Varices In Patients Research Articles

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.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

Non-invasive evaluation of esophageal varices in patients with liver cirrhosis using low-dose splenic perfusion CT

PurposeTo assess the value of splenic hemodynamic parameters measured using low-dose perfusion CT in the noninvasive evaluation of esophageal varices (EV) in patients with liver cirrhosis. MethodsWe retrospectively studied 43 cirrhotic patients with EV, which were divided into mild (EV1), moderate (EV2) and severe (EV3) groups. 14 patients with normal liver function and no EV were selected as the control group. All patients underwent low-dose splenic perfusion CT and radiation dose were recorded. Spleen perfusion parameters, including blood volume (BV), blood flow (BF) and permeability surface (PS), were obtained. The volume of the spleen (V-S) was measured. The total blood volume of the spleen (BV-S) was obtained using the product of V-S and BV. The measurement differences among the four groups were analyzed using ANOVA with Welch correction. Least Significant Difference (LSD) was used for the multiple comparison. P < 0.05 was considered statistically significant. ResultsThere were statistically significant differences in BV, BF, PS, V-S, and BV-S among different groups (p < 0.05). PS, V-S, and BV-S were higher, and BV and BF were lower in the study groups than those in the control group. There was a statistically significant difference between EV2 and EV1 groups, and EV2 and EV3 groups in BV and BF. The average dose-length product (DLP) was 1286.41 ± 261.15 mGy*cm, and the effective radiation dose（Deff）was 19.30 ± 3.92 mSv. ConclusionThe splenic perfusion parameters obtained in the low-dose splenic perfusion CT could be used to noninvasively evaluate the degrees of EV in cirrhotic patients.

Platelet count/spleen diameter ratio as a predictor of high-risk esophageal varices in patients with liver cirrhosis

Platelet count/spleen diameter ratio as a predictor of high-risk esophageal varices in patients with liver cirrhosis

Combined Pharmacological and Endoscopic Treatment for Worsening Gastroesophageal Varices in Patients with Cirrhosis.

BackgroundAt the present time, in patients with liver cirrhosis and gastroesophageal varices, primary prophylaxis of variceal bleeding made with combination therapy with non-selective β-blockers (NSBBs) and endoscopic band ligation (EBL) is not recommended. The aim of this study was to evaluate if patients with worsening varices while on NSBBs regimen benefit, in terms of bleeding and survival, from adding treatment with EBL.MethodsPatients with cirrhosis and endoscopic finding of gastroesophageal varices with high risk feature (increased variceal size and/or development of red signs) during primary prophylaxis with NSBBs, followed at the Unit of Internal Medicine and Hepatology, University and General Hospital of Padova, Italy, from 2012 to 2019, were retrospectively evaluated. When an increased bleeding risk of the varices was confirmed, patients maintained the pharmacological therapy alone or underwent also EBL. The primary endpoint of the study was the rate of variceal bleeding, the secondary endpoint was mortality at 30 months.ResultsCompared to patients treated only with NSBBs (n=56), in patients treated also with EBL (n=45), the 30‐month probability of variceal bleeding (29.1% vs 5.1%; P =0.036) was significantly reduced, while the probability of survival was similar (59.6% vs 65.7%; P=0.61). On multivariate analysis, treatment with EBL was found to be a weak protective factor for mortality (HR 0.47, P=0.044).ConclusionIn patients with liver cirrhosis, when varices show endoscopic feature of increased haemorrhagic risk, adding EBL to NSBBs is effective in reducing the probability of first bleeding.

Correlation between Serum Ascites Albumin Gradient and Endoscopic Grading of Esophageal Varices in patients with cirrhosis

Introduction: The serum-ascites albumin gradient (SAAG) is a medical calculation that can help determine the cause of your ascites. The SAAG may be a more effective discriminator than the usual method of dividing ascites fluid into transudates and exudates. Objective: The objective of this study was to see if there was a link between the serum ascites albumin gradient and the endoscopic grading of esophageal varices in cirrhotic individuals. Materials and Methods: This Cross-sectional study was conducted in Unit II, Department of Medicine, Lahore General Hospital, Lahore during 3-10-2018 to 3-4-2019. A total of 60 patients who met the study's inclusion criteria were included. Blood sample was taken and sent to the laboratory of the hospital for assessment of serum albumin level and SAAG was calculated. Results: Results of this study showed positive moderate correlation between grades of varices and SAAG i.e. r= 0.661, p-value=0.000. Esophageal varices appear to be directly linked to the severity of SAAG. Conclusion: In individuals with cirrhosis, there is a moderately strong significant association between the SAAG and the endoscopic grading of esophageal varices. In cirrhotic individuals, SAAG may be a useful biomarker for EV development. Key words: Correlation, Serum ascites, Albumin, Gradient, Endoscopic, Esophageal, Varices, Cirrhosis

Fontan-associated liver disease.

