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Sample records for bleeding oesophageal varices

  1. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    or recent bleeding from oesophageal varices. DATA COLLECTION AND ANALYSIS: The outcome measures extracted were: mortality, blood transfusions, use of balloon tamponade, initial haemostasis and rebleeding. Intention-to-treat analyses including all randomised patients were conducted if possible; a random...... it was substantially reduced in the other trials, relative risk 0.36 (0.19 to 0.68). Use of balloon tamponade was rarely reported. AUTHORS' CONCLUSIONS: The need for blood transfusions corresponded to one half unit of blood saved per patient. It is doubtful whether this effect is worthwhile. The findings do...

  2. Octreotide in the Control of Post-Sclerotherapy Bleeding from Oesophageal Varices, Ulcers and Oesophagitis

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    Spencer A. Jenkins

    1996-01-01

    Full Text Available Bleeding from oesophageal varices, oesophageal ulcers or oesophagitis is occasionally massive and difficult to control. Octreotide, a synthetic analogue of somatostin lowers portal pressure and collateral blood flow including that through varices, increases lower oesophageal sphincter pressure, and inhibits the gastric secretion of acid as well as pepsin. Our current experience suggests it is effective in controlling acute variceal haemorrhage. Therefore we have examined the efficacy of octreotide in the control of postsclerotherapy bleeding from oesophageal varices, oesophageal ulcers and oesophagitis. During the study period 77 patients experienced a significant gastrointestinal bleed (blood pressure 100 beats per min or the need to transfuse 2 or more units of blood to restore the haemoglobin level following injection sclerotherapy of oesophageal varices. The source of bleeding was varices in 42 patients, oesophageal ulcers in 31 and oesophagitis in 4. All patients received a continuous intravenous infusion of octreotide (50 μg/h for between 40–140h. If bleeding was not controlled in the first 12h after commencing octreotide hourly bolus doses (50 μg for 24h were superimposed on the continuous infusion. Haemorrhage was successfully controlled by an infusion of octreotide in 38 of the 42 patients with bleeding from varices, in 30 of 31 patients with oesophageal ulceration, and all patients with oesophagitis. In the 1 patient with persistent bleeding from oesophageal ulceration and in 2 of the 4 with continued haemorrhage from varices, haemostasis was achieved by hourly boluses of 50 μg octreotide for 24h in addition to the continuous infusion. No major complications were associated with octreotide administration. The results of this study clearly indicate that octreotide is a safe and effective treatment for the control of severe haemorrhage after technically successful injection sclerotherapy.

  3. Prognostic variables in patients with cirrhosis and oesophageal varices without prior bleeding

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Christensen, E;

    1994-01-01

    As identification of patients at risk of bleeding or death is essential for prophylaxis, we determined the prognostic influence of various patient characteristics on the risk of bleeding and death. Fifty-five patients with cirrhosis and oesophageal varices without previous bleeding were included...... a significant relation with an increased risk of bleeding or death: high plasma volume (p varices (p

  4. Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

    DEFF Research Database (Denmark)

    Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel;

    2010-01-01

    OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice is diffi......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...

  5. The recent reduction in mortality from bleeding oesophageal varices is primarily observed from Days 1 to 5

    DEFF Research Database (Denmark)

    Hobolth, Lise; Krag, Aleksander; Bendtsen, Flemming

    2010-01-01

    BACKGROUND: Several new treatments of bleeding oesophageal varices (BOV) have been introduced during the last 25 years; among these are vasoactive drugs, improved endoscopic techniques and prophylactic antibiotics. AIMS: The aim was to compare clinical outcomes based on Baveno IV criteria in two...

  6. [Dutch study on the optimal treatment strategy for patients with a first or second occurrence of gastro-oesophageal variceal bleeding: the TIPS-TRUE trial

    NARCIS (Netherlands)

    Buuren, H.R. van; Wils, A.; Rauws, E.A.; Hoek, B. van; Drenth, J.P.H.; Kuipers, E.J.; Pattynama, P.M.

    2008-01-01

    The main options for secondary prevention of gastrooesophageal variceal bleeding are endoscopic therapy and treatment with propranolol. Creation ofa transjugular intrahepatic portosystemic shunt (TIPS) is currently considered a valuable secondary 'rescue' treatment when other therapies fail. Recent

  7. Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte; Krag, Aleksander

    2012-01-01

    Non-selective beta-blockers are used as a first-line treatment for primary prevention in patients with medium- to high-risk oesophageal varices. The effect of non-selective beta-blockers on mortality is debated and many patients experience adverse events. Trials on banding ligation versus non......-selective beta-blockers for patients with oesophageal varices and no history of bleeding have reached equivocal results....

  8. Acute variceal bleeding: general management

    Institute of Scientific and Technical Information of China (English)

    David Patch; Lucy Dagher

    2001-01-01

    @@ TREATMENT STRATEGIES FOR ACUTE VARICEAL BLEEDING Backgound Acute variceal bleeding has a significant mortality which ranges form 5% to 50% in patients with cirrhosis[1].Overall survival is probably improving,because of new therapeutic approaches,and improved medical care.However,mortality is still closely related to failure to control hacmorrhage or carly rebleeding,which is a distinct characteristic of portal hypertensive bleeding and occures in as many as 50% of patients in the first days to 6 weeks after admission et al[2].

  9. Prevalence of oesophageal varices in newly diagnosed chronic liver disease patients at The Jos University Teaching Hospital, Jos

    Directory of Open Access Journals (Sweden)

    I G Achinge

    2011-01-01

    Full Text Available Background: Variceal bleeding is an important complication of portal hypertension and a major cause of death in patients with chronic liver disease (CLD world wide. This study was carried out to document the occurrence of oesophageal varices and its clinical correlates among 80 Nigerian patients with CLD. Patients and Methods: Eighty patients with CLD were stratified into three groups based on Child- Turcotte- pugh′s classification for severity of CLD in a one year study. They had upper gastrointestinal endoscopy to detect and characterize varices. Results: Sixty (75% of the patients had oesophageal varices at endoscopy with 88.3% having grade 2 or 3 varices while 73.3% had moderate/large varices. Thirty five percent of the varices had "red signs" with "red whale" markings as the predominant red sign. Gastric varices were seen in 12.5%. Variceal size was significantly associated with severity of liver disease (P<0.05 as 90% of the patients with varices presented with Child′s class B or C. A multiple logistic regression analysis identified advancing age, ascites, shrunken liver span and low platelet count as independent predictors of oesophageal varices. Conclusion: A large proportion of Nigerian CLD patients have advanced at-risk-for-bleeding oesophageal varices at diagnosis. Early diagnosis of CLD in Nigerians is warranted.

  10. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren

    2008-01-01

    The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...

  11. Long-term effects of oral propranolol on splanchnic and systemic haemodynamics in patients with cirrhosis and oesophageal varices

    DEFF Research Database (Denmark)

    Bendtsen, F; Henriksen, Jens Henrik Sahl; Sørensen, T I

    1991-01-01

    Splanchnic and systemic haemodynamics were measured in 24 patients with cirrhosis and oesophageal varices and no previous bleeding. The patients were randomized either to long-term treatment with propranolol (14 patients) or no active treatment (controls, 10 patients). Catheterization was performed...... 1 year of treatment with propranolol, whereas a decrease in azygos blood flow was observed only in the propranolol group. The beneficial effect of propranolol on the risk of bleeding from oesophageal varices may, therefore, mostly be due to a selective decrease in collateral blood flow and thereby...... variceal blood flow....

  12. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Erwin; Biecker

    2015-01-01

    Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions,erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor(PPI) therapy. These drugs are highly effective but the best route of application(oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal antiinflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.

  13. Practical Approach to Endoscopic Management for Bleeding Gastric Varices

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    Lim, Young Suk [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Bleeding from gastric varices is generally more severe than bleeding from esophageal varices, although it occurs less frequently. Recently, new endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for gastric varices. This review provides an overview of the classification and pathophysiology of gastric varices, an introduction to current endoscopic and interventional radiological management options for gastric varices, and details of a practical approach to endoscopic variceal obturation using N-butyl-2-cyanoacrylate.

  14. Association of Oesophageal Varices and Splanchnic Vein Thromboses in Patients with JAK2-Positive Myeloproliferative Neoplasms: Presentation of Two Cases and Data from a Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Cornelia S. Link

    2013-06-01

    Full Text Available Background: Oesophageal varices and gastrointestinal bleeding are common complications of liver cirrhosis. More rarely, oesophageal varices occur in patients with non-cirrhotic portal hypertension that results from thromboses of portal or splanchnic veins. Case Report: We describe 2 young men who initially presented with varices as a result of portal vein thromboses. In the clinical follow-up, both were tested positive for a JAK2 mutation and consequently diagnosed with myeloproliferative neoplasms (MPNs. In an attempt to characterise the frequency of gastrointestinal complications in patients with JAK2-positive MPNs, we retrospectively analysed all known affected patients from our clinic for the diagnosis of portal vein thromboses and oesophageal varices. Strikingly, 48% of those who had received an oesophagogastroduodenoscopy had detectable oesophageal or gastric varices, and 82% of those suffered from portal or splanchnic vein thromboses. Conclusion: While the association between JAK2, myeloproliferative disease and thrombotic events is well established, patients with idiopathic oesophageal varices are not regularly tested for JAK2 mutations. However, the occurrence of oesophageal varices may be the first presenting symptom of a MPN with a JAK2 mutation, and affected patients may profit from a close haematological monitoring to assure the early detection of developing MPN.

  15. Meta-analysis: banding ligation and medical interventions for the prevention of rebleeding from oesophageal varices

    DEFF Research Database (Denmark)

    Thiele, Maja; Krag, A; Rohde, Ulrich;

    2012-01-01

    In patients with oesophageal varices, the combination of endoscopic variceal ligation (EVL) and medical therapy is recommended as standard of care for prevention of rebleeding. The results of previous meta-analyses on this topic are equivocal.......In patients with oesophageal varices, the combination of endoscopic variceal ligation (EVL) and medical therapy is recommended as standard of care for prevention of rebleeding. The results of previous meta-analyses on this topic are equivocal....

  16. Effect of recombinant Factor VIIa on outcome of acute variceal bleeding

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; D'Amico, Gennaro; Rusch, Ea;

    2014-01-01

    BACKGROUND & AIMS: Two randomized controlled studies have evaluated the effect of recombinant Factor VIIa (rFVIIa) on variceal bleeding in cirrhosis without showing significant benefit. The aim of the present study was to perform a meta-analysis of the two trials on individual patient data...... vasoactive drug infusion and Child-Pugh score >8. RESULTS: 497 patients were eligible for the meta-analysis; 308 (62%) had active variceal bleeding at endoscopy (oozing or spurting) and 283 of these had a Child-Pugh score >8. Analysis on the composite endpoint in all patients with bleeding from oesophageal...... varices did not show any beneficial treatment effect. However, failure rate for the primary composite end-point was significantly lower in treated patients with active bleeding at endoscopy (17%) compared to placebo (26%, p=0.049). This difference was highly significant in patients with Child-Pugh score...

  17. Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Khalid Mumtaz; Shahid Majid; Hasnain A Shah; Kashif Hameed; Ashfaq Ahmed; Saeed Hamid; Wasim Jafri

    2007-01-01

    AIM: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC)sclerotherapy of gastric varix (GV).METHODS: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.RESULTS: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-Ⅰ) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV- Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P <0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7(57%). Three patients died after repeat sclerotherapy,one during transjugular intrahepatic portosysternic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50).CONCLUSION: GV can be seen in 15% of patients with portal hypertension and the incidence of bleeding is 22.7%. NBC is highly effective in controlling GV bleeding.In hospital mortality of patients with bleeding GV is 6%.

  18. Secondary prophylaxis for esophageal variceal bleeding.

    Science.gov (United States)

    Albillos, Agustín; Tejedor, Marta

    2014-05-01

    Combination therapy with beta-blockers and endoscopic band ligation (EBL) is the standard prophylaxis of esophageal variceal rebleeding in cirrhosis. Beta-blockers are the backbone of combination therapy, since their benefit extend to other complications of portal hypertension. EBL carries the risk of post-banding ulcer bleeding, which explains why overall rebleeding is reduced when beta-blockers are added to EBL, and not when EBL is added to beta-blockers. TIPS is the rescue treatment, but it could be considered as first choice in patients that first bleed while on beta-blockers, those with contraindications to beta-blockers or with refractory ascites, and those with fundal varices.

  19. Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

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    Brij Sharma

    2014-01-01

    Full Text Available Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO on CT angiography and managed this case.

  20. Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Supot Pongprasobchai; Sireethorn Nimitvilai; Jaroon Chasawat; Sathaporn Manatsathit

    2009-01-01

    AIM: To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score.METHODS: Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected.Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB.RESULTS: Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding.Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding;previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 x previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vornitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%,82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥3.1 for variceal bleeding were 79% and 97%, respectively.CONCLUSION: The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

  1. Supracardiac type total anomalous pulmonary venous connection (TAPVC) with oesophageal varices

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    Park, Ji Ae; Lee, Hyoung Doo; Ban, Ji Eun; Jo, Min Jung [Pusan National University School of Medicine, Department of Paediatrics, Medical Research Institute, Pusan National University Hospital, Busan (Korea); Sung, Si Chan; Chang, Yun Hee [Pusan National University School of Medicine, Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Busan (Korea); Choo, Ki Seok [Pusan National University School of Medicine, Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan (Korea)

    2008-10-15

    Oesophageal varices due to total anomalous pulmonary venous connection (TAPVC) is very rare. Additionally, the infradiaphragmatic type is the most common type of oesophageal varices due to TAPVC. Paraoesophageal varices due to stenosis of the vertical vein of supracardiac TAPVC has not previously been reported. We describe paraoesophageal varices developed as a result of a connection between the left lower pulmonary vein and the umbilicovitelline venous system because of stenosis of the proximal vertical vein in supracardiac type TAPVC in a 3-day-old female newborn who presented with general cyanosis, tachypnoea and dyspnoea. (orig.)

  2. Fallot′s tetralogy presenting with variceal bleed.

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    Kejariwal D

    2001-07-01

    Full Text Available The erythrocytosis of Fallot′s tetralogy may lead to spontaneous thrombosis at any site, but splenic vein thrombosis and variceal bleed is rarely a presentation of Fallot′s tetralogy. A case of a 48 years old female with undiagnosed Fallot′s tetralogy, presenting with variceal bleed due to splenic vein thrombosis, is reported. It is also interesting to note that the patient survived till this age without any medical or surgical treatment.

  3. Meta-analysis: isosorbide-mononitrate alone or with either beta-blockers or endoscopic therapy for the management of oesophageal varices

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte; Langholz, Ebbe; Krag, Aleksander Ahm

    2010-01-01

    The evidence concerning the use of isosorbide-mononitrate (IsMn) for oesophageal varices is equivocal.......The evidence concerning the use of isosorbide-mononitrate (IsMn) for oesophageal varices is equivocal....

  4. Prediction of esophageal varices and variceal hemorrhage in patients with acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Rockey, Don C; Elliott, Alan; Lyles, Thomas

    2016-03-01

    In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB. 2233 patients admitted for UGIB were identified; 1034 patients had cirrhosis (46%) and of these, 555 patients (54%) had acute UGIB due to esophageal varices. In all patients with UGIB, the platelet count (cut-off 122,000/mm(3)), APRI (cut-off 5.1), AAR (cut-off 2.8) and Lok index (cut-off 0.9) had area under the curve (AUC)s of 0.80 0.82, 0.64, and 0.80, respectively, for predicting the presence of varices prior to endoscopy. To predict varices as the culprit of bleeding, the platelet count (cut-off 69,000), APRI (cut-off 2.6), AAR (cut-off 2.5) and Lok Index (0.90) had AUCs of 0.76, 0.77, 0.57 and 0.73, respectively. Finally, in patients with cirrhosis and UGIB, logistic regression was unable to identify optimal cut-off values useful for predicting varices as the culprit bleeding lesion for any of the non-invasive markers studied. For all patients with UGIB, non-invasive markers appear to differentiate patients with varices from those without varices and to identify those with a variceal culprit lesion. However, these markers could not distinguish between a variceal culprit and other lesions in patients with cirrhosis.

  5. Embolization combined with endoscopic variceal ligation for the treatment of esophagogastric variceal bleeding in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    HUANG Liu-ye; CUI Jun; WU Cheng-rong; LIU Yun-xiang

    2007-01-01

    Background Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fundus varices combined with endoscopic variceal ligation (EVL) of esophageal varices for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis.Methods Totally 172 patients were diagnosed by endoscopic examination within 24 hours of hospitalization with active gastric fundus variceal bleeding and grade Ⅱ above esophageal varices caused by cirrhosis. Other causes leading to upper digestive tract bleeding were excluded. Patients were randomly divided into a control group (n=82) and a therapy group (n=90) following a random number table method. For the former, embolization for gastric fundus varices was performed, then an EVL for esophageal varices was performed 2 months later. For the therapy group, embolization for gastric fundus varices and EVL for esophageal varices were performed at the same time.Results The rate of emergency hemostasis in the therapy group was 100.0%, higher than that in the control group (87.8%, P<0.05). The rate of early rebleeding in the therapy group was 6.7% while the rate in the control group was 23.6% (P<0.05). No complications related to treatment occurred in both groups.Conclusion Embolization for gastric fundus varices combined with EVL for esophageal varices is a safe and effective method for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis.

  6. Long-term effects of oral propranolol on splanchnic and systemic haemodynamics in patients with cirrhosis and oesophageal varices

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; Henriksen, Jens Henrik; Sørensen, T I

    1991-01-01

    % versus -17% (p less than 0.05), respectively). Azygos blood flow was significantly reduced after 1 year in the propranolol group (-47%, n = 5 (p less than 0.05)), and no obvious effect was observed in the control group (-2%, n = 4). The cardiac index decreased significantly in the propranolol group...... 1 year of treatment with propranolol, whereas a decrease in azygos blood flow was observed only in the propranolol group. The beneficial effect of propranolol on the risk of bleeding from oesophageal varices may, therefore, mostly be due to a selective decrease in collateral blood flow and thereby...

  7. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

    Science.gov (United States)

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic.

  8. Improved Survival with the Patients with Variceal Bleed

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    Praveen Sharma; Sarin, Shiv K.

    2011-01-01

    Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB) and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin) and end...

  9. Liver transplantation in the treatment of bleeding esophageal varices

    Science.gov (United States)

    Iwatsuki, Shunzaburo; Starzl, Thomas E.; Todo, Satoru; Gordon, Robert D.; Tzakis, Andreas G.; Marsh, J. Wallis; Makowka, Leonard; Koneru, Baburao; Stieber, Andrei; Klintmalm, Goran; Husberg, Bo; van Thiel, David

    2010-01-01

    From March 1980 to July 1987, 1000 patients with various end-stage liver diseases received orthotopic liver transplants. Of the 7000 patients, three hundred two had definite histories of bleeding from esophageal varices before transplantation. There were 287 patients with nonalcoholic liver diseases and 15 patients with alcoholic cirrhosis. All patients had very poor liver function, which was the main indication for liver transplantation. One- through 5-year actuarial survival rates of the 302 patients were 79%, 74%, 71%, 71%, and 71%, respectively. These survival rates are far better than those obtained with other available modes of treatment for bleeding varices when liver disease is advanced. Long-term sclerotherapy is the treatment of primary choice for bleeding varices. Patients in whom sclerotherapy fails should be considered for liver transplantation unless clear contraindications exist. PMID:3051474

  10. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  11. Value of transient elastography for the prediction of variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Ioan Sporea; Iulia Ra(t)iu; Roxana (S)irli; Alina Popescu; Simona Bota

    2011-01-01

    AIM: To determine if liver stiffness (LS) measurements by means of transient elastography (TE) correlate with the presence of significant esophageal varices (EV) and if they can predict the occurrence of variceal bleeding. METHODS: We studied 1000 cases of liver cirrhosis divided into 2 groups: patients without EV or with grade 1 varices (647 cases) and patients with significant varices (grade 2 and 3 EV) (353 cases). We divided the group of 540 cases with EV into another 2 subgroups: without variceal hemorrhage (375 patients) and patients with a history of variceal bleeding (165 cases). We compared the LS values between the groups using the unpaired t-test and we established cut-off LS values for the presence of significant EV and for the risk of bleeding by using the ROC curve. RESULTS: The mean LS values in the 647 patients without or with grade 1 EV was statistically significantly lower than in the 353 patients with significant EV (26.29 ± 0.60 kPa vs 45.21 ± 1.07 kPa,P < 0.0001). Using the ROC curve we established a cut-off value of 31 kPa for the presence of EV,with 83% sensitivity (95% CI: 79.73%-85.93%) and 62% specificity (95% CI: 57.15%-66.81%),with 76.2% positive predictive value (PPV) (95% CI: 72.72%-79.43%) and 71.3% negative predictive value (NPV) (95% CI: 66.37%-76.05%) (AUROC 0.7807,P < 0.0001). The mean LS values in the group with a history of variceal bleeding (165 patients) was statistically significantly higher than in the group with no bleeding history (375 patients): 51.92 ± 1.56 kPa vs 35.20 ± 0.91 kPa,P < 0.0001). For a cut-off value of 50.7 kPa,LS had 53.33% sensitivity (95% CI: 45.42%-61.13%) and 82.67% specificity (95% CI: 78.45%-86.36%),with 82.71% PPV (95% CI: 78.5%-86.4%) and 53.66% NPV (95% CI: 45.72%-61.47%) (AUROC 0.7300,P < 0.0001) for the prediction of esophageal bleeding. CONCLUSION: LS measurement by means of TE is a reliable noninvasive method for the detection of EV and for the prediction of variceal bleeding.

