused by liver cirrhosis

Objective To predict the efficacy of endoscopic tissue adhesives in the treatment of gastric varices in patients with liver cirrhosis by Nomogram model. Methods From August 2014 to September 2017, 158 patients with liver cirrhosis caused esophagogastric variceal bleeding and received endoscopic tissue adhesives treatment at Zhongshan Hospital, Fudan University were collected. All patients were followed for 12 months. The primary outcome was rebleeding. The factors of rebleeding after endoscopic treatment of esophagogastric varices were analyzed. Nomogram prognostic model was developed and compared with Child-Pugh grading, computed tomography angiography (CTA) and hepatic venous pressure gradient (HVPG) in prognostic accuracy in rebleeding after endoscopic treatment in liver cirrhosis caused esophagogastric varices. Univariate and multivaricate Cox regression analysis, Kaplan-Meier curve and log-rank test were performed for statistical analysis. Results During the follow-up, rebleading occurred in 18 cases (11.4%), 37 cases (23.4%) and 49 cases (31.0%) at 2, 6, and 12 months after endoscopic treatment. The results of univariate Cox regression analysis showed the risk factors of rebleeding after endoscopic treatment of gastric varices included gender, alcoholic liver cirrhosis, diabetes mellitus, Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence vs. absence) HVPG ( 3 points), injection volume of tissue adhesive (≤ 3 mL vs. > 3 mL) (hazard ratio (HR)=0.575, 2.018, 1.562, 3.433, 2.945, 1.859, 2.743, 0.324, 1.840, 1.477, and 1.716; 95% confidence interval (CI) 0.305 to 1.084, 0.902 to 4.514, 1.753 to 6.724, 1.663 to 5.217, 1.012 to 3.415, 0.852 to 8.830, 0.079 to 1.335, 1.012 to 3.317, 0.839 to 2.602, and 0.935 to 3.152; all P<0.2). The results of multivariate Cox regression analysis indicated that Child-Pugh grade, extraluminal vessels by CTA, and HVPG (HR = 2.095, 95% CI 1.099 to 3.995, P = 0.025) were all independent risk factors of rebleeding after endoscopic treatment of gastric varices (HR=2.665, 2.886, and 2.095; 95% CI 1.339 to 5.300, 1.580 to 5.271, and 1.099 to 3.995; all P<0.05). Kaplan-Meier curves showed that Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence or absent) and HVPG (<16 mmHg vs. ≥16 mmHg) could effectively predict cumulative non-rebleeding rate in one year after endoscopic treatment of gastric varices, and the differences were statistically significant (all P<0.05). Receiver operataring characteristic curve analysis demonstrated that the predictive value of the model combined with Child-Pugh grade, extraluminal vessels on CTA and HVPG was higher than that of Child-Pugh grade and HVPG (AUC=0.746, 0.673 and 0.585; 95% CI 0.662 to 0.829, 0.583 to 0.762, and 0.486 to 0.683; P<0.01, P=0.001 and P=0.089, respectively). Patients were divided into low, medium, and high-risk groups according to the 25th and 75th percentiles of the Nomogram score. The results showed that Nomogram model could effectively distinguish high-risk groups of rebleeding after endoscopic treatment of gastric varices, and the difference was statistically significant (P <0.01). Conclusions Extraluminal vessels on CTA, HVPG and Child-Pugh grade are independent prognostic evaluation indexes of rebleeding after endoscopic treatment of gastric varices. The predictive accuracy of Nomogram model based on these three prognostic factors may be better than Child-Pugh grade and HVPG. Key words: Liver cirrhosis; Prognosis; Nomograms; Gastric varices; Endoscopic treatment

Endoscopic Therapy and Radiologic Intervention of Acute Gastroesophageal Variceal Bleeding.

Acute gastroesophageal variceal hemorrhage is a dreaded complication in patients with liver cirrhosis. Endoscopic therapy and radiologic intervention for gastroesophageal bleeding have rapidly developed in the recent decades. Endoscopic treatment is initially performed to stop variceal hemorrhage. For the treatment of esophageal variceal bleeding, endoscopic variceal ligation (EVL) is considered the endoscopic treatment of choice. In cases of gastric variceal hemorrhage, the type of gastric varices (GVs) is important in deciding the strategy of endoscopic treatment. Endoscopic variceal obturation (EVO) is recommended for fundal variceal bleeding. For the management of gastroesophageal varix type 1 bleeding, both EVO and EVL are available treatment options; however, EVO is preferred over EVL. If endoscopic management fails to control variceal hemorrhage, radiologic interventional modalities could be considered. Transjugular intrahepatic portosystemic shunt is a good option for rescue treatment in refractory variceal bleeding. In cases of refractory hemorrhage of GVs in patients with a gastrorenal shunt, balloon-occluded retrograde transvenous obliteration could be considered as a salvage treatment.