Fontan-associated liver disease.

Incidence of Esophageal Varices in Patients with Upper Gastrointestinal Bleeding

Objective: To determine the frequency of esophageal varices as a cause of upper gastrointestinal bleeding.&#x0D; Methodology: This descriptive cross sectional study was conducted in the emergency room and the department of medicine Khost Provincial Hospital Khost -Afghanistan. Duration of data collection was six months, starting from January 5, 2021 to June 4, 2021. The study included one hundred and six patients suffered from upper GI bleeding. After initial history and clinical examination, upper GI endoscopy was performed to evaluate the cause of bleeding and all the relevant data was entered in the specific proforma designed by researchers.&#x0D; Results: One hundred and six patients, 60 (56.6%) male and 46 (43.4%)females, of upper GI hemorrhage were included in the study. Mean age was 45.78 years (SD ±14.86) with age range of 21- 85years. Twenty patients (18.86%) had esophageal varices while 28 (26.41%) patients had duodenal ulcer, 31 (29.2%) had gastric ulcer, 14 (13.2%) had Gastric carcinoma,9 (8.49) patients had gastro-duodenal erosions, three patients (2.83%)had Mallory Weiss tear and one patient (0.94) had esophageal growth.&#x0D; Conclusion: In this area (Khost – Afghanistan) where this study was conducted, esophageal varices are the second most common cause of upper GI bleeding.

Screening and surveillance of oesophageal varices in patients with HCV-positive liver cirrhosis successfully treated by direct-acting antiviral agents.

Background & Aimslimited evidence is available to guide hepatologists regarding endoscopic surveillance of oesophageal varices (EV) in Hepatitis C Virus (HCV)‐positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long‐term prospective study on 427 HCV‐positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs).MethodsPatients were divided into two groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favourable Baveno VI status) and Group 2 (335, 78.5%, unfavourable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow‐up of 65.2 months according to Baveno VI recommendations.ResultsAbout 4.3% of Group 1 patients showed baseline EV compared with 30.1% of Group 2 patients (p < .0001). No patients belonging to Group 1 without baseline EV developed EV at follow‐up endoscopy compared with 6.5% in Group 2 patients (p = .02); 69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow‐up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 (p = .001). Improvement in Baveno VI status was observed in 118/335 (35.2%, p < .0001) of Group 2 patients and among those without pre‐therapy EV, none developed EV throughout the follow‐up.ConclusionsHCV‐positive cirrhotic patients cured by DAAs showing baseline favourable Baveno VI status and no worsening during follow‐up can safely avoid endoscopic screening and surveillance. Patients having unfavourable Baveno VI status without baseline EV who improve their status may suspend further endoscopic surveillance.

The use of Spleen Stiffness Measurement for the detection of high-risk esophageal varices in patients with portal hypertension

Introduction: Endoscopic surveillance for esophageal varices (EV) is part of the routine workup for individuals with portal hypertension. High-risk esophageal varices (HR-EV) represent a relevant morbid condition for this population. Recently, spleen stiffness measurement (SSM) has been suggested to stratify patients with EV. We aimed to assess the accuracy of SSM for the detection of HR-EV in individuals with portal hypertension undergoing surveillance endoscopy.

Prediction of high-risk esophageal varices in patients with chronic liver disease with point and 2D shear wave elastography: a systematic review and meta-analysis.