  12. Recent trends of study on esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    CHENG Liu-fang; LI Chang-zheng

    2010-01-01

    @@ Esophageal variceal bleeding (EVB), a severe complication and main mortality cause of portal hypertension, had reached a relatively mature stage in its research. The mortality rate of EVB within 5 days showed decreased tendency in recent years, which may be due to wide adoption of endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS).1 Endoscopic treatment had been widely used because of its simple procedure, high hemostasis rate and low recurrent bleeding rate, and had become a main measure in cease of first episode and prevention of recurrent bleeding. The technique of endoscopic procedures had less progress in the last 5 years. Recent studies on EVB mainly focused on further improvement of clinical outcome, including primary prevention by EVL, selection and combination of different hemostatic measures, minimizing complications, better long-term management and forecast of bleeding risk.

  13. Successful endoscopic sclerotherapy for cholecystojejunostomy variceal bleeding in a patient with pancreatic head cancer

    Institute of Scientific and Technical Information of China (English)

    Yu-Chun; Hsu; Hsu-Heng; Yen; Maw-Soan; Soon

    2010-01-01

    Variceal bleeding outside the esophagus and stomach is rare but important because of its difficult diagnosis and treatment.Bleeding from cholecystojejunostomy varices has been reported to be a late complication of palliative biliary surgery for chronic pancreatitis.Such ectopic variceal bleeding has never been reported after palliative surgery for pancreatic cancer,probably because of the limited lifespan of these patients. Herein,we report our successful experience using endoscopic cyanoacrylate sclerother...

  14. Non-invasive prediction of oesophageal varices in cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Sambit Sen; William JH Griffiths

    2008-01-01

    Non-invasive predictors of varices in cirrhosis would reduce the need for screening endoscopies. Platelet count and spleen size have been shown to be useful parameters, in mixed groups of cirrhotics with different aetiologies. We evaluated this in two homogeneous groups with cirrhosis due to hepatitis C and alcohol.Non-invasive predictors appear promising in the former group, but less so in the latter group.

  15. Therapeutic and Diagnostic Tactics for Bleedings from Esophagogastric Varices

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    F. G. Nazyrov

    2010-01-01

    Full Text Available Objective: to elaborate therapeutic and diagnostic tactics for bleedings from esophagogastric varices (EGV in an intensive care unit (ICU. Subjects and methods: The experience in treating 102 patients with profuse bleeding from EGV, admitted to the ICU, Acad. V. Vakhidov Republican Specialized Center of Surgery, in 2000—2008, was summarized. Results. The findings show that just less than 40% of the patients with hepatic cirrhosis are admitted for the clinical manifestations of active bleeding from EGV, the latter being profuse in 17.6%. These indicate that the noticeable admission preponderance of patients with first-degree blood loss and the low proportion of those with critical third-degree blood loss are noteworthy. Retrospective analysis demonstrated that hemostasis was achieved in 97 (95.1% patients, by applying solely conservative measures using a Blakemore tube (in both variants of its use. After removal of the Blakemore tube, stable hemostasis retained in 88.9% of the patients with bleedings from the veins of the middle third of the esophagus, in 71.8% of cases of those from its lower third and only in 24.1% of the patients with those from the cardiac stomach. Conclusion. According to the results of the study, we propose the therapeutic and diagnostic tactics for patients with profuse bleedings from EGV, which involve the use of a Blakemore tube and a complex of conservative measures with traditional hemostatic therapy, the administration of portal pressure-reducing agents to prevent or treat hepatic failure. Key words: bleeding, esophagogastric varices, hepatic failure, intensive therapy.

  16. [Surgical Removal of Migrated Coil after Embolization of Jejunal Variceal Bleeding: A Case Report].

    Science.gov (United States)

    Kim, Junhwan; Lee, Danbi; Oh, Kyunghwan; Lee, Mingee; So, Seol; Yang, Dong Hoon; Kim, Chan Wook; Gwon, Dong Il; Chung, Young Hwa

    2017-01-25

    Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic porto-systemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible. Complications of percutaneous coil embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after percutaneous coil embolization for jejunal variceal bleeding. The migrated coil was successfully removed using surgery.

  17. Improved survival with the patients with variceal bleed.

    Science.gov (United States)

    Sharma, Praveen; Sarin, Shiv K

    2011-01-01

    Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB) and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin) and endoscopic variceal ligation has become the first line treatment in the management of AVB. Short-term antibiotic prophylaxis, early use of lactulose for prevention of hepatic encephalopathy, application of early transjugular intrahepatic portasystemic shunts (TIPS), fully covered self-expandable metallic stent in patients for AVB may be useful in those cases where balloon tamponade is considered. Early and wide availability of liver transplantation has changed the armamentarium of the clinician for patients with AVB. High hepatic venous pressure gradient (HVPG) >20 mmHg in AVB has become a useful predictor of outcomes and more aggressive therapies with early TIPS based on HVPG measurement may be the treatment of choice to reduce mortality further.

  18. Improved Survival with the Patients with Variceal Bleed

    Directory of Open Access Journals (Sweden)

    Praveen Sharma

    2011-01-01

    Full Text Available Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin and endoscopic variceal ligation has become the first line treatment in the management of AVB. Short-term antibiotic prophylaxis, early use of lactulose for prevention of hepatic encephalopathy, application of early transjugular intrahepatic portasystemic shunts (TIPS, fully covered self-expandable metallic stent in patients for AVB may be useful in those cases where balloon tamponade is considered. Early and wide availability of liver transplantation has changed the armamentarium of the clinician for patients with AVB. High hepatic venous pressure gradient (HVPG >20 mmHg in AVB has become a useful predictor of outcomes and more aggressive therapies with early TIPS based on HVPG measurement may be the treatment of choice to reduce mortality further.

  19. Prediction of oesophageal varices in patients with primary biliary cirrhosis by non-invasive markers

    Science.gov (United States)

    Gao, Lili; Li, Hanwei; Han, Jun; Zhang, Weihui

    2017-01-01

    Introduction Preliminary data suggested that non-invasive methods could be useful to assess presence of oesophageal varices (OV) in liver cirrhosis. The primary objectives were to investigate non-invasive markers for diagnosing and grading OV in patients with primary biliary cirrhosis. Material and methods This study included a total of 106 consecutive treatment-naive patients with primary biliary cirrhosis (PBC). Results of physical examination, blood tests, and abdominal ultrasound scan (USS) were measured. Performance of non-invasive markers for OV was expressed as sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy, and area under the curve (AUC). Results Oesophageal varices were found in 54 (50.9%) and large OV in 28 of the 106 patients. Variables found to differ significantly between patients with any grade or large and without OV included increased spleen length, increased portal vein diameter, low platelet count, and low levels of albumin or low γ-glutamyltranspeptidase (γ-GTP) values. Area under the receiver operating characteristic curve showed that spleen length (cutoff = 156.0) had AUC 0.753 (95% CI: 0.657–0.849), and high NPV (82.1%) to exclude any grade OV. Large OV could be excluded with NPV 70.6% by spleen length. Conclusions Predictive risk factors that use readily available laboratory results and ultrasound scan results may reliably identify esophageal varices in patients with PBC. PMID:28261290

  20. Splenic artery embolization in a woman with bleeding gastric varices and splenic vein thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Schmid Roland M

    2010-08-01

    Full Text Available Abstract Introduction Gastric variceal bleeding due to splenic vein thrombosis is a life-threatening situation and is often difficult to manage by endoscopy. In the worst cases, an emergency splenectomy may be required to stop variceal bleeding. Case presentation We report the case of a 60-year-old Caucasian woman with bleeding gastric varices secondary to splenic vein thrombosis treated by splenic artery embolization. Successful embolization was performed by depositing coils into the splenic artery resulting in cessation of variceal bleeding. After embolization there was no recurrence of bleeding. Conclusion Splenic artery embolization can be an effective and definite treatment for variceal bleeding secondary to splenic vein thrombosis.

  1. Comparison of emergency endoscopic variceal ligation plus octride or octride alone for acute esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    LIU Jin-song; LIU Jun

    2009-01-01

    Background Octride was the main method for the treatment of esophageal variceal bleeding (EVB). The aim of this study was to compare the cost-effect and safety between esophageal variceal ligation (EVL) plus octride and octride alone in acute esophageal bleeding.Methods A total of 101 cirrhotic patients with EVB were involved in this study and received emergency EVL+octride (EVL group) or only octride therapy randomly. The cost, efficacy and safety were analyzed and compared between the two groups.Results Among 51 patients in EVL group, 5 (10%) patients failed. Among 50 patients in the octride treatment group, 13 patients (26%) failed. The difference was significant (P<0.05). The average blood transfusion volume was (2.4±2.2) units in the EVL group and (6.4±3.4) units in the octride treatment group (P <0.05). Hospital stay was (7.4±1.3) days in the EVL group and (11.4±3.3) days in the octride treatment group (P<0.05). The average hospital cost was (10 983±1147) yuan in the EVL group and (13 921 ±2107) yuan in the octride treatment group (P<0.05). Conclusion Emergency endoscopic ligation plus octride is superior to octride alone in the treatment of acute EVB with lower cost and higher efficacy with enough safety.

  2. Per rectal portal scintigraphy as a useful tool for predicting esophageal variceal bleeding in cirrhotic patients

    Institute of Scientific and Technical Information of China (English)

    Taned Chitapanarux; Ong-ard Praisontarangkul; Satawat Thongsawat; Pises Pisespongsa; Apinya Leerapun

    2007-01-01

    AIM: To investigate potential roles of per rectal portal scintigraphy in diagnosis of esophageal varices and predicting the risk of bleeding.METHODS: Fifteen normal subjects and fifty cirrhotic patients with endoscopically confirmed esophageal varices were included. Patients were categorized into bleeder and non-bleeder groups according to history of variceal bleeding. All had completed per rectal portal scintigraphy using 99mTechnetium pertechnetate.The shunt index was calculated from the ratio of 99mTechnetium pertechnetate in the heart and the liver.Data were analyzed using Student's t-test and receiver operating characteristics.RESULTS: Cirrhotic patients showed a higher shunt index than normal subjects (63.80 ± 25.21 vs 13.54 ± 6.46, P < 0.01). Patients with variceal bleeding showed a higher shunt index than those without bleeding (78.45 ± 9.40 vs 49.35 ± 27.72, P < 0.01). A shunt index of over 20% indicated the presence of varices and that of over 60% indicated the risk of variceal bleeding.CONCLUSION: In cirrhotic patients, per rectal portal scintigraphy is a clinically useful test for identifying esophageal varices and risk of variceal bleeding.

  3. A new candidate as a hemostatic agent for difficult situations during variceal bleeding: Ankaferd blood stopper

    Directory of Open Access Journals (Sweden)

    Ersan Ozaslan

    2011-01-01

    Full Text Available Variceal bleeding is the most challenging emergent situation among the causes of upper gastrointestinal bleeding. Despite substantial improvement, a need remains for therapeutic armamentarium of such cases, which is easy, effective and without side-effect. Ankaferd blood stopper (ABS is a standardized herbal extract acting as a hemostatic agent on the bleeding or injured areas. In this observational study, a total of four patients with variceal bleeding were treated with endoscopic ABS application. The lesions were bleeding gastric varices (n:3 and bleeding duodenal varix (n:1. ABS was selected as a bridge to definitive therapies due to unavailability or inappropriateness of bleeding lesions to conventional measures. ABS was instilled or flushed onto the bleeding areas by sclerotherotherapy needle or heater probe catheter. Periprocedural control of the bleeding was achieved in all instances. Thereafter, on an elective basis, two patients with gastric varices underwent cyanoacrylate injection, while third underwent Transjugular intrahepatic portosystemic shunt and embolization. The patient with duodenal varix refused further therapy, after a few hours after admission and was discharged. He again presented the same day with rebleeding, but died before any attempt could be made to control his bleeding. ABS seems to be effective in cases of variceal bleeding as a bridge to therapy. Its major advantages are the ease of use and lack of side-effects.

  4. Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

    Institute of Scientific and Technical Information of China (English)

    Christopher; Steevens; Maisa; Abdalla; Truptesh; H; Kothari; Vivek; Kaul; Shivangi; Kothari

    2015-01-01

    Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

  5. Splenic artery embolization for the treatment of bleeding gastric varices secondary to splenic vein thrombosis.

    Science.gov (United States)

    Stone, Patrick A; Phang, David; Richmond, Bryan; Gill, Gurpreet; Campbell, John E

    2014-04-01

    Splenic vein thrombosis can lead to gastric varices. Subsequent upper gastrointestinal bleeding may ensue related to the change in venous outflow to the portal system. Vascular surgeons are infrequently asked to assist in the management of this entity. However, with many vascular surgeons providing diverse endovascular-based interventions, understanding catheter-based solutions is imperative. This report presents a case in which arterial embolization was used to treat gastric variceal bleeding.

  6. Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization.

    Science.gov (United States)

    Sankararaman, Senthilkumar; Velayuthan, Sujithra; Vea, Romulo; Herbst, John

    2013-06-01

    Bleeding from gastric varices due to splenic vein obstruction is extremely rare in children, but it can be catastrophic. Reported herein is the case of a teenager with splenic vein thrombosis and chronic decompensated liver disease from autoimmune hepatitis who presented with massive gastric variceal bleeding. Standard medical management did not control the bleeding. Due to decompensated liver disease and continuous active bleeding, emergency partial splenic artery embolization was preferred over splenectomy or a shunt procedure. Bleeding was successfully controlled by partial splenic artery embolization by decreasing the inflow of blood into the portal system. It is concluded that emergency partial splenic artery embolization is a safer alternative life-saving procedure to manage severe gastric variceal bleeding due to splenic vein obstruction in a patient with high surgical risk. To our knowledge, only one other patient with similar management has been reported in the pediatric age group.

  7. Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

    DEFF Research Database (Denmark)

    Bosch, Jaime; Thabut, Dominique; Albillos, Agustín;

    2008-01-01

    A beneficial effect of recombinant activated factor VII (rFVIIa) in Child-Pugh class B and C patients with cirrhosis who have variceal bleeding has been suggested. This randomized controlled trial assessed the efficacy and safety of rFVIIa in patients with advanced cirrhosis and active variceal...... events, were comparable between groups. CONCLUSION: Treatment with rFVIIa had no significant effect on the primary composite endpoint compared with placebo. Therefore, decision on the use of this hemostatic agent in acute variceal bleeding should be carefully considered, because results of this study do...

  8. Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol

    Institute of Scientific and Technical Information of China (English)

    Bei Shi; Wei Wu; Hui Zhu; Yun-Lin Wu

    2008-01-01

    Two patients with liver cirrhosis and portal hypertension related to hepatitis infection were admitted to Shanghai Ruijin Hospital due to recurrent melena and hematemesis. Isolated gastric varices were observed in the gastric fundus during the retroflexion of gastroscope. We carried out endoscopic sclerotherapy successfully for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol, which disappeared dramatically several months after two courses of sclerotherapy for each patient. No complication and clinical signs of gastrointestinal re-bleeding were observed during the 6-mo endoscopic follow-up. CT portal angiography (CTPA) has been widely used in the assessment of variceal treatment and improves the results of endoscopic injection therapy.

  9. Living-related liver transplantation in patients with variceal bleeding:outcome and prognostic factors

    Institute of Scientific and Technical Information of China (English)

    Mohammed Saied Hedaya; Walid Mohamed El Moghazy; Shinji Uemoto

    2009-01-01

    BACKGROUND:Liver transplantation currently represents the ultimate therapy for bleeding esophageal varices in patients with liver cirrhosis. It is the only therapy that cures both portal hypertension and the underlying liver disease. The outcome of liver transplantation is thought to be correlated with several factors. In this study, the clinical outcome of living-related liver transplantation (LRLT) was evaluated in patients with variceal bleeding, and the prognostic indicators of short-term survival in these patients were identiifed. METHODS:We reviewed retrospectively 121 patients with a history of variceal bleeding who had received LRLT from 1998 to 2006. The clinical outcomes were analyzed, and the risk factors for short-term survival were deifned. RESULTS:The 3-month survival rate of patients with variceal bleeding was 83.4%, while that of non-bleeders was 87%. Sepsis was the commonest cause of death in both groups. Portal vein diameter and blood transfusion were the only independent prognostic factors for short-term survival among variceal bleeders. CONCLUSION:The outcome of LRLT in recipients with variceal bleeding is based on the improvement of portal hemodynamics, by minimizing intraoperative blood loss and subsequent blood transfusion.

  10. Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery.

    Science.gov (United States)

    Shim, Dong Jae; Shin, Ji Hoon; Ko, Gi-Young; Kim, Yook; Han, Kichang; Gwon, Dong-Il; Ko, Heung-Kyu

    2017-04-01

    Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7-1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.

  11. Is there an alternative therapy to cyanoacrylate injection for safe and effective obliteration of bleeding gastric varices?

    Institute of Scientific and Technical Information of China (English)

    Hiroo Imazu; Kuniyuki Kojima; Masahiko Katsumura; Salem Omar

    2006-01-01

    @@ TO THE EDITOR We read with interest the article entitled "Bleeding gastric varices: Results of endoscopic injection with cyanoacrylate at King Chulalongkorn Memorial Hospital" by Noophun et al[1]. They performed n-butyl-2-cyanoacrylate (CA) injection therapy for bleeding gastric varices in twentyfour patients, and hemostasis was achieved in seventeen (71%) patients. They concluded that CA injection therapy was effective and safe for bleeding gastric varices. However, we disagreed with the author's conclusion.

  12. Bleeding gastric varices: Results of endoscopic injection with cyanoacrylate at King Chulalongkorn Memorial Hospital

    Institute of Scientific and Technical Information of China (English)

    Phadet Noophun; Pradermchai Kongkam; Sutep Gonlachanvit; Rungsun Rerknimitr

    2005-01-01

    AIM: To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding.METHODS: Twenty-four patients (15 males, 9 females) with gastric variceal bleeding underwent endoscopic treatment with cyanoacrylate injection. Successful hemostasis, rebleeding rate, and complications were retrospectively reviewed. Followed up endoscopy was performed and repeat cyanoacrylate injection was given until gastric varices were obliterated. RESULTS: Seventeen patients achieved definite hemostasis. Of these, 14 patients had primary success after initial endoscopic therapy. Ten patients developed recurrent bleeding. Repeated cyanoacrylate injection stopped rebleeding in three patients. Transjugular intrahepatic portosystemic shunt (TIPS) was performed to control rebleeding in one patient which occured after repeat endoscopic therapy. Six patients died (three from uncontrolled bleeding, two from sepsis, and one from mesenteric vein thrombosis). Minor complications occurred in 11 patients (six epigastric discomfort and five post injection ulcers). Cyanoacrylate embolism developed in two patients. One of these patients died from mesenteric vein thrombosis. The other had pulmonary embolism which resolved spontaneously. Advanced cirrhosis and hepatocellular carcinoma (HCC) were major risk factors for uncontrolled bleeding.CONCLUSION: Endoscopic treatment for bleeding gastric varices with cyanoacrylate injection is effective for immediate hemostasis. Repeat cyanoacrylate injection has a lower success rate than the initial injection.Cyanoacrylate embolism is not a common serious complication.

  13. Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices

    Institute of Scientific and Technical Information of China (English)

    Lee-Guan Lim; Yin-Mei Lee; Lenny Tan; Stephen Chang; Seng-Gee Lim

    2009-01-01

    A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy ident i f ied the bleeding s i te in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.