A randomized controlled study of CT portograph combined with endoscopic ultrasonography for the precision treatment of esophagogastric varices in patients with cirrhosis

Objective To investigate the efficacy and safety of CT portograph combined with endoscopic ultrasonography for the pricision treatment of esophagogastric varices in patients with cirrhosis. Methods A total of 130 inpatients with cirrhosis complicated with esophagogastric variceal bleeding who received endoscopic treatment from January 2013 to January 2015 were selected. Using prospective randomized controlled design, the patients were divided into two groups, the experimental group and the control group, with 65 cases in each group. The number and degree of esophagogastric varices were assessed by CT portography in the experimental group. Then endoscopic ultrasonography was used to assess the paraesophageal vein and perforator vein before endoscopic treatment. The range and degree of esophagogastric varices were observed and the lesions were treated by endoscopy in the control group. Results A total of 62 patients completed the study in the experimental group, and 63 in the control group. The number of treatment was significantly lower in the experimental group than that in the control group(3.00±0.76 VS 5.63±0.92, P=0.000). The disappearance time of varices was significantly shorter in the experimental group than that in the control group(7.25±1.16 months VS 8.88±1.64 months, P=0.039). The variceal recurrence rate of the experimental group was significantly lower than that of the control group [1.6% (1/62) VS 12.7% (8/63), P=0.040]. The incidence of pleural effusion was significantly lower in the experimental group than that in the control group[0(0/62) VS 9.5% (6/63), P=0.040]. The total complication rate was significantly lower in the experimental group than that in the control group[27.4% (17/62) VS 58.7% (37/63), P=0.003]. Conclusion CT portography combined with endoscopic ultrasonography is safe and effective for esophageal gastric varices in patients with cirrhosis. Key words: Ultrasonography; Liver cirrhosis; Esophageal and gastric varices; CT portography; Endoscopic precise therapy

Progress in endoscopic treatment of gastric varices in patients with liver cirrhosis

Progress in endoscopic treatment of gastric varices in patients with liver cirrhosis

Effects of endoscope combined with drug therapy on the hemorrhage of esophageal varicose veins in cirrhosis

Objective To observe the clinical effect of endoscope combined with drug therapy in the treatment of hemorrhage of esophageal and gastric varices in patients with cirrhosis, thus to provide reference for clinical diagnosis and treatment. Methods From January 2017 to January 2018, 58 liver cirrhosis patients with ruptured esophageal gastric varices bleeding in Tongji Huangzhou Hospital of Huazhong University of Science and Technology were selected and divided into two groups by random number table method, with 29 cases in each group.The control group was treated with somatostatin alone.The observation group was treated with somatostatin combined with endoscopic therapy.The clinical efficacy of the two groups was compared, and the clinical indicators and the changes of indices of TCM syndromes before and after treatment were compared between the two groups. Results The total effective rate of the observation group was 89.8%, which was higher than 79.3% of the control group, and the difference was statistically significant(χ2=9.75, P<0.01). After treatment, the pain, abdominal distention, poor appetite, nausea, weakness of the body tired, depression, boredom, loose stool and other syndromes index scores of two groups were improved obviously, the improvements in the observation group was better than those in the control group, and the differences were statistically significant(t=8.847, 9.470, 7.833, 8.120, 9.029, 8.120, 9.029, all P<0.05). After treatment, the white blood cells, platelets of the two groups were increased, the spleen length to diameter, thickness of spleen, portal venous trunk, spleen vein diameter of the two groups were reduced, the improvements in the observation group was better than those in the control group, and the differences were statistically significant(t=8.934, 8.923, 8.933, 9.463, 9.478, 9.463, all P<0.05). Conclusion Endoscope combined with drugs in the treatment of cirrhotic esophageal variceal hemorrhage has significant clinical efficacy, and can effectively improve the patients' TCM syndrome score and clinical indicators. Key words: Endoscopy; Somatostatin; Liver cirrhosis; Esophageal and gastric varices; Hemorrhage