To assess the diagnostic performance of liver stiffness (LS) and spleen stiffness (SS) measured by point shear wave elastography (pSWE) and 2D shear wave elastography (2D-SWE) in the detection of high-risk esophageal varices (HREV) and to compare their diagnostic accuracy. Through systematic search of PubMed, Embase, and Web of Science databases, we included 17 articles reporting the diagnostic performance of LS or SS measured by pSWE or 2D-SWE for HREV. We used a bivariate random-effects model to estimate pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), area under summary receiver operator characteristic curve (AUSROC), and diagnostic odds ratio (DOR). For LS, there was no significant difference between the pooled sensitivity, 0.89 (95% confidence interval CI, 0.81-0.94) vs. 0.8 (95% CI, 0.72-0.86) (p = 0.13), and specificity, 0.81 (95% CI, 0.73-0.87) vs. 0.73 (95% CI, 0.65-0.79) (p = 0.07) of pSWE and 2D-SWE. The AUSROC and DOR of pSWE were higher than those of 2D-SWE: 0.92 (95% CI, 0.89-0.94) vs. 0.84 (95% CI, 0.80-0.87), p = 0.03, 33 (95% CI, 25-61) vs. 11 (95% CI, 5-22), (p < 0.01). For SS, there was no significant difference between the pooled sensitivity 0.91 (95% CI, 0.78-0.96) vs. 0.89 (95% CI, 0.80-0.94) (p = 0.43); specificity, 0.79 (95% CI, 0.72-0.84) vs. 0.72 (95% CI, 0.63-0.79) (p = 0.06); and DOR, 35 (95% CI, 13-100) vs. 20 (95% CI, 8-50) (p = 0.16) of pSWE and 2D-SWE. LS and SS measured by pSWE and 2D-SWE have good accuracy in predicting HREV. • There is modest difference between the diagnostic performance of LS and SS measured by pSWE and 2D-SWE. • LS and SS measured by pSWE and 2D-SWE both have high sensitivity, specificity, and AUSROC for the evaluation of HREV in patients with CLD. • pSWE and 2D-SWE are promising tools for noninvasive monitoring risk of esophageal varices bleeding of CLD patients.

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.

Diagnostic Value of Non-invasive Scoring Systems in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis-Single Center Experience.

Background and Objectives: Upper endoscopy is considered the gold standard for screening and diagnosis of esophageal varices (EV). Non-invasive methods for predicting EV have become a research hotspot in recent years. The aim of this study was to assess the role of non-invasive scores in predicting the presence of EV in patients with liver cirrhosis, and to determine the value of these scores in predicting the outcome of patients with cirrhosis presenting with acute variceal bleeding. Materials and Methods: A total of 386 patients with liver cirrhosis were included. The model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), fibrosis-4-index (FIB-4), fibrosis index (FI), King’s Score, albumin-bilirubin (ALBI) score, and platelet-albumin-bilirubin (PALBI) score were calculated. The discriminatory capacities of the examined scores in predicting the presence of esophageal varices were tested using receiver operating characteristic (ROC) curves. Results: The ROC curve analysis showed (area under the curve) AUC values of ALBI and PALBI of 0.603, and 0.606, respectively, for the prediction of EV. APRI, MELD, PALBI, King’s, FIB-4, and ALBI scores showed statistically significant correlation with EV bleeding (p < 0.05). AUC of APRI and MELD for predicting EV bleeding were 0.662 and 0.637, respectively. The AUC value of MELD in short-term mortality was 0.761. Conclusions: ALBI and PALBI scores had modest diagnostic accuracy of EVs in liver cirrhosis. APRI and MELD can be used as a reference index for the EV bleeding, and MELD score is best associated with short-term outcome in cirrhotic patients.

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

2D-Shear Wave Elastography in Predicting Esophageal Varices in Patients with Compensated Liver Cirrhosis

Background: Current guidelines require endoscopic screening for esophageal varices. It is a costly and invasive procedure. So, there has always been a search for non-invasive measures that can predict the varices obviating the use of endoscopy. We tried to see whether 2D-Shear wave elastography (2D-SWE) measurements could predict the presence of esophageal varices and high-risk esophageal varices in patients with compensated cirrhosis. Aim: To investigate the diagnostic performance of 2D-SWE in predicting the presence of esophageal varices and high-risk varices in patients with compensated cirrhosis and to compare the diagnostic capabilities of 2D-SWE with those of transient elastography(TE), and other non-invasive parameters. Methods: 108 patients with compensated cirrhosis undergoing B-mode, 2D-SWE, TE, and endoscopy were enrolled. Comparisons of the accuracy of prediction between groups were made by AUROCs. Regression analysis was performed for the multiple variables. Results: There were 64 males and 44 females, with a mean age of 51.73 ± 11.35 years. NASH(40%) and Alcohol(27%) were the main etiologies. Esophageal varices were found in 63 patients. 36 had high-risk varices. The AUROC value of 2D- SWE(0.967) was comparable to that of TE(0.961) but significantly higher than other non-invasive parameters(platelet count, spleen diameter, platelet count/spleen diameter ratio, FIB-4, APRI). 2D-SWE had 92.1% sensitivity, 88.7% specificity, 90.6% PPV, and 88.6% NPV for predicting the presence of varices at an optimal cut-off value > 21.1kPa, and 91.7% sensitivity, 88.6% specificity, 80.2 % PPV, and 95.1% NPV for predicting high-risk varices at an optimal cut-off value > 24.6 kPa. No patient with 2dSWE value <20.3 kPa had varices. Conclusion: In patients with compensated cirrhosis, liver stiffness measured by 2D- SWE is an effective non-invasive diagnostic tool for predicting the presence of esophageal varices and high-risk varices. The diagnostic performance of 2D-SWE is similar to that of TE, but better than other non-invasive parameters.