  14. Embolotherapy for Gastric Variceal Bleeding from Pseudoaneurysm of Short Gastric Artery: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jae Han; Kim, Young Dae; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2008-12-15

    The complications of pancreatitis, such as pseudocyst or abscesses, are well known to radiologists. Yet formation of a pseudoaneurysm of the short gastric artery is an uncommon complication of acute pancreatitis. It is also very rare for a psuedoaneurysm of the short gastric artery to cause splenic vein occlusion and the final result is gastric varices. We report here on a case that showed the dramatic effect of embolotherapy for a pseudoaneurysm of the short gastric artery that caused gastric variceal bleeding

  15. Predictors of In-hospital Mortality Among Patients Presenting with Variceal Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Amith S Kumar

    2015-01-01

    Full Text Available Background/Aim: The recent years have witnessed an increase in number of people harboring chronic liver diseases. Gastroesophageal variceal bleeding occurs in 30% of patients with cirrhosis, and accounts for 80%-90% of bleeding episodes. We aimed to assess the in-hospital mortality rate among subjects presenting with variceal gastrointestinal bleeding and (2 to investigate the predictors of mortality rate among subjects presenting with variceal gastrointestinal bleeding. Patients and Methods: This retrospective study was conducted from treatment records of 317 subjects who presented with variceal upper gastrointestinal bleeding to Government Medical College, Patiala, between June 1, 2010, and May 30, 2014. The data thus obtained was compiled using a preset proforma, and the details analyzed using SPSSv20. Results: Cirrhosis accounted for 308 (97.16% subjects with bleeding varices, with extrahepatic portal vein obstruction 9 (2.84% completing the tally. Sixty-three (19.87% subjects succumbed to death during hospital stay. Linear logistic regression revealed independent predictors for in-hospital mortality, including higher age (P = 0.000, Child-Pugh Class (P = 0.002, altered sensorium (P = 0.037, rebleeding within 24 h of admission (P = 0.000, low hemoglobin level (P = 0.023, and serum bilirubin (P = 0.002. Conclusion: Higher age, low hemoglobin, higher Child-Pugh Class, rebleeding within 24 h of admission, higher serum bilirubin, and lower systolic blood pressure are the independent predictors of in-hospital mortality among subjects presenting with variceal gastrointestinal bleeding.

  16. Variceal bleeding from ileum identified and treated by single balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Mario Traina; Ilaria Tarantino; Luca Barresi; Filippo Mocciaro

    2009-01-01

    We report a case of acute uncontrolled gastrointestinal bleeding in a patient with liver cirrhosis. The upper and lower endoscopy were negative for bleeding lesions. We decided to perform the examination of the small bowel using single-balloon enteroscopy. The lower enteroscopy revealed signs of bleeding from varices of the ileum. In this report, we showed that the injection of a sclerosant solution can be accomplished using a freehand technique via the single balloon enteroscopy.

  17. Influence of variceal bleeding on natural history of ACLF and management options.

    Science.gov (United States)

    Al-Mahtab, Mamun; Akbar, Sheikh Mohammad Fazle; Garg, Hitendra

    2016-05-01

    Patients with diagnosed and undiagnosed chronic liver diseases experience one or more acute assaults of a hepatic nature and develop a downhill course of liver diseases, a condition regarded as acute-on-chronic liver failure (ACLF). It is a medical emergency, the prognosis of ACLF is extremely bad and considerable numbers of patients with ACLF die even after diagnosis and receiving conservative treatment. ACLF is characterized by jaundice, coagulopathy, ascites and encephalopathy. ACLF patients are very sick and associated with different hemodynamic profiles and have very high 3-month mortality. As these groups of patients have high baseline hepatic venous pressure gradients, the chances of variceal bleed are also high, and the impact is also greater in comparison to stable cirrhosis; however, evidence is lacking to substantiate such effects. The aim of this review is to discuss the natural course of variceal bleeding in ACLF patients and to develop insights into the management of variceal bleeding in ACLF.

  18. A new technique of combined endoscopic sclerotherapy and ligation for variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Radha K. Dhiman; Yogesh K. Chawla

    2003-01-01

    AIM: To develop a technique of combined endoscopic sclerotherapy and ligation (ESL) in which both techniques of endoscopic sclerotherapy (ES) and endoscopic variceal ligation (EVL) can be optimally used.METHODS: ESL was performed in 10 patients (age 46.4±7.9;9 males, 1 female) with cirrhosis of liver using sclerotherapy needle and Speedband, Superview multiple band ligater (Boston Scientific, Microvasive, Watertown, MA). A single band was placed 5-10 cm proximal to the gastro-esophageal junction over each varix from proximal to distal margin,followed by intravariceal injection of 1.5 % ethoxysclerol (4 ml each) 2 to 3 cm proximal to the gastroesophageal junction on the ligated varices distal to deployed band. EVL was then performed at the injection site. Similarly other varices were also injected and ligated from distal to proximally. In the subsequent sessions, ES alone was performed to sclerose small varices at the gastroesophageal junction.RESULTS: ESL was successfully performed in all patients.A median of 3 (ESL 1, ES 2) sessions (ranged 1-4) were required to eradicate the varices in 9 (90 %) of 10 patients.Recurrence of varices without bleed was seen in 1 patient during a mean follow-up of 10.3 months (ranged 6-15).Two patients died of liver failure. None died of variceal bleeding. None of the patients had procedure related complications.CONCLUSION: ESL may be useful in the fast eradication of esophageal varices. However, randomised controlled trials are required to find out its relative efficacy and impact on variceal recurrence in comparison to ES or EVL.

  19. Upper non-variceal gastrointestinal bleeding-review the effectiveness of endoscopic hemostasis methods

    Institute of Scientific and Technical Information of China (English)

    Miros?aw; Szura; Artur; Pasternak

    2015-01-01

    Upper non-variceal gastrointestinal bleeding is a conditionthat requires immediate medical intervention and has a high associated mortality rate(exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the firstline treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy(within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature.

  20. Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Zamora, Carlos Armando; Sugimoto, Koji; Tsurusaki, Masakatsu; Izaki, Kenta; Fukuda, Tetsuya; Matsumoto, Shinichi; Kawasaki, Ryota; Taniguchi, Takanori; Sugimura, Kazuro [Kobe University School of Medicine, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Kuwata, Yoichiro [Nishi-Kobe Medical Center, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Hirota, Shozo [Hyogo Medical College, Department of Radiology, Nishinomiya-shi, Hyogo-ken (Japan)

    2006-01-01

    The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source. (orig.)

  1. Acute Management and Secondary Prophylaxis of Esophageal Variceal Bleeding: A Western Canadian Survey

    Directory of Open Access Journals (Sweden)

    Justin Cheung

    2006-01-01

    Full Text Available BACKGROUND: Acute esophageal variceal bleeding (EVB is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.

  2. Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: A randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Binay K De; Deep Dutta; Rimi Som; Pranab K Biswas; Subrata K Pal; Anirban Biswas

    2008-01-01

    AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding.METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day.RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to < 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05).CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.

  3. Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome

    DEFF Research Database (Denmark)

    Krag, Aleksander; Borup, Tine; Møller, Søren;

    2008-01-01

    Terlipressin is an analog of the natural hormone arginine-vasopressin. It is used in the treatment of patients with cirrhosis and bleeding esophageal varices (BEV) and in patients with hepatorenal syndrome (HRS): two of the most dramatic and feared complications of cirrhosis. Terlipressin exerts...

  4. Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding

    DEFF Research Database (Denmark)

    Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens;

    2016-01-01

    BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of admissions as well as aggressive transfusion of blood products. Whether the transfusion strategy in NVUGIB impacts on hemostasis is unknown and constitutes the focus of this study. METHOD: Retrospective...

  5. Portal hypertension and variceal bleeding: Clinical and pharmacological aspects

    DEFF Research Database (Denmark)

    Hobolth, Lise

    2010-01-01

    Blødende esophagus varicer er en af den mest frygtede komplikationer til cirrose og portal hypertension pga. den høje mortalitet. Et klassisk studie fra 1981 opgjorde 6-ugers mortaliteten til 42%, hvoraf 75% døde indenfor den første uge. Gennem de sidste 2-3 årtier er der introduceret en række nye...

  6. Treatment of Rare Gastric Variceal Bleeding in Acute Pancreatitis Using Embolization of the Splenic Artery Combined with Short Gastric Vein

    Directory of Open Access Journals (Sweden)

    Lixin Li

    2012-12-01

    Full Text Available In the acute stage of pancreatitis, sinistral portal hypertension is a rare reason for gastric variceal bleeding. Here we report a 20-year-old female patient with massive upper gastrointestinal hemorrhage 7 days after an episode of severe acute pancreatitis. Computed tomography showed gastric varices caused by splenic venous thrombosis. Emergency endoscopic examination was performed, however tissue adhesive utilized to restrain the bleeding was not successful. Although interventional therapy was controversial to treat the gastric variceal hemorrhage resulting from sinistral portal hypertension, the bleeding was successfully treated by embolization of the splenic artery combined with short gastric vein. Two weeks after the interventional the patient was discharged from our hospital without recurrence of bleeding. Embolization of the splenic artery combined with short gastric vein proved to be an effective emergency therapeutic method for gastric variceal bleeding caused by sinistral portal hypertension in the acute stage of pancreatitis.

  7. Gastric variceal bleeding due to pancreatitis-induced splenic vein thrombosis.

    Science.gov (United States)

    Gotto, Antonio; Lieberman, Michael; Pochapin, Mark

    2014-03-24

    Obscure gastrointestinal bleeding is a common clinical scenario. In the upper gastrointestinal tract, gastric varices can be frequently overlooked on endoscopy, particularly if not suspected or volume depleted. We report a case of suspected gastrointestinal bleeding in a patient with a childhood history of pancreatitis, who also experienced severe epigastric pain while in hospital. After transfer to an academic medical centre, the presence of gastric varices was identified and presumed to be due to splenic vein thrombosis. Pancreatitis is the most common cause of splenic vein thrombosis and accords with the patient's history, even though it occurred many years previously. This case highlights the importance of recognising pancreatitis-induced splenic vein thrombosis as a possible aetiology for upper gastrointestinal bleeding.

  8. Prognostic factors associated with rebleeding in cirrhotic inpatients complicated with esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    WANG Mei-tang; LIU Tao; MA Xiu-qiang; HE Jian

    2011-01-01

    Background Esophageal variceal bleeding is a frequent and severe complication in patients with cirrhosis. The aim of this study was to identify prognostic factors of esophageal variceal rebleeding in cirrhotic inpatients.Methods Consecutive cirrhotic patients who were admitted to Changhai Hospital because of esophageal variceal bleeding were retrospectively analyzed. To assess the independent factors for recurrent hemorrhage after esophageal variceal bleeding, medical assessment was completed at the time of their initial hospital admission, including documentation of clinical, biochemical, and treatment methods that might contribute to variceal rebleeding. Univariate and multivariate analyses were retrospectively performed.Results Totally 186 patients (35.8%) were assigned to a rebleeding group and the other 334 patients (64.2%) to a non-rebleeding group. Multivariate stepwise regression analysis showed that four variables were positively correlated with rebleeding: Child-pugh grade B (OR=2.664, 95% CI 1.680-4.223) (compared with Child-pugh grade A), total bilirubin (Tbil) (OR=1.0006, 95% CI 1.002-1.0107), creatinine (OR=1.008, 95% CI 1.002-1.015) and the cumulative volume of blood transfusion (OR=1.519, 95% CI 1.345-1.716). The presence of ascites (OR=0.270, 95% CI 0.136-0.536) and prophylactic antibiotics (OR=0.504, 95% CI 0.325-0.780) were negatively correlated with rebleeding of the cirrhotic inpatients. According to standardized coefficient, the importance of rebleeding predictors ranked from the most to the least was as follows: the cumulative volume of blood transfusion, Child-pugh grade B, Tbil and creatinine.Conclusion Rebleeding in cirrhotic inpatients was associated with more blood transfusions, Child-pugh grade B, higher Tbil and creatinine.

  9. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding patient

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Seong, Chang Kyu; Kim, Yong Joo; Park, Noh Hyuk [Kyungpook National University School of Medicine, Daegu (Korea, Republic of); Shin, Tae Beom [Dong-A University Medical Center, Pusan (Korea, Republic of); Choi, Jin Soo [Soonchunhyang University College of Medicine, Asan (Korea, Republic of)

    2003-03-01

    To evaluate the technical feasibility and clinical efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in the treatment of gastric variceal bleeding. Between September 2001 and March 2002, ten patients with gastric variceal bleeding and gastrorenal shunt, underwent BRTO. Three of the ten also had hepatic encephalopathy. To evaluated the gastrorenal shunt and exclude portal vein thrombosis, all patients underwent pre-procedural CT scanning. An occlusion balloon catheter was inserted from the right internal jugular vein and on ballooning was wedged into the left adrenal vein. A sclerosing agent (5% ethanolamine oleate-lipiodol mixture) was injected until the varices were completely filled. In four patients, the collateral veins seen at balloon-occluded adrenal venography were embolized with coils prior to sclerotherapy. Post-procedural follow-up CT (n=3) or endoscopy (n=8) was performed 1-4 weeks later, and both before and after the procedure, hepatic function was also monitored. Treatment was successful in nine cases: the failure involed rupture of the occlusion balloon during inflation, and a transjugular intrahepatic portosystemic shunt was performed. The cessation of bleeding was confirmed endoscopically or clinically; in three patients, follow-up CT showed complete obliteration of the varices. Hepatic function improved in eight patients, but three weeks after the procedure, one expired due to progressive infiltrative hepatoma. The clinical symptoms of the three patients with hepatic encephalopathy showed remarkable improvement. Although more extensive studies and long-term follow up are needed to overcome the limitations of our study, we believe that BRTO is a technically feasible and clinically effective treatment for gastric varices and hepatic encephalopathy.

  10. Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

    Institute of Scientific and Technical Information of China (English)

    Min Joung Kim; Byoung Kuk Jang; Woo Jin Chung; Jae Seok Hwang; Young Hwan Kim

    2012-01-01

    We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO),which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS).A 57-year-old man was admitted to the emergency room suffering from melena.He had undergone BRTO to treat gastric varix bleeding 5 mo before admission.Endoscopy and a computed tomography (cr) scan showed complete obliteration of the gastric varix,but the nodular varices in the second portion of the duodenum expanded after BRTO,and spurting blood was seen.TIPS was performed for treatment of duodenal variceal bleeding,because attempts at endoscopic varix ligation were unsuccessful.The postoperative course was uneventful and the patient was discharged without complications.A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices,but multinodular hepatocellular carcinoma had developed.He died of hepatic failure 28 mo after TIPS.

  11. Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Yan-Mei Wang; Liu-Fang Cheng; Nan Li; Kai Wu; Jun-Shan Zhai; Ya-Wen Wang

    2009-01-01

    AIM: To investigate glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding and to evaluate the long-term efficacy and safety of this therapy.METHODS: A total of 148 cirrhotic patients in our hospital with esophagogastric variceal bleeding (EGVB) were included in this study. N-butyl-2-cyanoacrylate was mixed with lipiodol in a 1:1 ratio and injected as a bolus of 1-3 mL according to variceal size. Patients underwent endoscopic follow-up the next week, fourth week, second month, fourth month, and seventh month after injection and then every 6 mo to determine the cast shape. An abdominal X-ray film and ultrasound or computed tomographic scan were also carried out in order to evaluate the time of variceal disappearance and complete extrusion of the cast. The average follow-up time was 13.1 mo.RESULTS: The instantaneous hemostatic rate was 96.2%. Early re-bleeding after injection in 9 cases (6.2%) was estimated from rejection of adhesive. Late re-bleeding occurred in 12 patients (8.1%) at 2-18 mo. The glue cast was extruded into the lumen within one month in 86.1% of patients and eliminated within one year. Light erosion was seen at the injection position and mucosa edema in the second week. The glue casts were extruded in 18 patients (12.1%) after one week and in 64 patients (42.8%) after two weeks. All kinds of glue clumping shapes and colors on endoscopic examination were observed in 127 patients (86.1%) within one month, including punctiform, globular, pillar and variform. Forty one patients (27.9%) had glue extrusion after 3 mo and 28 patients (28.9%) after six months. The extrusion time was not related to the injection volume of histoacryl. Obliteration was seen in 70.2% (104 cases) endoscopically. The main complication was re-bleeding resulting from extrusion. The prognosis of the patients depended on the severity of the underlying liver disease.CONCLUSION: Endoscopic injection of cyanoacrylate is highly effective for

  12. Analysis of the treatment effect on recurrent bleeding and death in patients with cirrhosis and esophageal varices

    DEFF Research Database (Denmark)

    Thomsen, B L; Sørensen, T I

    1998-01-01

    Multiple recurrences of bleeding with high mortality in cirrhosis with esophageal varices have been inadequately analyzed in previous trials. We propose analysis by the multistage competing-risks model, specifying the effect on overall mortality as an effect on mortality during bleeding, rate...

  13. Esophageal Stent for Refractory Variceal Bleeding: A Systemic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Shao

    2016-01-01

    Full Text Available Background. Preliminary studies suggest that covered self-expandable metal stents may be helpful in controlling esophageal variceal bleeding. Aims. To evaluate the effectiveness and safety of esophageal stent in refractory variceal bleeding in a systematic review and meta-analysis. Methods. A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 1970 to December 2015. Data were selected and abstracted from eligible studies and were pooled using a random-effects model. Heterogeneity was assessed using I2 test. Results. Five studies involving 80 patients were included in the analysis. The age of patients ranged from 18 to 91 years. The mean duration of follow-up was 46.8 d (range, 30–60 d. The success rate of stent deployment was 96.7% (95% CI: 91.6%–99.5% and complete response to esophageal stenting was in 93.9% (95% CI: 82.2%–99.6%. The incidence of rebleeding was 13.2% (95% CI: 1.8%–32.8% and the overall mortality was 34.5% (95% CI: 24.8%–44.8%. Most of patients (87.4% died from hepatic or multiple organ failure, and only 12.6% of patients died from uncontrolled bleeding. There was no stent-related complication reported and the incidence of stent migration was 21.6% (95% CI: 4.7%–46.1%. Conclusion. Esophageal stent may be considered in patients with variceal bleeding refractory to conventional therapy.

  14. Role of Self-Expandable Metal Stents in Acute Variceal Bleeding

    Directory of Open Access Journals (Sweden)

    Fuad Maufa

    2012-01-01

    Full Text Available Acute variceal bleeding continues to be associated with significant mortality. Current standard of care combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. Rescue therapies using balloon tamponade or transjugular intrahepatic portosystemic shunt are implemented when first-line therapy fails. Rescue therapies have many limitations and are contraindicated in some cases. Placement of fully covered self-expandable metallic stent is a promising therapeutic technique that can be used to control bleeding in cases of refractory esophageal bleeding as an alternative to balloon tamponade. These stents can be left in place for as long as two weeks, allowing for improvement in liver function and institution of a more definitive treatment.

  15. Successful Treatment of Bleeding Gastric Varices with Splenectomy in a Patient with Splenic, Portal, and Mesenteric Thromboses

    Directory of Open Access Journals (Sweden)

    Lior Menasherian-Yaccobe

    2013-01-01

    Full Text Available A 59-year-old female with a history of multiple splanchnic and portal thromboses treated with warfarin underwent an esophagogastroduodenoscopy for cancer screening, and a polypoid mass was biopsied. One week later, she was admitted with upper gastrointestinal hemorrhage. Her therapeutic coagulopathy was reversed with fresh frozen plasma, and she was transfused with packed red blood cells. An esophagogastroduodenoscopy demonstrated an erosion of a gastric varix without evidence of recent bleeding. Conservative measures failed, and she continued to bleed during her stay. She was not considered a candidate for a shunt procedure; therefore, a splenectomy was performed. Postoperative esophagogastroduodenoscopy demonstrated near complete resolution of gastric varices. One year after discharge on warfarin, there has been no recurrence of hemorrhage. Gastric varices often arise from either portal hypertension or splenic vein thrombosis. Treatment of gastric variceal hemorrhage can be challenging. Transjugular intrahepatic portosystemic shunt is often effective for emergency control in varices secondary to portal hypertension. Splenectomy is the treatment for varices that arise from splenic vein thrombosis. However, treatment of gastric variceal hemorrhage in the context of multiple splanchnic and portal vein thromboses is more complicated. We report splenectomy as a successful treatment of gastric varices in a patient with multiple extrahepatic thromboses.

  16. Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding

    OpenAIRE

    Arruda,Severino Marcos Borba de; Barreto,Victorino Spinelli Toscano; Amaral,Fernando José do

    2008-01-01

    BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive pa...