864 SUCCESSFUL EUS-GUIDED TREATMENT OF GASTRIC VARICES WITH COIL EMBOLIZATION AND INJECTION OF ABSORBABLE GELATIN SPONGE

Gastric varices occur in 15-20% of patients with portal hypertension and are associated with significant gastrointestinal bleeding and high mortality. Endoscopic options are currently limited in patients with bleeding gastric varices. Here, we report our experience with endoscopic ultrasound-guided coil embolization and injection of absorbable gelatin sponge for the treatment of gastric varices. A 51 year old female with alcoholic cirrhosis, complicated by ascites, hepatic encephalopathy, and known type 1 gastric varices, presents to the hospital with hematemesis. She was deemed by interventional radiology to not be a suitable candidate for either transjugular intrahepatic portosystemic shunt (TIPS) or balloon occluded retrograde transvenous obliteration (BRTO). It was therefore decided to offer EUS-guided treatment of her gastric varices. On EUS, four large collections of gastric varices were visualized, each with multiple individual compartments measuring 7-12 mm in short axis. Multiple varices were seen to directly contact the surface of the fundus. Using a 19 gauge EUS needle, a collection of gastric varices was punctured, followed by deployment of multiple 20 mm x 14 cm and 20 mm x 7 cm embolization coils. Following coil embolization, there was immediate obliteration of Doppler flow. After multiple coils were deployed, and contrast injections ruled out the presence of a gastrorenal shunt, additional injection was performed of absorbable gelatin sponge (prepared as a slurry) in order to further enhance variceal eradication. The process was then repeated until all four collections of gastric varices were eradicated. In total, eight vascular coils were deployed. The patient tolerated the procedure well and has not had recurrent bleeding on follow-up. EUS guided coil embolization and injection of absorbable gelatin sponge is a feasible and effective technique for the endoscopic management of symptomatic gastric varices in patients considered to be poor candidates for standard treatments such as TIPS and BRTO. This case highlights the advantages of coil embolization and absorbable gelatin sponge application, as well as the benefit of EUS guidance, over traditional direct cyanoacrylate injection for the endoscopic management of gastric varices.

PRIMARY PREVENTION OF BLEEDING FROM ESOPHAGEAL AND GASTRIC VARICES IN PATIENTS WITH PORTAL HYPERTENSION

The problem of primary prevention of bleeding from esophageal and gastric varices in patients with portal hypertension is discussed in the review. It was analyzed main views on the mechanisms of bleeding whose study is important to define pathogenetic primary prevention. The role of accurate diagnosis of the esophageal and gastric varices state is presented to predict the risk of bleeding. It was reviewed the variants of primary prevention of bleeding using medical, endoscopic, surgical and X-ray endovascular techniques. Also different drugs for primary prevention of bleeding were characterized depending on main disease nature and degree of compensation. Minimally invasive methods for primary prevention including endoscopic, endovascular techniques and medical therapy were compared. The authors discuss some unsolved problems of primary prevention of bleeding in patients with intrahepatic and extrahepatic portal hypertension, as well as in primary distribution of varices in stomach.

Feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease.

Background and study aims Screening for esophageal and gastric varices is indicated for patients with portal hypertension or cirrhosis. Typically, conventional endoscopy is used; however, the need for sedation increases the costs and risks, especially in cirrhotic patients. Use of transnasal endoscopy with an ultrathin endoscope enables study of the upper gastrointestinal tract without the need for sedation. The objective of this study is to evaluate the feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease. Patients and methods This was a prospective study in which transnasal endoscopy was carried out in patients with cirrhosis or portal hypertension who had indications for screening of esophageal and gastric varices. The following variables were evaluated: demographical data, duration of procedure, patient tolerance and acceptance, adverse events (AEs), endoscopic findings and interobserver agreement related to portal hypertension alterations ( kappa index). Results A total of 50 patients entered the study. The most common cause of liver disease was chronic viral hepatitis (66 %). Among the cirrhotic patients, most of the patients were Child-Pugh A (74 %). In 5 patients (10 %), nasal intubation was not possible. Two patients (4 %) experienced minor epistaxis. Tolerance was excellent or good in 92 % according with a visual analogic scale. In 16 patients (32 %), esophageal varices were detected and in 2 patients (4 %) gastric varices were detected. The mean duration of the procedure was 7 minutes. Conclusions Transnasal endoscopy is feasible, effective and well tolerated for screening of esophageal and gastric varices in patients with chronic liver disease. It can be performed in outpatient clinics safely and without the use of sedation.