2D-SWE of liver in predicting esophageal varices in patients with liver cirrhosis

Background and Aim: Non-invasive surrogates in predicting portal hypertension complications . The aim of study was to assess the diagnostic accuracy of SWE in predicting oesophageal varices in patients with liver cirrhosis (cACLD & CSPH) with secondary objective to compare sensitivity and specificity of SWE alone & combination with biochemical parameters in predicting oesophageal varices

Utility of Non Invasive Tests to detect any varices in patients with compensated advanced chronic liver disease

Background and Aims: Baveno-VII recommends treatment of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). Apart from hepatic venous pressure gradient, the presence of esophageal varices (EVs) irrespective of their size remains the most definitive evidence of CSPH. While non-invasive tools (NITs) accurately detect patients who have varices needing treatment (VNTs), we evaluated if these tools can be used to triage patients with regard to the risk of having any EVs.

Relationship Between Disorders of Lipid Profile and Features of Liver Cirrhosis- An Open Prospective and Comparative Analysis of Patients of Stavropol Territory in Russian Federation

Introduction: Liver plays an essential role in the metabolism, synthesis, transport and clearance of lipids and lipoproteins, therefore, changes in the lipid profile in liver pathology reflects the degree of its dysfunction. Leading role in the development of atherosclerosis belongs to lipid spectrum disorders in the form of hyperlipidaemia and dyslipidaemia, associated with an increased cardiovascular risk in liver cirrhosis. Aim: To study the relationship between violations of lipid profile of blood with the features and the clinical picture of Liver Cirrhosis (LC). Material and methods: The study was an open prospective and comparative analysis of patients with LC, conducted at Stavropol State Medical University (Stavropol State, Russia). Research was conducted from June 2020 till August 2020. In 108 patients with LC, blood concentration of total cholesterol, triglycerides, High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL) were studied in association with manifestations of the disease. Control group constituted of 45 healthy individuals, comparable in sex, age and ethnicity. Two sample Student’s t-test, Newman Keuls test, chi-square test with Yates’s correction and Pearson’s linear correlation coefficient (r) were calculated. Receiver Operating Characteristic (ROC) analysis was used, the Odds Ratio (OR) and its 95% Confidence Interval (CI), sensitivity, specificity, positive and negative predictive value, and accuracy were determined. Differences were considered statistically significant at p≤0.05. Results: Regardless of gender and age of patients, decrease of serum levels of total cholesterol (p&lt;0.05), triglycerides (p&lt;0.05), HDL (p&lt;0.05) and LDL (p&lt;0.05) were marked, associated with expression of portal hypertension and severity of liver cirrhosis. Parameters of LDL more than 2.16 mmol/L {OR 6.78-95% CI (2.74-16.78)} were connected with absence of oesophageal varices. Levels of triglycerides less than 0.83 mmol/L {OR 10.85-95% CI (2.86-41.19)} were associated with presence of oesophageal varices of grade III. Generally, hyperlipidaemia was observed in 17.6% of patients, and it was associated with alcoholic etiology of liver cirrhosis (c2 =3.7; p=0.053). Hypocholesterolaemia (81.5 % of cases) or hypotriglyceridemia (48.1 % of cases) was more commonly observed in patients with ascites (c2 =8.8; p=0.003), and classes B, C according ChildPugh score (c2 =4.0; p=0.045). Conclusion: In this study it was found that, in liver cirrhosis, there is a decrease in the serum content of total cholesterol, triglycerides, HDL and LDL, regardless of gender and age of patients. The LDL values of more than 2.16 mmol/L are associated with an increased chance of absence of oesophageal varices in patients with liver cirrhosis.

A Novel Model for the Screening of Varices in Patients With Compensated Cirrhosis: An International Multicenter Study

A Novel Model for the Screening of Varices in Patients With Compensated Cirrhosis: An International Multicenter Study