  17. Severe bleeding from esophageal varices resistant to endoscopic treatment in a non cirrhotic patient with portal hypertension

    Science.gov (United States)

    Caronna, Roberto; Bezzi, Mario; Schiratti, Monica; Cardi, Maurizio; Prezioso, Giampaolo; Benedetti, Michele; Papini, Federica; Mangioni, Simona; Martino, Gabriele; Chirletti, Piero

    2008-01-01

    A non cirrhotic patient with esophageal varices and portal vein thrombosis had recurrent variceal bleeding unsuccessfully controlled by endoscopy and esophageal transection. Emergency transhepatic portography confirmed the thrombosed right branch of the portal vein, while the left branch appeared angulated, shifted and stenotic. A stent was successfully implanted into the left branch and the collateral vessels along the epatoduodenal ligament disappeared. In patients with esophageal variceal hemorrhage and portal thrombosis if endoscopy fails, emergency esophageal transection or nonselective portocaval shunting are indicated. The rare patients with only partial portal thrombosis can be treated directly with stenting through an angioradiologic approach. PMID:18644135

  18. Severe bleeding from esophageal varices resistant to endoscopic treatment in a non cirrhotic patient with portal hypertension

    Directory of Open Access Journals (Sweden)

    Mangioni Simona

    2008-07-01

    Full Text Available Abstract A non cirrhotic patient with esophageal varices and portal vein thrombosis had recurrent variceal bleeding unsuccessfully controlled by endoscopy and esophageal transection. Emergency transhepatic portography confirmed the thrombosed right branch of the portal vein, while the left branch appeared angulated, shifted and stenotic. A stent was successfully implanted into the left branch and the collateral vessels along the epatoduodenal ligament disappeared. In patients with esophageal variceal hemorrhage and portal thrombosis if endoscopy fails, emergency esophageal transection or nonselective portocaval shunting are indicated. The rare patients with only partial portal thrombosis can be treated directly with stenting through an angioradiologic approach.

  19. A rare case of splenic lymphoma in a patient with polymyositis manifesting as gastric variceal bleeding.

    Science.gov (United States)

    Parekh, Ravish; Walia, Sandeep; Zalawadia, Ashish; Siddiqui, Yousuf

    2015-04-01

    We report an unusual case of upper gastrointestinal bleeding due to isolated gastric variceal bleeding in a patient with splenomegaly who was subsequently diagnosed with diffuse large B-cell lymphoma. The patient is a 47-year-old male with a history of polymyositis who presented to the emergency room with complaints of lightheadedness and melena for 2 days. On initial presentation, the patient had positive orthostatic vital signs. He was found to be anemic with presenting hemoglobin of 5.8 g/dl (compared with 13.4 g/dl 4 months prior to presentation). The patient was aggressively resuscitated with intravenous fluid and blood transfusions. An emergency esophagogastroduodenoscopy was performed which showed isolated gastric varices in the fundus of the stomach, with no active bleeding or high-risk stigmata. Abdominal computed tomography revealed focal splenic vein thrombosis and splenomegaly with ill-defined hypodensities. Portal and superior mesenteric veins were patent. Mild edema was seen surrounding the spleen and non-specific abdominal lymphadenopathy was also reported. A surgical consultation recommended an urgent splenectomy. Pathology of the removed spleen revealed diffuse large B-cell lymphoma. Positron emission tomography-computed tomography revealed lymphomatous disease in the thorax, abdomen, pelvis and bone marrow. The patient was subsequently started on chemotherapy.

  20. Endoscopic sclerotherapy compared with no specific treatment for the primary prevention of bleeding from esophageal varices. A randomized controlled multicentre trial [ISRCTN03215899].

    NARCIS (Netherlands)

    H.R. van Buuren (Henk); M.C. Rasch (Marijke); P.L. Batenburg (Piet); C.L. Bolwerk (Clemens); J.J. Nicolai (Jan); S.D.J. Werf, van der (Sjoerd); J. Scherpenisse (Joost); J. van Hattum (Jan); E.A. Rauws (Erik); S.W. Schalm (Solko); L.R. Arends (Lidia)

    2003-01-01

    textabstractBACKGROUND: Since esophageal variceal bleeding is associated with a high mortality rate, prevention of bleeding might be expected to result in improved survival. The first trials to evaluate prophylactic sclerotherapy found a marked beneficial effect of prophylactic tre

  1. Esophagogastric variceal bleeding in cirrhotic portal hypertension:consensus on prevention and management(2008)

    Institute of Scientific and Technical Information of China (English)

    Task Force for the Prevention and Management of Esophagogastric Variceal Bleeding of the Chinese Society of Gastroenterology,Chinese Society of Hepatology,and Chinese Society of Digestive Endoscopy

    2009-01-01

    @@ Portal hypertension is a clinical syndrome which is a consequence of a pathological increase in portal vein pressure due to various causes,liver cirrhosis being the most common.The basic pathophysioiogical characteristic of portal hypertension is resistance to portal vein flow or an increase in portal vein flow,which results in elevation of ressure in the portal vein and its tributaries and the formation of collateral circulation.Portal hypertension is manifested as a clinical syndrome including ascites,hepatoencephalopathy,esophagogastric variceal bleeding (EVB),etc.Among these manifestations,EVB has the highest mortality which is also one of the most common emergencies of the digestive system.

  2. Ascending colonic variceal bleeding: utility of phase-contrast MR portography in diagnosis and follow-up after treatment with TIPS and variceal embolization

    Energy Technology Data Exchange (ETDEWEB)

    Chevallier, P.; Motamedi, J.P.; Oddo, F.; Padovani, B. [Department of Radiology, Centre Hospitalier Regional et Universitaire de Nice, Hopital Archet II, 06 - Nice (France); Demuth, N.; Caroli-Bosc, F.X. [Department of Hepatology, Centre Hospitalier Regional et Universitaire de Nice, Hopital Archet II, 06 - Nice (France)

    2000-08-01

    The authors describe the discovery of ascending colonic variceal veins via celiomesenteric diagnostic angiography following a bout of melena in a 44-year-old woman. Magnetic resonance imaging, including phase-contrast MR venography, allowed visualization of the portal and systemic veins immediately after the initial angiograms. The hemorrhagic episode did not resolve until after transjugular intrahepatic shunt insertion and selective variceal embolization through the shunt. At 1 week-, 3 months-, and 6 months post treatment, follow-up MR venography no longer revealed the presence of colonic varices. Colonoscopy at 6 months was normal and the patient did not have any further episodes of bleeding until a liver transplantation was performed after 9 months. (orig.)

  3. Value of color Doppler ultrasound in diagnosis of portal hypertension liver cirrhosis merged with esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Hai-Rong Yang

    2016-01-01

    Objective:To explore the value of color Doppler ultrasound in the diagnosis of portal hypertension liver cirrhosis merged with esophageal variceal bleeding.Methods:The clinical materials of 30 patients with portal hypertension liver cirrhosis merged with esophageal varices who were admitted in our hospital from August, 2014 to August, 2015 were retrospectively analyzed. According to whether there was a history of hematemesis and melena or not before and 3 months after ultrasound examination, and whether was esophageal variceal bleeding or not confirming by the electronic gastroscopy, the patients were divided into the bleeding group (17 cases) and non-bleeding group (13 cases). The color Doppler ultrasonic diagnosis apparatus was used to detect the inner diameter and blood flow rate of splenic vein, portal vein, and left gastric vein. The blood flow volume of splenic vein, portal vein, and left gastric vein was calculated.Results:The inner diameter and blood flow volume of splenic vein in the bleeding group were significantly higher than those in the non-bleeding group, but the blood flow rate was significantly lower than that in the non-bleeding group (P0.05). The inner diameter of left gastric vein in the bleeding group was significantly higher than that in the non-bleeding group, but the blood flow rate was significantly lower that that in the non-bleeding group (P0.05).Conclusions:Color Doppler ultrasound can detect the inner diameter of splenic vein, portal vein, and left gastric vein, and the related hemodynamic indicators, particularly, the inner diameter, blood flow rate, and blood flow volume of splenic vein are effective in predicting the risk of esophageal variceal bleeding.

  4. ALCOHOLIC VERSUS NONALCOHOLIC CIRRHOSIS IN A RANDOMIZED CONTROLLED TRIAL OF EMERGENCY THERAPY OF BLEEDING VARICES

    Science.gov (United States)

    Orloff, Marshall J.; Isenberg, Jon I.; Wheeler, Henry O.; Haynes, Kevin S.; Jinich-Brook, Horacio; Rapier, Roderick; Vaida, Florin; Hye, Robert J.; Orloff, Susan L.

    2010-01-01

    Background It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial. Methods 211 unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n=106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 hours. EST failure was treated by rescue PCS. 10-yr follow-up was 96%. Results Results strongly favored EPCS over EST (p<0.001). Among EPCS patients, 83% were alcoholic and 17% nonalcoholic. Outcomes were (1) permanent control of bleeding 100% vs. 100%; (2) 5-yr survival 71% vs.78%; (3) encephalopathy 14% vs. 19%; (4) yearly charges $38,300 vs. $43,000. Conclusions EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic. PMID:21195430

  5. Analysis of the treatment outcomes of esophageal variceal bleeding patients from multiple centers in China

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    This study aimed to investigate the treatment outcomes of esophageal variceal bleeding(EVB)in China.A total of 1087 cases were collected from 19 hospitals in 16 large and medium sized cities across China between January 1st,2005 and January 1st,2006.There were 313 cases(29.0%)of mild(<400 mL),494 cases(45.8%)of moderate(400-1500 mL)and 272 cases(25.2%)of severe (>1500 mL)bleeding.Successful hemostasis was achieved in 89.8% of cases.Seven hundred and eighty-five cases were treated by medication with a hemostasis rate of 91.8%.Seventy-one cases were treated using a SengstakenBlakemore tube with a hemostasis rate of 54.9%.Thirtyseven cases were treated with emergency endoscopic variceal ligation with a hemostasis rate of 83.8%.Seventyseven cases were treated with endoscopic sclerotherapy with a hemostasis rate of 94.8%.Forty-three cases were treated with emergency surgical operation with a hemostasis rate of 95.3%.Sixty-six cases were treated with combined therapy with a hemostasis rate of 97.0%.There was a significant difference(P<0.01)in the successful hemostasis rate between different treatments.The overall mortality was 10.1%,among which 6.6% was directly caused by bleeding.The multivariate logistic regression analysis shows that the severity of bleeding,treatment methods,liver dysfunction and activation of hepatitis were predictive factors for successful hemostasis.Most cases of EVB were mild and moderate in severity.The first-line treatment for EVB is medication.Emergency endoscopic intervention has not been widely available yet.The overall management outcome of EVB has been improved.

  6. Self-Expandable Metal Stents for Persisting Esophageal Variceal Bleeding after Band Ligation or Injection-Therapy: A Retrospective Study.

    Directory of Open Access Journals (Sweden)

    Martin Müller

    Full Text Available Despite a pronounced reduction of lethality rates due to upper gastrointestinal bleeding, esophageal variceal bleeding remains a challenge for the endoscopist and still accounts for a mortality rate of up to 40% within the first 6 weeks. A relevant proportion of patients with esophageal variceal bleeding remains refractory to standard therapy, thus making a call for additional tools to achieve hemostasis. Self-expandable metal stents (SEMS incorporate such a tool.We evaluated a total number of 582 patients admitted to our endoscopy unit with the diagnosis "gastrointestinal bleeding" according to our documentation software between 2011 and 2014. 82 patients suffered from esophageal variceal bleeding, out of which 11 cases were refractory to standard therapy leading to SEMS application. Patients with esophageal malignancy, fistula, or stricture and a non-esophageal variceal bleeding source were excluded from the analysis. A retrospective analysis reporting a series of clinically relevant parameters in combination with bleeding control rates and adverse events was performed.The initial bleeding control rate after SEMS application was 100%. Despite this success, we observed a 27% mortality rate within the first 42 days. All of these patients died due to non-directly hemorrhage-associated reasons. The majority of patients exhibited an extensive demand of medical care with prolonged hospital stay. Common complications were hepatic decompensation, pulmonary infection and decline of renal function. Interestingly, we found in 7 out of 11 patients (63.6% stent dislocation at time of control endoscopy 24 h after hemostasis or at time of stent removal. The presence of hiatal hernia did not affect obviously stent dislocation rates. Refractory patients had significantly longer hospitalization times compared to non-refractory patients.Self-expandable metal stents for esophageal variceal bleeding seem to be safe and efficient after failed standard therapy

  7. ENDOSCOPIC SCLEROTHERAPY IN ESOPHAGEAL VARICES: AN EFFECTIVE TREATMENT MODALITY

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    Karbhari

    2014-12-01

    Full Text Available BACKGROUND: Varices are expanded blood vessels that develop most commonly in the esophagus. Esophageal varices is responsible for 5-11% of all cases of upper GI bleeding. Endoscopic injection sclerotherapy (EST is a valuable therapeutic modality for the management of variceal bleeding. Other options for treatment such as variceal band ligation are either expensive or unavailable. AIM: To study the common causes for development of portal hypertension to present as esophageal varices and its different clinical mode of presentation and to know the effect of endoscopic sclerotherapy with absolute alcohol particularly in acute bleeding varices of different grades. MATERIALS AND METHODS: A clinical study of esophageal varices who presented to casualty in Basaveshwar Teaching and General Hospital, Gulbarga; from May 2012 to May 2014. Etiology, presentation, outcome from EST was evaluated. RESULTS: Common affected age group was 30-50yrs, common presentation is haematemesis (90%, melena (55%, distension of abdomen (70%, haemorrhoids (20% and all cases of esophageal varices were due to portal hypertension, the common pathological condition was cirrhosis (alcoholic, cryptogenic, posthepatitis cirrhosis and next common was portal vein thrombosis followed by splenic vein thrombosis. 70% cases of bleeding varices were very well controlled with EST alone and some needed initial sengstaken balloon tamponade treatment to control the bleeding followed by EST (30%. Recurrence of bleeding and complications of EST is less. CONCLUSION: This study provides evidence that endoscopic injection sclerotherapy is an important component in the management of bleeding oesophageal varices caused by portal hypertension. It is a safe and effective procedure.

  8. Repeated pancreatitis-induced splenic vein thrombosis leads to intractable gastric variceal bleeding: A case report and review.

    Science.gov (United States)

    Tang, Shan-Hong; Zeng, Wei-Zheng; He, Qian-Wen; Qin, Jian-Ping; Wu, Xiao-Ling; Wang, Tao; Wang, Zhao; He, Xuan; Zhou, Xiao-Lei; Fan, Quan-Shui; Jiang, Ming-De

    2015-10-16

    Gastric varices (GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has been confirmed to be highly effective for most patients in many studies. However, this treatment might be ineffective for some types of GV, such as splenic vein thrombosis-related localized portal hypertension (also called left-sided, sinistral, or regional portal hypertension). Herein, we report a case of repeated pancreatitis-induced complete splenic vein thrombosis that led to intractable gastric variceal bleeding, which was treated by splenectomy. We present detailed radiological and pathological data and blood rheology analysis (the splenic artery - after a short gastric vein or stomach vein - gastric coronary vein - portal vein). The pathophysiology can be explained by the abnormal direction of blood flow in this patient. To our knowledge, this is the first reported case for which detailed pathology and blood rheology data are available.

  9. EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis:A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Ming; Bai; Xing-Shun; Qi; Zhi-Ping; Yang; Kai-Chun; Wu; Dai-Ming; Fan; Guo-Hong; Han

    2014-01-01

    AIM: To evaluate the clinical effects of transjugular intrahepatic portosystemic shunt (TIPS) vs endoscopic variceal sclerotherapy (EVS) in the management of gastric variceal (GV) bleeding in terms of variceal rebleeding, hepatic encephalopathy (HE), and survival by meta-analysis.METHODS: Medline, Embase, and CNKI were searched. Studies compared TIPS with EVS in treating GV bleeding were identified and included according to our predefined inclusion criteria. Data were extracted independently by two of our authors. Studies with prospective randomized design were considered to be of high quality. Hazard ratios (HRs) or odd ratios(ORs) were calculated using a fixed-effects model when there was no inter-trial heterogeneity. Oppositely, a random-effects model was employed.RESULTS: Three studies with 220 patients who had at least one episode of GV bleeding were included in the present meta-analysis. The proportions of patients with viral cirrhosis and alcoholic cirrhosis were 39% (range 0%-78%) and 36% (range 12% to 41%), respectively. The pooled incidence of variceal rebleeding in the TIPS group was significantly lower than that in the EVS group (HR = 0.3, 0.35, 95% CI: 0.17-0.71, P = 0.004). However, the risk of the development of any degree of HE was significantly increased in the TIPS group (OR = 15.97, 95% CI: 3.61-70.68). The pooled HR of survival was 1.26(95% CI: 0.76-2.09, P = 0.36). No inter-trial heterogeneity was observed among these analyses. CONCLUSION: The improved effect of TIPS in the prevention of GV rebleeding is associated with an increased risk of HE. There is no survival difference between the TIPS and EVS groups. Further studies are needed to evaluate the survival benefit of TIPS in cirrhotic patients with GV bleeding.

  10. An Unusual Case of Gastrointestinal Bleeding from Isolated Gallbladder Varices in a Patient with Pancreatic Cancer Complicated by Portal Biliopathy

    Directory of Open Access Journals (Sweden)

    Mahir Gachabayov

    2016-01-01

    Full Text Available Portal biliopathy is the complex of abnormalities of extrahepatic and intrahepatic bile ducts, cystic duct, and gallbladder, arising as a result of extrahepatic portal vein obstruction and noncirrhotic portal fibrosis, which can be caused by coagulopathies, tumors, inflammation, postoperative complications, dehydration, and neonatal umbilical vein catheterization. We report a case of a 55-year-old male patient with the history of pancreatic cancer and cholecystoenteric anastomosis presenting with gastrointestinal bleeding from gallbladder varices via the anastomosis.

  11. Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2015, Nanchang, China).

    Science.gov (United States)

    Bai, Yu; Li, Zhao Shen

    2016-02-01

    Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies in China and worldwide. In 2009, we published the "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" for the patients in China; however, during the past years numerous studies on the diagnosis and treatment of ANVUGIB have been conducted, and the management of ANVUGIB needs to be updated. The guidelines were updated after the databases including PubMed, Embase and CNKI were searched to retrieve the clinical trials on the management of ANVUGIB. The clinical trials were evaluated for high-quality evidence, and the advances in definitions, diagnosis, etiology, severity evaluation, treatment and prognosis of ANVUGIB were carefully reviewed, the recommendations were then proposed. After several rounds of discussions and revisions among the national experts of digestive endoscopy, gastroenterology, radiology and intensive care, the 2015 version of "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" was successfully developed by the Chinese Journal of Internal Medicine, National Medical Journal of China, Chinese Journal of Digestion and Chinese Journal of Digestive Endoscopy. It shall be noted that although much progress has been made, the clinical management of ANVUGIB still needs further improvement and refinement, and high-quality randomized trials are required in the future.

  12. Transjugular intrahepatic portosystemic shunt in patients with active variceal bleeding due to portal hypertension and portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hyun Woong; Ryeom, Hun Kyu; Lee, Sang Kwon; Lee, Jong Min; Kim, Young Sun; Suh, Kyung Jin; Kim, Tae Hun; Kim, Yong Joo [Kyungpook National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous trans-formation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patents portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with knoncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. The procedures were technically successful in all except one patient. Immediate hemostatis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion.

  13. Isolated jejunal varices.

    Directory of Open Access Journals (Sweden)

    Bhagwat S

    1995-04-01

    Full Text Available Isolated jejunal varices are an uncommon manifestation of portal hypertension. A one and a half year old boy presented with recurrent, massive gastrointestinal bleeding from jejunal varices. The bleeding site was identified at exploratory laparotomy. Jejunal resection and anastomosis resulted in complete resolution of the bleeding and there has been no recurrent bleeding over an eight month follow-up period.

  14. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Ho; Yoon, Chang Jin; Park, Jae Hyung; Chung, Jin Wook; Kwon, Jong Won [Seoul Natioonal University College of Medicine, Seoul (Korea, Republic of); Choi, Guk Myung [Cheju National University College of Medicine, Jeju (Korea, Republic of)

    2003-06-01

    To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test. One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02). BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.

  15. Usefulness of angiographic embolization endoscopic metallic clip placement in patient with non-variceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Min Jae; Hwang, Cheol Mog; Kim, Ho Jun; Cho, Young Jun; Bae, Seok Hwan [Dept. of Radiology, Konyang University Hospital, Daejeon (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young [Dept. of Radiology, Chungnam National University College of Medicine, Daejeon (Korea, Republic of); Kang, Chae Hoon [Dept. of Radiology, Inje University College of Medicine, Pusan Paik Hospital, Busan (Korea, Republic of)

    2013-08-15

    The aim of this study is to assess the usefulness of angiographic embolization after endoscopic metallic clip placement around the edge of non-variceal upper gastrointestinal bleeding ulcers. We have chosen 41 patients (mean age, 65.2 years) with acute bleeding ulcers (22 gastric ulcers, 16 duodenal ulcers, 3 malignant ulcers) between January 2010 and December 2012. We inserted metallic clips during the routine endoscopic treatments of the bleeding ulcers. Subsequent transcatheter arterial embolization was performed within 2 hours. We analyzed the angiographic positive rates, angiographic success rates and clinical success rates. Among the 41 patients during the angiography, 19 patients (46%) demonstrated active bleeding points. Both groups underwent embolization using microcoils, N-butyl-cyano-acrylate (NBCA), microcoils with NBCA or gelfoam particle. There are no statistically significant differences between these two groups according to which embolic materials are being used. The bleeding was initially stopped in all patients, except the two who experienced technical failures. Seven patients experienced repeated episodes of bleeding within two weeks. Among them, 4 patients were successful re-embolized. Another 3 patients underwent gastrectomy. Overall, clinical success was achieved in 36 of 41 (87.8%) patients. The endoscopic metallic clip placement was helpful to locate the correct target vessels for the angiographic embolization. In conclusion, this technique reduced re-bleeding rates, especially in patients who do not show active bleeding points.

  16. Therapeutic approach to "downhill" esophageal varices bleeding due to superior vena cava syndrome in Behcet's disease: a case report

    Directory of Open Access Journals (Sweden)

    Haghighi Mahshid

    2006-12-01

    Full Text Available Abstract Background One of the rare presentations of superior vena cava syndrome is bleeding of "downhill" esophageal varices (DEV and different approaches have been used to control it. This is a case report whose DEV was eradicated by band ligation for the first time. Case presentation We report a 42-year-old man who is a known case of Behcet's disease. The patient's first presentation was superior vena cava syndrome due to thrombosis followed by bipolar ulcers and arthralgia. He received warfarin, prednisolone and azathioprine. The clinical course of the patient was complicated by one episode of hematemesis without abdominal pain when the patient's PT was in therapeutic range. After resuscitation and correction of PT with fresh frozen plasma transfusion, upper gastrointestinal endoscopy was done. Prominent varices were seen in the upper third of the esophagus, tapering to the middle part without acute bleeding. Stomach and duodenum were normal. Color ultrasonography evaluation of the portal, hepatic and splenic veins was negative for thrombosis. Band ligation was done and the patient's bleeding did not recur. Conclusion Band ligation is a safe and effective method for controlling DEV bleeding in patients with uncorrectable underlying disorders.

  17. Prognostic variables in patients with cirrhosis and oesophageal varices without prior bleeding

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming; Christensen, E

    1994-01-01

    in the study and followed up after an average observation period of 446 days (range: 5-1211 days). A total of 55 clinical, biochemical, haemodynamic, and endoscopic variables were classified as systemic haemodynamic, portal haemodynamic, or metabolic. Using univariate analysis, the following variables showed...... serum bilirubin (p variables as described earlier...

  18. Banding ligation or beta-blockers for primary prevention of variceal bleeding?

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    Petre Cotoras Viedma

    2016-12-01

    Full Text Available Resumen La hemorragia digestiva alta variceal es una de las complicaciones más serias de la cirrosis hepática. Los betabloqueadores no selectivos y la ligadura endoscópica se consideran efectivos como estrategia de prevención primaria de hemorragia variceal, pero no hay consenso sobre cuál de las dos constituye la mejor opción. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos siete revisiones sistemáticas que en conjunto incluyen 21 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la ligadura variceal probablemente disminuye el riesgo de sangrado digestivo variceal y se asocia a menos efectos adversos al ser comparada con betabloqueadores no selectivos, aunque probablemente no existen diferencias en términos de mortalidad.

  19. Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report

    Directory of Open Access Journals (Sweden)

    Michalopoulos Antonis

    2010-05-01

    Full Text Available Abstract Introduction Splenic vein thrombosis results in localized portal hypertension called sinistral portal hypertension, which may also lead to massive upper gastrointestinal bleeding. Symptomatic sinistral portal hypertension is usually best treated by splenectomy, but interventional radiological techniques are safe and effective alternatives in the management of a massive hemorrhage, particularly in cases that have a high surgical risk. Case presentation We describe a 23-year-old Greek man with acute massive gastric variceal bleeding caused by splenic vein thrombosis due to a missing von Leiden factor, which was successfully managed with splenic arterial embolization. Conclusions Interventional radiological techniques are attractive alternatives for patients with a high surgical risk or in cases when the immediate surgical excision of the spleen is technically difficult. Additionally, surgery is not always successful because of the presence of numerous portal collaterals and adhesion. Splenic artery embolization is now emerging as a safe and effective alternative to surgery in the management of massive hemorrhage from gastric varices due to splenic vein thrombosis, which often occurs in patients with hypercoagulability.

  20. Endoscopic injection sclerotherapy in non-variceal upper gastrointestinal bleeding. A comparative study of polidocanol and thrombin.

    Science.gov (United States)

    Benedetti, G; Sablich, R; Lacchin, T

    1991-01-01

    To date several agents have been used to achieve haemostasis in patients with non-variceal upper gastrointestinal bleeding using endoscopic sclerotherapy techniques. Polidocanol has been widely used but local complications have been reported after treatment. We have compared the efficacy and safety of thrombin and polidocanol in 82 consecutive patients with ongoing or recent bleeding from duodenal, gastric, or anastomotic ulcers. Primary control of haemostasis from spurting vessels was achieved in 90% of cases using polidocanol and in 86.6% using thrombin. Definitive haemostasis was obtained in 80% of patients in both groups. When a non-bleeding vessel was visible, injection of polidocanol or thrombin effectively prevented rebleeding in 90.9% and 85.7% of cases, respectively. When a non-bleeding sentinel clot was present, injection of polidocanol or thrombin provided definitive haemostasis in 100% and 92.8% of cases, respectively. No statistically significant difference was evident between the two agents. In the polidocanol group, one local haemorrhagic complication was noted. No general or local complications were recorded in the thrombin group.

  1. Determination of correlation of Adjusted Blood Requirement Index with outcome in patients presenting with acute variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Naheed Akhtar; Bader Faiyaz Zuberi; Syed Riazul Hasan; Raj Kumar; Salahuddin Afsar

    2009-01-01

    AIM: To determine the correlation of Adjusted Blood Requirement Index (ABRI) with the 7th day outcome in patients presenting with acute variceal bleeding.METHODS: All patients presenting with acute variceal hemorrhage (AVH) were included. Patients with previous band ligation, sclerotherapy, gastrointestinal or hepatic malignancies were excluded. Patients were managed as per standard protocol for AVH with terlipressin and band ligation. ABRI scores were calculated using the formula outcome of alive or expired up to the 7th day after treatment. The correlation between ABRI and mortality was estimated and a receiver operative characteristic (ROC) curve was plotted.RESULTS: A total of 113 patients (76 male; 37 female) were included. On assessment, 18 were in Child's Pugh Class A, 82 in Class B and 13 were in Class C. The median number of blood units transfused ± inter-quartile range was 3.0 ± 2.0. The median ± inter-quartile range for ABRI was 1.3 ± 1.1. The ROC curve of ABRI for expiry showed a significantly large area of 0.848 ( P < 0.0001; 95% CI: 0.75-0.95). A significant correlation of log transformation of ABRI with an outcome of mortality was present ( P < 0.0001). CONCLUSION: ABRI correlates strongly with mortality.

  2. Blood flow parameters in the short gastric vein and splenic vein on Doppler ultrasound reflect gastric variceal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Hitoshi, E-mail: maru-cib@umin.ac.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670 (Japan); Ishihara, Takeshi, E-mail: ishihara@faculty.chiba-u.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670 (Japan); Ishii, Hiroshi, E-mail: hiroshi.ishii@jfcr.or.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670 (Japan); Tsuyuguchi, Toshio, E-mail: tsuyuguchi@faculty.chiba-u.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670 (Japan); Yoshikawa, Masaharu, E-mail: yoshikawa@faculty.chiba-u.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670 (Japan); Matsutani, Shoichi, E-mail: shoichi.matsutani@cchs.ac.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670 (Japan); Yokosuka, Osamu, E-mail: yokosukao@faculty.chiba-u.j [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670 (Japan)

    2010-07-15

    Purpose: Hemodynamic features associated with the bleeding from gastric fundal varices (FV) have not been fully examined. The purpose of this study was to elucidate hemodynamics in the short gastric vein (SGV) which is a major inflow route for FV and flow direction of the splenic vein (SV) in relation to bleeding FV. Materials and Methods: The subject of this retrospective study was 54 cirrhotic patients who had medium- or large-sized FV (20 bleeders, 34 non-bleeders) on endoscopy with SGV on both angiogram and sonogram. Diameter, flow velocity, flow volume of SGV and flow direction in the SV were evaluated by Doppler ultrasound. Results: Diameter, flow velocity and flow volume of SGV were significantly greater in bleeders (9.6 {+-} 3.1 mm, 11.4 {+-} 5.2 cm/s, 499 {+-} 250.1 ml/min) than non-bleeders (6.5 {+-} 2.2 mm, p = 0.0141; 7.9 {+-} 3.3 cm/s, p = 0.022; 205 {+-} 129.1 ml/min, p = 0.0031). SV showed forward flow in 37 (68.5%), to and fro in 3 (5.6%) and reversed flow in 14 patients (25.9%). The frequency of FV bleeding was significantly higher in case with reversed or 'to and fro' SV flow (11/17) than forward SV flow (9/37, p = 0.0043). The cumulative bleeding rate at 3 and 5 years was significantly higher in patients without forward SV flow (38.8% at 3 years, 59.2% at 5 years) than in patients with forward SV flow (18.7% at 3 years, 32.2% at 5 years, p = 0.0199). Conclusion: Advanced SGV blood flow and reversed SV flow direction may be a hemodynamic features closely related to the FV bleeding.

  3. Covered TIPS for secondary prophylaxis of variceal bleeding in liver cirrhosis

    Science.gov (United States)

    Qi, Xingshun; Tian, Yulong; Zhang, Wei; Zhao, Haitao; Han, Guohong; Guo, Xiaozhong

    2016-01-01

    Abstract 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. Methods: All relevant randomized controlled trials were searched via the PubMed, EMBASE, and Cochrane Library databases. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) and P values were calculated for the cumulative risk and overall risk, respectively. Heterogeneity among studies was also calculated. Results: Three of 111 retrieved papers were eligible. Among them, the proportion of patients who were switched from drug plus endoscopic therapy to TIPS was 16% to 25%. The risk of bias was relatively low in all included randomized controlled trials. Meta-analyses demonstrated that the covered TIPS group had a similar overall survival (HR = 0.84, 95% CI = 0.55–1.28, P = 0.41; OR = 1.00, 95% CI = 0.59–1.69, P = 0.99), a significantly lower risk of variceal rebleeding (HR = 0.30, 95% CI = 0.18–0.48, P < 0.00001; OR = 0.24, 95% CI = 0.12–0.46, P < 0.0001), and a similar risk of hepatic encephalopathy (HR = 1.35, 95% CI = 0.72–2.53, P = 0.36; OR = 1.28, 95% CI = 0.54–3.04, P = 0.57). In most of meta-analyses, the heterogeneity among studies was not statistically significant. Conclusions: Compared with drug plus endoscopic therapy, covered TIPS had a significant benefit of preventing from variceal rebleeding, but did not increase the overall survival or risk of hepatic encephalopathy. PMID:27977618

  4. Endoscopic treatment of non-variceal gastrointestinal bleeding: hemoclips and other hemostatic techniques

    Institute of Scientific and Technical Information of China (English)

    Rossana M. Moura; Jamie S. Barkin

    2000-01-01

    @@ Although the number of hospitalizations for nonvariccal gastrointestinal bleeding has decreased in recent years, acute upper gastrointestinal hemorrhage continues to be a common reason for hospital admission, and peptic ulcers account for at least fifty percent of all cases. Despite the fact that bleeding from ulcers ceases spontaneously in approximately 80% of patients, it is still a diagnosis associated with substantial medical costs and significant morbidity and mortality, the latter ranging between 8 and 14%[1], especially in the elderly.

  5. LIVER TRANSPLANTATION IN A RANDOMIZED CONTROLLED TRIAL OF EMERGENCY TREATMENT OF ACUTELY BLEEDING ESOPHAGEAL VARICES IN CIRRHOSIS

    Science.gov (United States)

    Orloff, Marshall J.; Isenberg, Jon I.; Wheeler, Henry O.; Haynes, Kevin S.; Jinich-Brook, Horacio; Rapier, Roderick; Vaida, Florin; Hye, Robert J.; Orloff, Susan L.

    2010-01-01

    Background Bleeding esophageal varices (BEV) in cirrhosis has been considered an indication for liver transplantation (LT). This issue was examined in a randomized controlled trial (RCT) of unselected, consecutive patients with advanced cirrhosis and BEV that compared endoscopic sclerotherapy (EST) (n=106) to emergency direct portacaval shunt (EPCS) (n=105). Methods Diagnostic workup and treatment were initiated within 8 hours. Patients were evaluated for LT on admission and repeatedly thereafter. 96% underwent over 10 years of regular follow-up. The analysis was supplemented by 1300 unrandomized cirrhotic patients who previously underwent portacaval shunt (PCS) with 100% follow-up. Results In the RCT, long-term bleeding control was 100% following EPCS, only 20% following EST. 3, 5, 10, and 15-year survival rates were 75%, 73%, 46%, and 46% following EPCS, compared to 44%, 21%, 9%, and 9% following EST (p<0.001). Only 13 RCT patients (6%) were ultimately referred for LT mainly because of progressive liver failure; only 7 (3%) were approved for LT and only 4 (2%) underwent LT. 1- and 5-year LT survival rates were 0.68% and 0, compared to 81% and 73% after EPCS. In the 1300 unrandomized PCS patients. 50 (3.8%) were referred and 19 (1.5%) underwent LT. Five-year survival rate was 53% compared to 72% for all 1300 patients. Conclusions If bleeding is permanently controlled, as occurred invariably following EPCS, cirrhotic patients with BEV seldom require LT. PCS is effective first-line and long-term treatment. Should LT be required in patients with PCS, although technically more demanding, numerous studies have shown that PCS does not increase mortality or complications. EST is not effective emergency or long-term therapy. PMID:21168637

  6. MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Wei-Ting Chen; Cheng-Tang Chiu; Chun-Yen Lin; I-shyan Sheen; Chang-Wen Huang; Tsung-Nan Lin; Chun-Jung Lin; Wen-Juei Jeng; Chien-Hao Huang; Yu-Pin Ho

    2011-01-01

    AIM: To investigate the outcomes, as well as risk factors for 6-wk mortality, in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH). METHODS: Among 817 EVL procedures performed for EVH between January 2007 and December 2008, 128 patients with early rebleeding, defined as rebleeding within 6 wk after EVL, were enrolled for analysis. RESULT: The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817). The 5-d, 6-wk, 3-mo, and 6-mo mortality rates were 7.8%, 38.3%, 55.5%, and 58.6%, respectively, in these early rebleeding patients. The use of beta-blockers, occurrence of hypovolemic shock, and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality. A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value were 77.6%, 81%, 71.7%, and 85.3%, respectively. As for the 6-mo survival rate, patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001). CONCLUSION: This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.

  7. Sentinel Bleeding as a Sign of Gastroaortic Fistula Formation after Oesophageal Surgery

    Directory of Open Access Journals (Sweden)

    M. Uittenbogaart

    2014-01-01

    Full Text Available Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

  8. Asymptomatic Esophageal Varices Should Be Endoscopically Treated

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    Nib Soehendra

    1998-01-01

    Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

  9. CT and MRI findings of cirrhosis-related benign nodules with ischaemia or infarction after variceal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y.K., E-mail: jmyr@dreamwiz.co [Department of Diagnostic Radiology, Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Jeon Ju (Korea, Republic of); Park, G.; Kim, C.S.; Han, Y.M. [Department of Diagnostic Radiology, Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Jeon Ju (Korea, Republic of)

    2010-10-15

    Aim: To present computed tomography (CT) and magnetic resonance imaging (MRI) findings of cirrhosis-related benign nodules with ischaemia or infarction. Materials and methods: Sixteen consecutive patients (14 men and two women) who had been diagnosed with cirrhosis-related benign nodules with ischaemia or infarction after variceal bleeding based on the results of dynamic CT (n = 15) and MRI (n = 8) were included in this study. Five patients had histopathological confirmation via liver transplantation (n = 2) and percutaneous biopsy (n = 3). Images were analyzed for the enhancement pattern, signal intensities, location, and configuration of the lesions. Results: Most of the lesions were depicted as multifocal discrete or clustered nodules with some irregular patchy areas (size range 3-28 mm). They were predominantly found in subcapsular area or caudate lobe. Most nodular lesions were seen as hypoattenuating (hypointense) nodules with rim enhancement during dynamic CT or MRI. On T2-weighted images, nodular lesions were predominantly seen as target appearing hyperintense nodules. On follow-up images (range 2-24 months), most of the lesions disappeared or decreased in size. Conclusion: CT and MRI can be used to demonstrate characteristic findings of cirrhosis-related benign nodules with ischaemia or infarction. Rapid resolution of the nodules at follow-up imaging can also be helpful for diagnosing these lesions.

  10. Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting

    Institute of Scientific and Technical Information of China (English)

    Robert A Enns; Yves M Gagnon; Alan N Barkun; David Armstrong; Jamie C Gregor; Richard N Fedorak

    2006-01-01

    AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death.METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals.Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used x2 goodness-of-fit tests to assess the degree of calibration,and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system.RESULTS: For rebleeding, the x2 goodness-of-fit test indicated an acceptable fit for the model [x2 (8) = 12.83,P = 0.12]. For surgical procedures [x2 (8) = 5.3, P = 0.73]and death [x2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI:0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing a poor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78),indicating an acceptable discriminative ability.CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.

  11. Esophageal variceal pressure is a major predictor of variceal bleeding in cirrhotic patients%食管曲张静脉压力是预测肝硬化曲张静脉破裂出血的主要危险因素

    Institute of Scientific and Technical Information of China (English)

    孔德润; 许建明; 张磊; 郝加虎; 孙斌

    2009-01-01

    Objective To prospectively study the main risk factors of variceal bleeding in cirrhotic patients. Methods Fifty-seven patients with liver cirrhosis and esophageal varices who had never experienced variceal bleeding were followed up for 12 months. The patients underwent measurements of esophageal variceal pressure by non-invasive endoscopic balloon technique. The endpoint of the study was the presence of a variceal hemorrhage. The relationship between variceal hemorrhage and endoscopic findings including varices, variceal pressure, Child-Pugh status, ascites, and etiology of cirrhosis was studied. Results Thirty-four patients (59.6% ) developed a variceal hemorrhage. In univariate analysis, the level of variceal pressure (P= 0. 001), the size of varices (P=0. 006), and the endoscopic red color sign on the variceal wall (P=0. 012) predicted higher risks of variceal hemorrhage. The multiple logistic regression revealed that variceal pressure was a major predictor of the risk for a first variceal bleeding (OR=2. 817, P=0. 003). The area under the receiver operating characteristic (ROC) of variceal pressure for predicting variceal bleeding was 0. 98, and the variceal pressure cutoff value was 25.3 mm Hg (1 mm Hg=0. 133 kPa) with both specificity and sensitivity of 91 %. Conclusion The level of variceal pressure is a major predictor for variceal bleeding in cirrhotic patients.%目的:前瞻性研究影响肝硬化食管曲张静脉破裂出血的主要危险因素.方法:随访未发生过食管曲张静脉出血的57例肝硬化患者1年.采用内镜下无创性食管曲张静脉气囊测压仪检测曲张静脉压,研究终点为出现食管曲张静脉出血.研究食管曲张静脉内镜下表现、食管曲张静脉压力、肝功能分级、肝硬化病因及腹水指标与食管曲张静脉破裂出血的关系.结果:1年内34例(59.6%)患者发生首次食管曲张静脉破裂出血.单因素分析显示,食管曲张静脉压力(P=0.001)

  12. Aspirin use for primary prophylaxis: Adverse outcomes in non-variceal upper gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Karina M Souk; Hani M Tamim; Hussein A Abu Daya; Don C Rockey; Kassem A Barada

    2016-01-01

    AIM: To compare outcomes of patients with nonvariceal upper gastrointestinal bleeding(NVUGIB) taking aspirin for primary prophylaxis to those not taking it.METHODS: Patients not known to have any vascular disease(coronary artery or cerebrovascular disease) who were admitted to the American University of Beirut Medical Center between 1993 and 2010 with NVUGIB were included. The frequencies of in-hospital mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome defined as the occurrence of any of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics. We also compared frequency of in hospital complications and length of hospital stay between the two groups.RESULTS: Of 357 eligible patients, 94 were on aspirin and 263 patients were on no antithrombotics(controlgroup). Patients in the aspirin group were older, the mean age was 58 years in controls and 67 years in the aspirin group(P < 0.001). Patients in the aspirin group had significantly more co-morbidities, including diabetes mellitus and hypertension [25(27%) vs 31(112%) and44(47%) vs 74(28%) respectively,(P = 0.001)], as well as dyslipidemia [21(22%) vs 16(6%), P < 0.0001).Smoking was more frequent in the aspirin group [34(41%) vs 60(27%), P = 0.02)]. The frequencies of endoscopic therapy and surgery were similar in both groups. Patients who were on aspirin had lower inhospital mortality rates(2.1% vs 13.7%, P = 0.002),shorter hospital stay(4.9 d vs 7 d, P = 0.01), and fewer composite outcomes(10.6% vs 24%, P = 0.01). The frequencies of in-hospital complications and re-bleeding were similar in the two groups.CONCLUSION: Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes. Thus aspirin may have a protective effect beyond its cardiovascular benefits.

  13. An Unusual Cause of Gastrointestinal Bleeding: Duodenal Lipoma

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    R. Kadaba

    2011-04-01

    Full Text Available Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.

  14. Emergency Portacaval Shunt Versus Rescue Portacaval Shunt in a Randomized Controlled Trial of Emergency Treatment of Acutely Bleeding Esophageal Varices in Cirrhosis—Part 3

    Science.gov (United States)

    Isenberg, Jon I.; Wheeler, Henry O.; Haynes, Kevin S.; Jinich-Brook, Horacio; Rapier, Roderick; Vaida, Florin; Hye, Robert J.

    2010-01-01

    Background Emergency treatment of bleeding esophageal varices in cirrhosis is of singular importance because of the high mortality rate. Emergency portacaval shunt is rarely used today because of the belief, unsubstantiated by long-term randomized trials, that it causes frequent portal-systemic encephalopathy and liver failure. Consequently, portacaval shunt has been relegated solely to salvage therapy when endoscopic and pharmacologic therapies have failed. Question: Is the regimen of endoscopic sclerotherapy with rescue portacaval shunt for failure to control bleeding varices superior to emergency portacaval shunt? A unique opportunity to answer this question was provided by a randomized controlled trial of endoscopic sclerotherapy versus emergency portacaval shunt conducted from 1988 to 2005. Methods Unselected consecutive cirrhotic patients with acute bleeding esophageal varices were randomized to endoscopic sclerotherapy (n = 106) or emergency portacaval shunt (n = 105). Diagnostic workup was completed and treatment was initiated within 8 h. Failure of endoscopic sclerotherapy was defined by strict criteria and treated by rescue portacaval shunt (n = 50) whenever possible. Ninety-six percent of patients had more than 10 years of follow-up or until death. Results Comparison of emergency portacaval shunt and endoscopic sclerotherapy followed by rescue portacaval shunt showed the following differences in measurements of outcomes: (1) survival after 5 years (72% versus 22%), 10 years (46% versus 16%), and 15 years (46% versus 0%); (2) median post-shunt survival (6.18 versus 1.99 years); (3) mean requirements of packed red blood cell units (17.85 versus 27.80); (4) incidence of recurrent portal-systemic encephalopathy (15% versus 43%); (5) 5-year change in Child’s class showing improvement (59% versus 19%) or worsening (8% versus 44%); (6) mean quality of life points in which lower is better (13.89 versus 27.89); and (7) mean cost of care per

  15. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

    Science.gov (United States)

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy.

  16. Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding Dopplerfluxometria portal na esquistossomose hepatoesplênica com e sem antecedentes de hemorragia por varizes esofágicas

    OpenAIRE

    Severino Marcos Borba de Arruda; Victorino Spinelli Toscano Barreto; Fernando José do Amaral

    2008-01-01

    BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive pa...

  17. Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany

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    Garbe Edeltraut

    2011-08-01

    Full Text Available Abstract Background Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM. Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany. Methods We analysed hospitalisation diagnoses for oesophageal bleeding (OB and upper gastrointestinal bleeding (UGIB from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided or "unspecific" (origin of bleeding not provided coding. We studied regional (former East versus West Germany differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density. Results Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32 for specific and 0.67 (95% CI 0.60-0.74 for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51 for specific and 0.83 (95% CI 0.80-0.87 for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively. Conclusions During the study

  18. 儿童食管静脉曲张出血结扎治疗%Endoscopic variceal ligation in pediatric patients with esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    张宁; 于杰; 董丽丽; 毛建新

    2005-01-01

    食管静脉曲张(esophageal varices,EV)出血的内镜下诊断和治疗,近几年已取得很大进展,并且已经取代外科手术,作为首选的治疗方法。在内镜下食管静脉曲张硬化治疗(endoscopic variceal sclerotherapy,EVS)之后,由Stigmann首先进行了内镜下食管静脉曲张结扎治疗(endoscopic variceal ligation,EVL),在成人目前已有大量报道,但在儿童报道不多。我院1999年1月至2003年12月共有287例患者行EVL治疗,其中小于14岁儿童有7例,并取得显著疗效。现报道如下。

  19. Ectopic Varices in Colonic Stoma: MDCT Findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jae Woong; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min; Kim, Jin Yong [Guro Hospital of Korea University, Seoul (Korea, Republic of)

    2006-12-15

    We describe the 2D reformatted and 3D volume rendered images by MDCT in a patient with an episode of acute bleeding from the colonic stoma. This case indicates that the 2D reformatted and 3D volume rendered images are useful to detect this rare complication of portal hypertension, and they help to tailor adequate treatment for the patients with bleeding from stomal varices. Ectopic varices are an uncommon cause of gastrointestinal hemorrhage, but they account for up to 5% of all variceal bleedings (1). Bleeding from stomal varices has been reported in up to 20% of the patients suffering with chronic liver failure with permanent stoma (2). However, the diagnosis of stomal varices is difficult because bleeding from stoma may also be associated with lower gastrointestinal bleeding. To the best of our knowledge, the 2D reformatted and 3D volume rendered images by MDCT for visualization of ectopic stomal varices have not been previously reported in the medical literature.

  20. EUS-Assisted Evaluation of Rectal Varices before Banding

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    Malay Sharma

    2013-01-01

    Full Text Available Rectal varices are an important cause of bleed. The bleeding can be sometimes fatal. Endoscopic management is possible and is generally done in emergency situation. Rectal variceal banding is useful. Hemodynamic evaluation has shown that the blood flow in rectal varices is from above downwards; however, the site of banding of rectal varices is unclear. This case series shows that the rectal varices should be banded at the highest point of inflow.

  1. Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

    Institute of Scientific and Technical Information of China (English)

    Fabrizio Parente; Andrea Anderloni; Stefano Bargiggia; Venerina Imbesi; Emilio Trabucchi; Cinzia Baratti; Silvano Gallus; Gabriele Bianchi Porro

    2005-01-01

    AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for

  2. A RARE CASE OF OESOPHAGODUODENAL VARICES

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    Keisham

    2015-10-01

    Full Text Available Varices are sequelae of portal hypertension and can occur in both cirrhotic and noncirrhotic portal hypertension. They are commonly seen in the oesophagus and stomach. Presentation of varix in the duodenum is rare. The commonest site is in the duodenal bulb followed by the second and third parts of duodenum. The treatment of duodenal varices is challenging and various modalities of treatment are described in literature. Here, we present a case of oesophago-duodenal varices successfully treated by endoscopic variceal ligation for oesophageal varix and injection sclerotherapy for duodenal varix.

  3. New methods for the management of gastric varices

    Institute of Scientific and Technical Information of China (English)

    Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Takashi Tajiri

    2006-01-01

    Bleeding from gastric varices has been successfully treated by endoscopic modalities. Once the bleeding from the gastric varices is stabilized, endoscopic treatment and/or interventional radiology should be performed to eradicate varices completely. Partial splenic artery embolization is a supplemental treatment to prolong the obliteration of the veins feeding and/or draining the varices. The overall incidence of bleeding from gastric varices is lower than that from esophageal varices. No studies to date have definitively characterized the causal factors behind bleeding from gastric varices. The initial episodes of bleeding from esophageal varices or gastric varices without prior treatment may be at least partly triggered by a violation of the mucosal barrier overlying varices. This is especially likely in the case of varices of the fundus. In view of the high rate of hemostasis achieved among bleeding gastric varices, treatment should be administered in selective cases. Among untreated cases, steps to prevent gastric mucosal injury confer very important protection against gastric variceal bleeding.

  4. Management of Bleeding Duodenal Varices with Combined TIPS Decompression and Trans-TIPS Transvenous Obliteration Utilizing 3% Sodium Tetradecyl Sulfate Foam Sclerosis

    Directory of Open Access Journals (Sweden)

    Wael E Saad

    2014-01-01

    Full Text Available Objectives: Endoscopic experience in the management of duodenal varices (DVs is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%. The purpose of the study is to evaluate the clinical outcome of combined TIPS decompression and transvenous obliteration/sclerosis. Materials and Methods: This is a retrospective study (case series of two institutions, evaluating patients who underwent TIPS and/or transvenous obliteration/sclerosis for bleeding DVs (from January 2009 to June 2013. TIPS was performed according to a standard procedure using covered stents. Transvenous obliteration (variceal sclerosis from the systemic and/or portal venous circulation was performed utilizing 3% sodium tetradecyl sulfate foam. Transvenous obliteration was commonly augmented with coils and/or vascular plugs. Technical (technical success of establishing TIPS and completely obliterating the DVs and clinical outcomes (rebleeding rate and survival were evaluated. Results: Five patients with liver cirrhosis presenting with bleeding DVs were included in the study with all eventually (and coincidentally receiving TIPS and transvenous obliteration. Two of the five patients underwent concomitant TIPS and transvenous obliteration in the same procedural setting. However, three patients underwent transvenous obliteration due to bleeding despite a patent TIPS that had been previously placed. The average time from TIPS placement to transvenous obliteration was 125 days (range: 3-324 days. After having both procedures, there was no rebleeding in the patients during a mean follow-up period of 22 months (6-50 months

  5. A Canadian Clinical Practice Algorithm for the Management of Patients with Non-Variceal Upper Gastrointestinal Bleeding

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    Alan Barkun

    2004-01-01

    Full Text Available AIM: To use current evidence-based recommendations to provide a user-friendly clinical algorithm for the management of upper gastrointestinal bleeding, adapted to the Canadian environment.

  6. Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology Hemorragia digestiva alta varicosa: relatório do 1º Consenso da Sociedade Brasileira de Hepatologia

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    Paulo Lisboa Bittencourt

    2010-06-01

    Full Text Available In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all participants met together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manuscript is the summary of the systematic review that was presented during the meeting, organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.Vários avanços científicos obtidos nas últimas duas décadas foram incorporados no manejo da hemorragia digestiva alta varicosa, levando a uma redução significante da sua morbimortalidade, atribuída à abordagem multidisciplinar do sangramento varicoso por paramédicos, emergencistas, intensivistas, gastroenterologistas, hepatologistas, endoscopistas, radiologistas intervencionistas e cirurgiões. Recentemente, a Sociedade Brasileira de Hepatologia patrocinou uma reunião de consenso, visando o estabelecimento de recomendações nacionais

  7. Effects of somatostatin,octreotide and pitressin plus nitroglycerin on systemic and hepatic hemodynamics in the control of acute variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective:To examine the hemodynamic effects of somatostatin(SS) and octreotide(OC) versus pitressin plus nitroglycerin(PN) in the control of variceal bleeding.Methods:224 of patients with acute esophageal and gastric variceal hemorrhage were randomly divided into three groups and treated with SS,OC and PN,and measured their Doppler ultrasound parameters,heart rates,mean artery pressure and cardiac output before treatment,during and after end.A SengstakenBlakemore's tube without aerated was used for the observation of bleeding.Results:The success rates of bleeding control in SS group(80.9%,86.8% and 89.7%,P<0.001) and in OC group (75.3%,80.8% and 84.9%,P<0.01-0.005) were significantly higher than in PN group(51.8%,59.0% and 65.1%) at 24h,48h and 72h,and the average duration of SS(12.7h±6.8h) and of OC(13.8h±8.0h) were significantly decreased than that of PN(24.6h±15.4h,P<0.001),moreover,the side-effect of both SS(7.4%) and OC(8.2%) were more less than of PN(41.0%,P<0.001 and P<0.01).The diameter of portal vein (PVD),velocity of portal vein(PVV),volume of portal blood flow (PVF) and hepatic artery pulsatility index(HA-PT) in three groups were significantly decreased at during initial treatments,but the above-mentioned data recovered from the levels defore treatment when the trcatmcnts had been stopped.In addition,there was a positive correlation between the changes of cardiac output and the PVF increasing at before the treatments or during the initial(SS:r=+0.81,P<0.001;OC:r=+0.76,P<0.001;PN:r=+0.71,P<0.001,P<0.01).Systemic hemodynamic data showed that the heart rates and cardiac output decreased significantly in the patients treated with SS and OC,and the mean artery pressure was unchanged significantly,however,the heart rates and mean arterial pressure increased significantly,and the cardiac output decreased significantly with PN.Conclusions:Somatostatin and octreotide were more effective than pitressin plkus nitroglycerin in the treatment for patients with

  8. Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Natalie; Funakoshi; Frédérique; Ségalas-Largey; Yohan; Duny; Frédéric; Oberti; Jean-Christophe; Valats; Michael; Bismuth; Jean-Pierre; Daurès; Pierre; Blanc

    2010-01-01

    AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif ied.Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and De...

  9. Balloon occluded retrograde transvenous obliteration of bleeding stomal varices using sodium tetradecyl sulfate foam: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Chang; Yang, Po Sang; Lee, Yeon Soo; Kim, Hyun Jeong; Park, Gun [Dept. of Radiology, The Catholic University of Korea College of Medicine, Daejeon St. Mary' s Hospital, Daejeon (Korea, Republic of)

    2015-05-15

    A small varix is an uncommon complication with a high mortality rate occurring secondary to portal hypertension in patients with a stoma. We describe a case of recurrent stomal varix bleeding successfully managed by balloon occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam.

  10. Evolução das varizes esofagogástricas após anastomose esplenorrenal proximal versus esplenorrenal distal Esophagogastric variceal evolution after proximal vs distal splenorenal shunt

    Directory of Open Access Journals (Sweden)

    Raquel Aparecida Antunes

    2000-04-01

    Full Text Available Avaliou-se, retrospectivamente, a evolução pós-operatória das varizes esofagogástricas em 40 pacientes submetidos a um dos seguintes procedimentos cirúrgicos: a (n=27 derivação esplenorrenal distal (ERD e B (n=13 derivação esplenorrenal proximal (ERP. Todos os pacientes tinham hipertensão porta esquistossomótica com diagnóstico prévio de varizes do esôfago, presentes ou não no estômago, com um ou mais episódios de sangramento. Os pacientes foram submetidos a um dos procedimentos cirúrgicos de acordo com a preferência do cirurgião assistente. Foram realizadas, nesses pacientes, endoscopias no período pré-operatório e aos seis, 12 e 18 meses no pós-operatório. Os dados de cada endoscopia foram coletados e comparados entre os grupos, verificando-se a presença de varizes do esôfago e estômago nos diferentes períodos, comparando esses achados através do teste do qui-quadrado, com significância para pBleeding due to esophagogastric varices is the major cause of death in patients with hepatic disease. The most frequent treatment of these varices in elective conditions are based in mechanisms that interrupt the connection between splancnic and systemic venous bed. Surgical procedures are divided into portosystemic shunts (selective and non-selective and disconnection. In portasystemic shunt, the purpose is to derive the splancnic flux, diminishing the esophagogastric varices and prevent re-bleeding. But literature is controversial about the index of re-bleeding and hepatic encephalophaty after proximal or distal splenorenal shunts. We performed this study to evaluate the evolution of esophagogastric varices after proximal splenorenal (PS or distal splenorenal (DS shunt. Postoperative outcome of oesophageal and gastric varices were retrospectively evaluated in forty patients submitted to one of two following procedures: A (n=27, distal splenorenal shunt (DS, and B (n=13, proximal splenorenal shunt (PS. All patients had

  11. Management of rectal varices in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Rectal varices are portosystemic collaterals that form asa complication of portal hypertension, their prevalencehas been reported as high as 94% in patients withextrahepatic portal vein obstruction. The diagnosis istypically based on lower endoscopy (colonoscopy orsigmoidoscopy). However, endoscopic ultrasonographyhas been shown to be superior to endoscopy in diagnosingrectal varices. Color Doppler ultrasonography isa better method because it allows the calculation of thevelocity of blood flow in the varices and can be used topredict the bleeding risk in the varices. Although rare,bleeding from rectal varices can be life threatening. Themanagement of patients with rectal variceal bleedingis not well established. It is important to ensurehemodynamic stability with blood transfusion and tocorrect any coagulopathy prior to treating the bleedingvarices. Endoscopic injection sclerotherapy has beenreported to be more effective in the management ofactive bleeding from rectal varices with less rebleedingrate as compared to endoscopic band ligation. Transjugularintrahepatic portsystemic shunt alone or incombination with embolization is another method usedsuccessfully in control of bleeding. Balloon-occludedretrograde transvenous obliteration is an emergingprocedure for management of gastric varices that hasalso been successfully used to treat bleeding rectalvarices. Surgical procedures including suture ligationand porto-caval shunts are considered when othermethods have failed.

  12. Gastric varices: Classification, endoscopic and ultrasonographic management

    Directory of Open Access Journals (Sweden)

    Zeeshan Ahmad Wani

    2015-01-01

    Full Text Available Gastric varices (GV are responsible for 10-30% of all variceal hemorrhage. However, they tend to bleed more severely with higher mortality. Around 35-90% rebleed after spontaneous hemostasis. Approximately 50% of patients with cirrhosis of liver harbor gastroesophageal varices. In this review, new treatment modalities in the form of endoscopic treatment options and interventional radiological procedures have been discussed besides discussion on classification and pathophysiology of GV.

  13. Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding Factores predictivos de mortalidad intrahospitalaria en pacientes con sangrado de tubo digestivo alto no variceal

    Directory of Open Access Journals (Sweden)

    José Alberto González-González

    2011-04-01

    Full Text Available Objective: to determine the independent predictors of in-hospital death of Hispanic patients with nonvariceal upper gastrointestinal bleeding (NVUGB. Experimental design: prospective and observational trial. Patients: in a period between 2000 and 2009, all patients with NVUGB admitted to our hospital were studied. Demographical and clinical characteristics, endoscopic findings and laboratory tests were evaluated χ² and Mann-Whitney U analyses were performed for comparisons, and binary logistic regression was employed to identify independent predictors of in-hospital mortality. Results: 1,067 patients were included, 65% male with a mean age of 58.8 years. Mean number of comorbidities per patient was 1.6 ± 0.76. The most frequent cause of bleeding were gastric and duodenal ulcers (55.4%; 278 patients (25.8% received endoscopic treatment of which 69.1% had combined therapy. Rebleeding occurred in 36 patients (3.4% of which 50% died. In-hospital mortality was 10.2%, of which only 3.1% was associated to bleeding. When comparing causes of death among patients with and without comorbidities, only hypovolemic shock was found significative (48.3 vs. 25%; p = 0.020. Binary logistic regression found that the number of comorbidities, Rockall scale score; serum albumin Objetivo: determinar los factores de riesgo para mortalidad intrahospitalaria en pacientes hispanos con sangrado de tubo digestivo alto no variceal (STDANV. Diseño experimental: estudio prospectivo y observacional. Pacientes: del año 2000 al 2009 se estudiaron pacientes con STDANV. Se evaluaron variables demográficas y clínicas así como resultados de laboratorio y hallazgos endoscópicos. Se utilizaron análisis de χ² y U de Mann-Whitney para las comparaciones y de regresión logística binaria para la identificación de factores predictores de mortalidad. Resultados: se estudiaron 1.067 pacientes (65% hombres con promedio de edad de 58,8 años. La media de comorbilidades por

  14. Case report: massive lower intestinal bleeding from ileal varices. Treatment with transjugular intrahepatic portosystemic shunt (TIPSS); Fallbericht: Massive untere gastrointestinale Blutung aus ilealen Varizen. Behandlung mittels transjugulaerem intrahepatischem portosystemischem Shunt (TIPSS)

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Benitez, R. [Universitaetsklinikum Heidelberg (Germany). Abteilung fuer Diagnostische und Iinterventionelle Radiologie; Universitaetsklinikum, Abteilung fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Seidensticker, P.; Richter, G.M.; Stampfl, U.; Hallscheidt, P. [Universitaetsklinikum Heidelberg (Germany). Abteilung fuer Diagnostische und Iinterventionelle Radiologie

    2007-05-15

    Acute gastrointestinal bleeding in patients with liver cirrhosis is associated with a high mortality. Ileal varices and collaterals from ectopic vessels are extremely rare, encountered in less than 5% of the cirrhotic patients. The diagnosis is frequently delayed because the regular diagnostic methods such as gastroscopy or colonoscopy are unsuccessful in accurate the source of bleeding in the majority of the cases. We report an unusual case of massive and uncontrollable lower intestinal bleeding from ileal varices with right ovarian vein anastomosis in a 56 year-old female patient with liver cirrhosis and previous history of abdominal and pelvic surgery. The accurate angiographic and computed tomography diagnosis allowed fast decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt. (orig.) [German] Akute gastrointestinale Blutungen sind bei Leberzirrhosepatienten mit einer hohen Mortalitaet verbunden. Ileale Varizen und Kollateralen aus anderen ektopen Gefaessen des Darms sind extrem selten und treten bei weniger als 5% aller Zirrhosepatienten auf. Die Diagnosestellung erfolgt oft verspaetet, da die ueblichen diagnostischen Untersuchungsmethoden wie Gastroskopie oder Koloskopie in den meisten Faellen die Blutungsquelle nicht ausreichend darstellen. Wir berichten ueber einen ungewoehnlichen Fall von massiver und unkontrollierbarer unterer gastroinstestinaler (GI-)Blutung aus ilealen Varizen mit Verbindung zur rechten V. ovarica einer 56-jaehrigen Frau, bei der anamnestisch eine Leberzirrhose und abdominelle Operationen sowie Operationen im Bereich des Beckens bekannt waren. Die genaue angiographische und computertomographische Diagnose erlaubte eine rasche Dekompression des Portalvenensystems mittels eines transjugulaeren portosystemischen Shunts. (orig.)

  15. Eosinophilic oesophagitis

    DEFF Research Database (Denmark)

    Nielsen, Rasmus Gaardskjær; Husby, Steffen

    2007-01-01

    in males, and patients often belong to the paediatric or adolescence age groups. The exact prevalence of eosinophilic oesophagitis is unknown, but it has been suggested that the United States has a higher prevalence than Europe. Several treatment algorithms have been suggested, including elemental diets......Eosinophilic oesophagitis is characterised by age-dependent symptoms mimicking gastrooesophageal reflux disease, a distinct endoscopic appearance and a histological picture with extensive infiltration of eosinophils in the oesophageal mucosa. Eosinophilic oesophagitis is more frequently seen...

  16. Splenic irradiation-induced gastric variceal bleeding in a primary splenic diffuse large B-cell lymphoma patient: a rare complication successfully treated by splenectomy with short gastric vein ligation

    Directory of Open Access Journals (Sweden)

    Lin Ying-Chu

    2012-07-01

    Full Text Available Abstract Primary splenic diffuse large B-cell lymphoma (DLBCL is a rare clinical condition, which is generally treated by six to eight cycles of chemotherapy involving a combination of rituximab and the cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP regimen. However, the treatment for chemorefractory primary splenic DLBCL remains controversial. Therapeutic splenic irradiation (SI might be a reasonable and possibly the only treatment option with curative intention for patients with chemorefractory primary splenic DLBCL. However, the efficacy and safety of therapeutic SI are unclear. Herein, we present the case of a primary splenic DLBCL patient who was refractory to multiple chemotherapy regimens but achieved complete remission after administration of therapeutic SI. However, his condition was complicated with severe gastric variceal bleeding due to splenic venous thrombosis, which was successfully treated via splenectomy and short gastric vein ligation. On the basis of our findings, we concluded that the splenic venous thrombosis-induced gastric variceal bleeding was a rare but life-threatening adverse effect of the therapeutic SI administered for primary splenic DLBCL. Surgical intervention involving splenectomy and short gastric vein ligation is mandatory and should be performed as soon as possible for such patients.

  17. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  18. Endoscopic treatment of duodenal varices with cyanoacrylate

    Directory of Open Access Journals (Sweden)

    Ana Mora-Soler

    2013-12-01

    Full Text Available Background: the duodenum is the most common location for ectopic varices. Bleeding is rare, but when it appears, it is massive and difficult to control. Material and methods: retrospective description of five clinical cases of digestive bleeding secondary to duodenal varices that we observed between the years 2011 and 2012, together with their clinical characteristics, endoscopic diagnosis, endoscopic treatment with cyanoacrylate injection and the posterior follow-up and assessment of new bleeding. Results: all five patients were treated with an endoscopic cyanoacrylate injection and two of the patients experienced a digestive rebleeding. Three of the patients died during the follow-up period, only one due to cause digestive bleeding. Conclusion: in conclusion we can state that endoscopic treatment of duodenal varices with cyanoacrylate is technically possible, and it permits us to control the first bleeding before doing other definitive treatments, if the patient condition allows it.

  19. Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Takahiro Sato

    2011-01-01

    Full Text Available Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. Forty-three patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The frequency of ectopic varices was 43/1218 (3.5% among portal hypertensive patients in our ward. The locations of the ectopic varices were rectal in thirty-two, duodenal in three, intestinal in two, vesical in three, stomal in one, and colonic in two patients. Endoscopic or interventional radiologic treatment was performed successfully for ectopic varices. Hemorrhage from ectopic varices should be kept in mind in patients with portal hypertension presenting with lower gastrointestinal bleeding.

  20. Ultrasonographic findings of esophageal varices

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hyo Seouk; Seol, Byeong Ryong; Rha, Seung Woon [Shilla General Hospital, Seoul (Korea, Republic of)

    1999-05-01

    To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices. In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasonographic findings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of the esophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. The anterior and posterior mural thickeness of normal esophagus was 2.2{+-}0.7 and 2.4{+-}0.8mm respectively, but for variceal esophagus, the corresponding readings were 5.9{+-}1.3 and 5.2{+-}1.3mm respectively. The anteroposterior diameter of normal esophagus was 7.9{+-}2.1mm and that of variceal esophagus was 14.0{+-}1.8mm. There was a stastically significant difference (p<0.01) in mural thickness and anteroposterior diameter of the esophagus between a normal and variceal patient with regard to change of echogenic nature at the esphagogastric junction. Normal esophageal mucosa showed a thin and uniform echogenic line, but for variceal mucosa, the echogenic pattern was irregular, tortuous and thick. The athors believe that transabdominal US is helpful for detecting esophageal varices in patients with liver cirrhosis and UGI bleeding. Important clinically useful sonographic findings in diagnosing esophageal varix are as follows:1) mural thickness more than 6mm; 2) anteroposterior diameter of the esophagus of more than 15mm;3) irregular, tortuous and thickened echogenic mucosa.

  1. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

    OpenAIRE

    2001-01-01

    BACKGROUND AND AIMS—The transjugular intrahepatic portosystemic shunt (TIPS) is a new therapeutic modality for variceal bleeding. In this study we compared the two year survival and rebleeding rates in cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding.
METHODS—Eighty cirrhotic patients (Pugh score 7-12) with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding.
RESULTS—Mean follow up was 581 day...

  2. EFFICACY OF THROMBIN FIBRIN GLUE AND SCLE ROSANT IN THE MANAGEMENT OF BLEEDI NG GASTRIC VARICES

    Directory of Open Access Journals (Sweden)

    Sanjay Gupta

    2015-01-01

    Full Text Available Gastric varices are noted in up to 20 % of patents with portal hypertension , and are more common in those with non - cirrhotic etiology 1 . They bleed at lower portal pressures , bleed more severely and are associated with higher rates of rebleed , encephalopathy and mortality 1,2,3 . Variceal obliteration using tissue adhesives such as N - butyl cyanoacrylate leading to plugging and thrombosis of the gastric varices is currently the first line management option for obliteration of the gastric varices 3 . Although various options have been proposed , gold standard for management of gastric variceal bleeds is yet to be defined. We theorized that injection of the gastric varices using thrombin based glue followed by injection of a sclerosant shall be effective in optimum sclerotherapy and eradication of gastric varices. MATERIAL AND METHODS : All patients presenting with gastric variceal bleed were offered sclerotherapy with Thrombin fibrin based glue and sclerosant (TFG/S . During the study period 18 patients were enrolled in the TGF/S group. 21 patients underwent variceal plugging with n - butyl cyanoacrylate (NBC . There was no significant difference in age/ sex , duration of bleed or time interval between onset of bleed and endotherapy. RESULTS: Patients undergoing endotherapy with TGF/S had less episodes of bleed , and greater eradication of varices. CONCLUSION: The results with thrombin / fibrin glue and sclerotherapy are highly encouraging. Well - designed trials need to be performed KEYWORDS:Gastric varices; Thrombin Sclerotherapy

  3. Percutaneous transhepatic obliteration of stomal variceal hemorrhage from an ileal conduct: Case report and brief literature review

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seung Hyun; Lee, Shin Jae; Won, Jong Yun; Park, Sung Il; Lee, Do Yun; Kim, Man Deuk [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Do Young [Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-11-15

    Variceal bleeding is an unusual complication of ileal conduits. We report a case in which recurrent stomal variceal hemorrhage from an ileal conduit for bladder cancer was successfully treated by percutaneous transhepatic obliteration (PTO) using microcoils and N-butyl cyanoacrylate. Therefore, PTO can be one treatment option to prevent recurrent stomal variceal bleeding from ileal conduits.

  4. 内镜下套扎术预防肝硬化食管静脉曲张破裂出血的远期随访观察%Long-term follow-up for prophylaxis of esophageal variceal bleeding in patients with hepatic cirrhosis after endoscopic variceal ligation

    Institute of Scientific and Technical Information of China (English)

    陈光兰; 徐磊; 陈成龙; 朱雅碧; 汪望月; 黎红光

    2010-01-01

    Objective To investigate the esophageal variceal bleeding,mortality,degree of varices and changes of liver function in patients with hepatic cirrhosis Who underwent endoscopic varieeal ligation (EVL) or received propranolol therapy.Methods One hundred and eighteen patients received either EVL (n=66) or propranolol therapy(n=52).The patients in EVL group were treated with EVL for several times untill varicose vein disappeared.However,the patients in propranolol group received 10 mg of propranolol twice daily at the beginning of treatment.and it was increased to maximum tolerated dose gradually.All patients were followed up for 20 months.The bleeding rate, mortality,improvement of varicose vein and changes of hepatic function before and after treatment were compared between two groups.Results Among 58 patients in EVL group,bleeding was found in 7(12.1%) patients,and 2(3.4%) patients died.Whereas in propranolol group bleeding was found in 14(30.4%) of 46 patients and 6(13%) patients died.There was significant difference between EVL group and propranolol group (P0.05).Conclusions Compared with propranolol therapy,EVL has advantages in decreasing bleeding and mortality as well as improving the degree of varicose vein without liver damage.%目的 观察肝硬化食管静脉曲张患者分别行食管静脉曲张套扎术(endoscopic variceal ligation,EVL)和口服普萘洛尔后的再出血发生率、死亡率、治疗前后静脉曲张程度以及肝功能分级变化.方法 共纳入患者118例,其中66例采用EVL治疗,52例采用药物预防治疗.EVL 治疗组给予多次套扎,直到曲张静脉消失;药物治疗组给予普萘洛尔,起始剂量10 mg,每日2次,逐渐增至最大耐受剂量.对所有患者随访20个月,观察比较两组出血发生率和死亡率、治疗前后静脉曲张程度以及肝功能分级变化.结果 EVL治疗组有效随访58例,其问发生出血7例(12.1%),死亡2例(3.4%);药物治疗组有效随访46例,期间发生出血14

  5. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... GI Bleeding in Children (North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition) - PDF Patient Handouts Bleeding esophageal varices (Medical Encyclopedia) Also in Spanish Bloody or tarry stools (Medical Encyclopedia) Also in ...

  6. Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices

    DEFF Research Database (Denmark)

    Gluud, Lise L; Klingenberg, Sarah; Nikolova, Dimitrinka

    2007-01-01

    To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding.......To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding....

  7. Propranolol or propranolol combined endoscopic treatments for secondary prophylaxis of esophageal variceal bleeding: a comparison study%心得安单纯或联合使用在二级预防食管静脉曲张出血中的疗效比较

    Institute of Scientific and Technical Information of China (English)

    程文芳; 凌亭生; 施瑞华; 陈晓星; 丁静; 陈莉

    2011-01-01

    Objective To evaluate the prophylactic effects of propranolol, propranolol plus endoscopic variceal ligation (EVL) and propranolol plus endoscopic sclerotherapy (EVS), and to determine the most effective combination for secondary prevention of esophageal variceal bleeding.Methods After hemostasis, a total of 78 patients with esophageal variceal bleeding were randomly assigned to receive propranolol (propranolol group), propranolol plus EVL (ligation group) or propranolol plus sclerotherapy (EVS group), with 26 in each group.All patients were followed up for 12 months, and the rates of variceal re-bleeding, mortality, portal hypertensive gastropathy (PHG), re-occurrence of esophageal varices and formation of gastric fundus varices were compared among different groups.Results During the 12-month follow-up, the rate of re-bleeding in EVL group (30.77%) was significantly lower than those of the EVS group (42.31%) or propranolol group (53.85%) (P<0.05).The occurrence of PHG and fundal varices in patients of EVL group was similar to that of propranolol group, which were both lower than that of EVS group (P<0.05), but the re-occurrence of esophageal varices in EVL group was significantly higher than that of EVS group (P<0.05).Conclusion EVL plus propranolol might be the most effective therapy for secondary prophylaxis of esophageal variceal bleeding.%目的 比较单纯心得安、套扎+心得安、硬化剂+心得安二级预防食管静脉曲张出血的疗效,探寻心得安二级预防食管静脉曲张出血的最佳组合.方法 78例食管静脉曲张出血患者随机分成3组,每组26例,止血后分别给予心得安(心得安组)、套扎+心得安(套扎组)、硬化剂+心得安(硬化剂组),比较各组12个月内再出血率、死亡率,以及各组门脉高压性胃病、胃底静脉曲张发生率、食管曲张静脉复发率.结果 12个月内再出血率套扎组为30.77%,明显低于心得安组(53.85%)及硬化组(42.31%)(P均<0.05);套扎组和

  8. Gastrointestinal bleeding 30 years after a complicated cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Thorsten; Brechmann; Wolff; Schmiegel; Volkmar; Nicolas; Markus; Reiser

    2010-01-01

    Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from smallbowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled ...

  9. Endoscopic treatment of esophageal varices in patients with liver cirrhosis

    Science.gov (United States)

    Triantos, Christos; Kalafateli, Maria

    2014-01-01

    Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or large-sized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers (NSBBs) or endoscopic variceal ligation (EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt (TIPS) with polytetrafluoroethylene (PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred option in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompanying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclusion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events. PMID:25278695

  10. Endoscopic variceal ligation plus propranolol vs. transjugular intrahepatic portosystemic stent shunt : A long-term randomized trial

    NARCIS (Netherlands)

    Sauer, P; Hansmann, J; Richter, GM; Stremmel, W; Stiehl, A

    2002-01-01

    Background and Study Aims: After a first variceal bleeding episode in patients with cirrhosis of the liver, treatment with transjugular intrahepatic portosystemic stent shunt (TIPS) and endoscopic variceal ligation (EVL) plus propranolol were compared, with regard to prevention of variceal rebleedin

  11. Clinical observation of embolotherapy by endoscopic injection with α-cyanoacrylate alkyl for treatment of gastric varices bleeding%α-氰丙烯酸烷基酯栓塞治疗胃静脉曲张破裂出血的临床观察

    Institute of Scientific and Technical Information of China (English)

    卢向东; 张志广; 辛昱

    2011-01-01

    目的 评价经内镜注射组织黏合剂α氰丙烯酸烷基酯栓塞治疗胃静脉曲张的临床疗效及不良反应.方法 18例临床确诊的肝硬化合并急性胃静脉曲张破裂出血的患者中,活动出血5例,近期出血13例,胃静脉曲张Sarin分类胃食管静脉曲张Ⅰ型(GOV)7例,胃食管静脉曲张Ⅱ型(GOV)8例,孤立性胃静脉曲张Ⅰ型(IGV)7例,在静脉滴注奥曲肽的同时,经内镜首先选择靶静脉及穿刺点,根据曲张静脉的直径确定组织黏合剂的剂量,依次对胃曲张静脉采用三明治法进行组织黏合剂栓塞治疗,11例合并食管静脉曲张的患者在栓塞治疗后联合食管曲张静脉套扎治疗,术后进行内镜随访,观察止血成功率,早期再出血率、病死率、静脉曲张消退情况以及不良反应.结果 急诊止血成功率100%,早期再出血率0%、静脉曲张消退显效13例(72.2%),有效3例(16.7%),无效2例(11.1%),3例出现术后低热,1例出现大肠杆菌败血症,11例注射部位出现糜烂,4例注射部位形成溃疡,1例术中出血.结论 经内镜注射组织黏合剂a氰丙烯酸烷基酯栓塞治疗胃静脉曲张破裂出血是一种简便、安全、有效的方法.%Objective To evaluate the clinical effect and side effect of the tissue adhesive named α-cyanoacrylate alkyl in the treatment of gastric variceal. Methods 18 patients with gastric variceal bleeding who were diagnosed by endoscopy received tissue adhesive,among which 5 cases were active bleeding and 13 cases were recent bleeding. Based on Sarin Classification of Gastric Varices,7 cases belonged to type Ⅰ of gastroesophageal varices(GOV1 ),8 cases to type Ⅱ of gastroesophageal varices(GOV2) and 7 cases to type Ⅰ of isolated gastric varices(IGV1 ). During the process of octreotide being given venously,gastric varices to be treated and injection spot were chosen by means of endoscopy.The dose of tissue adhesive was determined according to the diameter of varices. To

  12. Successful treatment of giant rectal varices by modified percutaneous transhepatic obliteration with sclerosant:Report of a case

    Institute of Scientific and Technical Information of China (English)

    Hirotoshi Okazaki; Kazunari Tominaga; Toshio Watanabe; Yasuhiro Fujiwara; Kenji Nakamura; Tetsuo Arakawa; Kazuhide Higuchi; Masatsugu Shiba; Shirou Nakamura; Tomoko Wada; Kazuki Yamamori; Ai Machida; Kaori Kadouchi; Akihiro Tamori

    2006-01-01

    We present a female patient with continuous melena,diagnosed with rectal variceal bleeding. She had a history of esophageal varices, which were treated with endoscopic therapy. Five years after the treatment of esophageal varices, continuous melena occurred. Since colonoscopy showed that the melena was caused by giant rectal varices, we thought that they were not suitable to receive endoscopic treatment. We chose the modified percutaneous transhepatic obliteration with sclerosant, which is one of the interventional radiology techniques but a new clinical procedure for rectal varices.After the patient received this therapy, her condition of rectal varices was markedly improved.

  13. Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding Dopplerfluxometria portal na esquistossomose hepatoesplênica com e sem antecedentes de hemorragia por varizes esofágicas

    Directory of Open Access Journals (Sweden)

    Severino Marcos Borba de Arruda

    2008-03-01

    Full Text Available BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive patients with hepatosplenic Manson’s schistosomiasis were divided into two groups: group I (six men and six women; mean age 48.7 years with a past history of bleeding and group II (four men and eight women; mean age 44.7 years without a past history of upper gastrointestinal bleeding, underwent duplex sonography examination. All patients underwent the same upper gastrointestinal endoscopy and laboratory examinations. Those with signs of mixed chronic liver disease or portal vein thrombosis (three cases were excluded. RESULTS: Group I showed significantly higher mean portal vein flow velocity than group II (26.36 cm/s vs 17.15 cm/sec. Although, as a whole it was not significant in all forms of collateral vessels (83% vs 100%, there was a significantly higher frequency of splenorenal collateral circulation type in group II compared with group I (17% vs 67%. The congestion index of the portal vein was significantly lower in group I than in group II (0.057 cm vs 0.073 cm/sec. CONCLUSION: Our duplex sonography findings in hepatosplenic Manson’s schistosomiasis support the idea that schistosomotic portal hypertension is strongly influenced by overflow status, and that collateral circulation seems to play an important role in hemodynamic behavior.RACIONAL: Hipertensão portal pré-sinusoidal com freqüentes episódios de hemorragia digestiva alta são aspectos característicos da esquistossomose hepatoesplênica, forma clínica que acomete cerca de 5% dos

  14. Estudio coste-efectividad sobre la medición del gradiente de presión venosa hepática en la profilaxis secundaria de la hemorragia digestiva varicosa A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding

    Directory of Open Access Journals (Sweden)

    A. Amorós

    2008-07-01

    favorable comparado con la no realización del mismo.Objective: variceal rebleeding is common following a first episode of hemorrhage in cirrhotic patients. The objective of this study was to determine the cost-effectiveness of monitoring hepatic venous pressure gradient (HVPG to guide secondary prophylaxis. Methods: we created a Markov decision model to calculate cost-effectiveness for two strategies: Group 1: HVPG monitoring to decide treatment -when portal pressure was reduced by at least 20 percent or HVPG was less than 12 mmHg after beta-blocker administration, patients received beta-blockers; when portal pressure did not meet these criteria therapy was endoscopic band ligation. Group 2: in this group there was no monitoring of HVPG. Patients with large varices received treatment with beta-blockers combined with EBL; patients with small varices received beta-blockers plus isosorbide mononitrate. Results: there was no recurrent variceal bleeding in group 1 for good responders, and for 17% of poor responders. In group 2 a 25% rebleeding rate was detected in patients with small varices and 13% for those with big varices. Overall cost in group 1 was 14,100.49 euros, and 14,677.16 in group 2. Conclusions: HVPG measurement is cost-effective for the secondary prophylaxis of variceal bleeding.

  15. FibroScan can be used to diagnose the size of oesophageal varices in patients with HBV-related cirrhosis%FibroScan技术判断乙型肝炎肝硬化患者食管静脉曲张程度的临床研究

    Institute of Scientific and Technical Information of China (English)

    李梵; 闫涛; 张健; 邵清; 李冰; 李忠斌; 陈国凤

    2012-01-01

    Objective To study ability of FibroScan (FS) in diagnosing the size of oesophageal varices (OV) in patients with HBV-related cirrhosis.Methods A total of 158 patients with HBV-related liver cirrhosis were enrolled in the study.The relation between the presence of OV assessed by endoscopy,and liver stiffness measurement by Fibroscan was studied,and ROC curves were drawn to assess the diagnostic ability of FS value.Results For the patients without OV,mild OV,moderate OV,and severe OV,their corresponding FS values were (21.7 ±9.9) kPa,(32.1 ± 13.6) kPa,(42.3 ±20.0) kPa and (54.5 ± 16.2) kPa,respectively.Significant difference was found among the groups (P < 0.001) and also between any two groups (P < 0.05).ROC curve for the diagnosis of with vs.without OV,< moderate vs.>moderate OV,and < severe vs.severe OV were 0.798 (95% CI:73.1%-86.5%),0.823 (95% CI:74.5%-90.0%)and 0.879 (95% CI:80.8%-95.0%),respectively,with corresponding FS cut-off value of 23.3 kPa,31.5 kPa and 34.6 kPa.Conclusion Liver stiffness measurement allows to predict the sizes of oesophageal varices in patients with HBV-related cirrhosis.%目的 研究FibroScan对于乙型肝炎肝硬化患者食道静脉曲张程度的诊断效能.方法 人选乙型肝炎肝硬化患者158例,所有患者进行胃镜及FibroScan检测.对比不同食道静脉曲张程度患者FS值(FibroScan检测值)差异,绘制相应ROC曲线.结果 无食道静脉曲张患者、轻度食道静脉曲张患者、中度食道静脉曲张患者和重度食道静脉曲张患者的FS值分别是(21.7±9.9)kPa、(32.1±13.6) kPa、(42.3±20.0) kPa、(54.5 ±16.2) kPa.各组间比较差异有统计学意义(F值33.4,P<0.001);组间两两比较,差异均有统计学意义(P均<0.05).FS值判断是否存在静脉曲张、判断中重度静脉曲张和判断重度静脉曲张的ROC曲线下面积分别为0.798(95% CI:73.1%~86.5%)、0.823(95%CI:74.5%~90.0%)和0.879(95% CI:80.8% ~ 95

  16. Nursing coordination in endoscopic treatment of non - variceal upper gastrointestinal bleeding with titanium clips%内镜下钛夹治疗上消化道非静脉曲张出血60例的护理配合

    Institute of Scientific and Technical Information of China (English)

    王连英

    2012-01-01

    目的 通过对60例上消化道非静脉曲张出血患者采用金属钛夹在内镜下直接止血,总结护理配合技巧和要点.方法 用金属钛夹推送器安装钦夹,对准出血部位释放金属钛夹达到止血目的.结果 60例非静脉曲张上消化道出血,根据Forrest分级标准,Ⅰa6例,Ⅰb38例,Ⅱa9例,Ⅱb7例.共用金属钛夹125枚,所有病例内镜下首次止血成功率100%,术后无不良反应及并发症.结论 掌握内镜性能,正确使用金属钛夹推送器,可确保内镜下金属钛夹治疗消化道出血的成功.%Objective To sum up nursing coordination skills in the treatment of non -variceal upper gastrointestinal bleeding with titanium clips. Methods Data of 60 patients with a-cute non - variceal upper gastrointestinal tract bleeding were collected. The bleeding site was identified by endoscope, and both ends of the bleeding area were clipped with a titanium clip adjuster. Results Sixty patients with non - variceal upper gastrointestinal bleeding were divided into Ia stage ( n = 6), Ib stage ( n = 38),Ⅱa stage (n = 9) and Ⅱb stage (n = 7), according to Forrest classification standards. A total of 125 titanium clips were used and the bleedings were stopped immediately in all cases and the success rate was 100 %. No postoperative adverse reactions and complications were found. Conclusion A good command of endoscope and proper use of titanium clip adjuster can ensure the success of endoscopic treatment for gastrointestinal bleeding.

  17. Treatment of gastric varices with partial splenic embolization in a patient with portal vein thrombosis and a myeloproliferative disorder.

    Science.gov (United States)

    Gianotti, Robert; Charles, Hearns; Hymes, Kenneth; Chandarana, Hersh; Sigal, Samuel

    2014-10-21

    Therapeutic options for gastric variceal bleeding in the presence of extensive portal vein thrombosis associated with a myeloproliferative disorder are limited. We report a case of a young woman who presented with gastric variceal bleeding secondary to extensive splanchnic venous thrombosis due to a Janus kinase 2 mutation associated myeloproliferative disorder that was managed effectively with partial splenic embolization.

  18. Challenges of banding jejunal varices in an 8-year-old child

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Endoscoic variceal ligation (EVL) by the applicationof bands on small bowel varices is a relatively rareprocedure in gastroenterology and hepatology. Thereare no previously reported paediatric cases of EVLfor jejunal varices. We report a case of an eight-yearoldmale patient with a complex surgical backgroundleading to jejunal varices and short bowel syndrome,presenting with obscure but profound acute gastrointestinalbleeding. Wireless capsule endoscopy and double balloonenteroscopy (DBE) confirmed jejunal varices as thesource of bleeding. The commercially available varicealbanding devices are not long enough to be used eitherwith DBE or with push enteroscopes. With the useof an operating gastroscope, four bands were placedsuccessfully on the afferent and efferent ends of theleads of the 2 of the varices. Initial hemostasis wasachieved with obliteration of the varices after threeseparate applications. This case illustrates the feasibilityof achieving initial hemostasis in the pediatric population.

  19. Human thrombin for the treatment of gastric and ectopic varices

    Institute of Scientific and Technical Information of China (English)

    Norma C McAvoy; John N Plevris; Peter C Hayes

    2012-01-01

    AIM:To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices.METHODS:Retrospective observational study in a Tertiary Referral Centre.Between January 1999-October 2005,we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic varices.Patient details including age,gender and aetiology of liver disease/ segmental portal hypertension were documented.The thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection needle.All patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was recorded.Initial haemostasis rates,rebleeding rates and mortality were catalogued along with the incidence of any immediate complications which could be attributable to the thrombin therapy.The duration of follow up was also listed.The study was conducted according to the United Kingdom research ethics guidelines.RESULTS:Thirty-seven patients were included.33 patients (89%) had thrombin (250 U/mL) for gastric varices,2 (5.4%) for duodenal varices,1 for rectal varices and 1 for gastric and rectal varices.(1) Gastric varices,an average of 15.2 mL of thrombin was used per patient.Re-bleeding occurred in 4 patients (10.8%),managed in 2 by a transjugular intrahepatic portosystemic shunt (TIPSS) (one unsuccessfully who died) and in other 2 by a distal splenorenal shunt; (2) Duodenal varices (or type 2 isolated gastric varices),an average of 12.5 mL was used per patient over 2-3 endoscopy sessions.Re-bleeding occurred in one patient,which was treated by TIPSS; and (3) Rectal varices,an average of 18.3 mL was used per patient over 3 endoscopy sessions.No re-bleeding occurred in this group.CONCLUSION:Human thrombin is a safe,easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices.

  20. Esophageal and gastric variceal bleeding in the prevention of early rebleeding given enteral nutrition value after endoscopic variceal ligation and treatment%食管胃底静脉出血早期给予肠内营养对预防早期再出血的价值

    Institute of Scientific and Technical Information of China (English)

    刘晶华; 邹玉; 常巍

    2015-01-01

    目的 观察肝硬化食管胃底静脉出血(GEVB)内镜治疗后早期口服营养液对患者降低早期再出血的风险.方法 将78例GEVB内镜治疗后营养不良患者随机分为治疗组(营养液口服组40例)和对照组(常规饮食组38例),于内镜治疗后12h给予进食,14 d后比较两组再出血发生率及肝功能恢复情况.计量资料用t检验或秩和检验,计数资料用x2检验或Fisher确切概率法. 结果 治疗组40例患者在术后14d内无再出血发生,对照组38例中5例发生再出血,x2=5.624,P=0.018.治疗组肝功能各项指标均有明显改善,与对照组差异均具有统计学意义(P值均<0.05). 结论 GEVB内镜治疗后患者早期口服营养液可降低患者早期再出血风险并改善患者肝功能及营养不良状况.%Objective To observe liver cirrhosis with esophageal and gastric variceal bleeding (GEVB) after endoscopic variceal ligation and treatment of early oral nutrition liquid in patients administered to reduce the risk of early rebleeding.Methods Seventy-eight patients with cirrhosis who received therapeutic endoscopy after GEVB and who suffered from malnutrition were randomly divided into a treatment group (oral solution group,n =40) and a control group (regular diet group,n =38).Both of the two groups received food at 12 hours after therapeutic endoscopy.After 14 days,the rates of early rebleeding rate and liver function recovery were compared for the two groups.T-test,rank test,chi-square test and Fisher's exact test were used for statistical analyses.Results Compared with the control group,less patients in the treatment group experienced rebleeding (0/40 vs.5/38; x 2 =5.624,P =0.018); the treatment group also showed significantly improved indexes of liver function (all P < 0.05).Conclusions GEVB after endoscopic treatment with early oral nutrition liquid administration can reduce in the early rebleeding risk and improve function and malnutrition status.

  1. Percutaneous Transhepatic Variceal Embolization Combined with Partial Splenic Embolization for Treatment of Esophagogastric Variceal Bleeding in Patients with Liver Cirrhosis%经皮经肝食管胃底曲张静脉栓塞术联合部分脾栓塞术治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈翔; 马鋆; 陈胜良; 李金辉; 许建荣; 程杰军; 张庆; 吴华伟; 严琦; 周孝雯; 曾帅

    2016-01-01

    Background:Esophagogastric variceal bleeding is a severe and commonly seen complication of portal hypertension in patients with liver cirrhosis. Prevention of rebleeding remains an important issue in the management of patients suffered from the disease. Aims:To evaluate the efficacy and safety of percutaneous transhepatic variceal embolization(PTVE) combined with partial splenic embolization(PSE)for treatment of esophagogastric variceal bleeding in patients with liver cirrhosis. Methods:Ten liver cirrhosis patients with esophagogastric variceal bleeding were prospectively selected and treated by PTVE combined with PSE. The blood flow of portal system was measured by Doppler ultrasonography pre- and post-operatively;meanwhile peripheral blood cells were counted. A 1-2-year follow-up was carried out and the rebleeding and procedure-related complications were recorded. Results:The postoperative inner diameter of main portal vein,as well as the blood flow velocity of main portal vein and splenic vein were significantly reduced as compared with those before operation(P < 0. 05). Three months after operation,the peripheral white blood cell and platelet were still significantly higher than those before operation(P < 0. 05). During 1-year follow-up,rebleeding appeared in 2 patients,one of them was found having main portal vein thrombosis developed,and was treated by endoscopic esophageal variceal ligation because the gastric varices was not as evident as ever. The rebleeding rate and incidence of portal system thrombosis after the PTVE-PSE procedure was 20. 0% and 10. 0%,respectively. Conclusions:PTVE combined with PSE seemed efficient for alleviating portal hypertension,and might be recommended as a safe and effective interventional therapy for liver cirrhosis patients with esophagogastric variceal bleeding.%背景:食管胃底静脉曲张破裂出血是肝硬化门静脉高压常见且严重的并发症,再出血的预防是该病的治疗重点。目的:评价

  2. Prevention and treatment of variceal haemorrhage in 2017.

    Science.gov (United States)

    Brunner, Felix; Berzigotti, Annalisa; Bosch, Jaime

    2017-01-01

    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. In patients with compensated liver disease, the correction of factors influencing the progression of fibrosis, in particular aetiologic factors, is now feasible in many cases and should be achieved to prevent the development or progression of gastroesophageal varices and hepatic decompensation. Once gastroesophageal varices have developed, non-selective beta-blockers remain the cornerstone of therapy. Carvedilol provides a greater decrease in portal pressure and is currently indicated as a first-choice therapy for primary prophylaxis. The treatment of acute variceal haemorrhage includes a combination of vasoactive drugs, antibiotics and endoscopic variceal band ligation. In high-risk patients, the early use of transjugular intrahepatic portosystemic shunt (TIPS) lowers the risk of re-bleeding and improves survival. Transjugular intrahepatic portosystemic shunt is the choice for uncontrolled variceal bleeding; a self-expandable metal stent or balloon tamponade can be used as a bridging measure. The combination of non-selective beta-blockers and endoscopic variceal band ligation reduces the risk of recurrent variceal bleeding and improves survival. In these cases, statins seem to further improve survival. Transjugular intrahepatic portosystemic shunt is indicated in patients who rebleed during secondary prophylaxis.

  3. Massive upper gastrointestinal bleeding due to splenoportal axis thrombosis in a patient with a tested JAK2 mutation: A case report and review literature

    Directory of Open Access Journals (Sweden)

    Isabel Macías, PhD

    2016-01-01

    Full Text Available Portal hypertension is a clinical syndrome defined as a portal venous pressure that exceeds 10 mmHg. Cirrhosis is the most common cause of portal hypertension and thrombosis of the splenoportal axis not associated with liver cirrhosis is the second cause of portal hypertension in the Western world. The primary myeloproliferative disorders are the main cause of portal venous thrombosis and somatic mutation of Janus Kinase 2 gene (JAK2 V617F can be found in approximately 90% of polycythemia vera, 50% of essential thrombocyrosis and 50% primary myelofibrosis. A a 55-year-old man with JAK2 mutation-associated splenoportal axis hypertension and bleeding complications due to oesophageal varices is reported. A massive upper bleeding episode made an emergent surgery to be done immediatelly at seventh day. The patient was discharged home at fifteenth day after surgery.

  4. Evaluation of the effects of combined endoscopic variceal ligation and splenectomy with pericardial devascularization on esophageal varices

    Institute of Scientific and Technical Information of China (English)

    Bo Liu; Mei-Hai Deng; Nan Lin; Wei-Dong Pan; Yun-Biao Ling; Rui-Yun Xu

    2006-01-01

    AIM:To detect the hemodynamic alterations in collateral circulation before and after combined endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization by ultrasonography,and to evaluate their effect using hemodynamic parameters.METHODS: Forty-three patients with esophageal varices received combined EVL and splenectomy with pericardial devascularization for variceal eradication. The esophageal vein structures and azygos blood flow (AZBF) were detected by endoscopic ultrasonography and color Doppler ultrasound. The recurrence and rebleeding of esophageal varices were followed up.RESULTS:Patients with moderate or severe varices in the esophageal wall and those with severe periesophageal collateral vein varices had improvements after treatment, while the percentage of patients with severe para-esophageal collateral vein varices decreased from 54.49% to 2.33%, and the percentage of patients with detectable perforating veins decreased from 79.07% to 4.65% (P < 0.01). Color Doppler flowmetry showed a significant decrease both in AZBF (43.00%,P < 0.05) and in diameter of the azygos vein (28.85%, P < 0.05), while the blood flow rate was unchanged. The recurrence rate of esophageal varices was 2.5% (1/40,mild), while no re-bleeding cases were recorded.CONCLUSION:EVL in combination with splenectomy with pericardial devascularization can block the collateral veins both inside and outside of the esophageal wall, and is more advantagious over splenectomy in combination with pericardial devascularization or EVL in preventing recurrence and re-bleeding of varices.

  5. 兰索拉唑治疗胃镜下活动性非静脉曲张性上消化道出血的疗效观察%The Clinical Curative Effect Observation of Lansoprazole in Therapy of Active Non-Variceal Upper Gastrointestinal Bleeding after Gastrointestinal Endoscopy Examination

    Institute of Scientific and Technical Information of China (English)

    何灏澜

    2012-01-01

      Objective To observe the homeostasis effect of Lansoprazole in the therapy of active non-variceal upper gastrointestinal bleeding after gastrointestinal endoscopy examination. Methods 70 cases with active non-variceal upper gastrointestinal bleeding after gastrointestinal endoscopy examination were randomly divided into two groups. The therapy group was used Lansoprazole, the control group was used Omeprazole.Results In the therapy group, the significant effective cases,effective cases were 31, 5, respectively, and the total effective ratio was 97.30%. And in the control group, the significant effective cases,effective cases were 14, 13, respectively, and the total effective ratio was 81.81%. And there was statistical significance. In both groups, no side effect was found. Conclusion Early use Lansoprazole in the therapy of active non-variceal upper gastrointestinal bleeding after gastrointestinal endoscopy examination, the incidence rate of upper gastrointestinal bleeding and mortality can be lower markedly.%  目的观察应用兰索拉唑对胃镜下活动性非静脉曲张性上消化道出血的治疗作用.方法将70例胃镜下活动性非静脉曲张性上消化道出血患者随机分为两组.治疗组应用兰索拉唑;对照组应用奥美拉唑.结果治疗组显效31例,有效5例,总有效率为97.30%;对照组分别为14例,13例及81.81%,两组间差异有统计学意义.两组均无明显不良反应.结论胃镜下活动性非静脉曲张性上消化道出血患者早期应用兰索拉唑,可显著降低消化道出血的发生率,降低病死率,值得临床推广.

  6. New methods for the management of esophageal varices

    Institute of Scientific and Technical Information of China (English)

    Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Takashi Tajiri

    2007-01-01

    Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatments for EVs. In the 1970s, interventional radiology procedures such as transportal obliteration, left gastric artery embolization, and partial splenic artery embolization were introduced, improving the survival of patients with bleeding EVs. In the 1980s, endoscopic treatment, endoscopic injection sderotherapy (HS), and endoscopic variceal ligarJon (EVL), further contributed to improved survival. We combined IVR with endoscopic treatment or EIS with EVL. Most patients with EVs treated endoscopically required follow-up treatment for recurrent varices. Proper management of recurrent EVs can significantly improve patients' quality of life. Recently, we have performed EVL at 2-mo (bi-monthly) intervals for the management of EVs. Longer intervals between treatment sessions resulted in a higher rate of total eradication and lower rates of recurrence and additional treatment.

  7. An unusual cause of gastrointestinal bleed

    Directory of Open Access Journals (Sweden)

    C K Adarsh

    2014-01-01

    Full Text Available Gastrointestinal (GI bleed often brings the patient to the emergency medical service with great anxiety. Known common causes of GI bleed include ulcers, varices, Mallory-Weiss among others. All causes of GI bleed should be considered however unusual during the evaluation. Aortoenteric fistula (AEF is one of the unusual causes of GI bleed, which has to be considered especially in patients with a history of abdominal surgery in general and aortic surgery in particular.

  8. Safety of direct endoscopic necrosectomy in patients with gastric varices

    Institute of Scientific and Technical Information of China (English)

    Andrew C Storm; Christopher C Thompson

    2016-01-01

    AIM: To determine the feasibility and safety of transgastric direct endoscopic necrosectomy(DEN) in patients with walled-off necrosis(WON) and gastric varices. METHODS: A single center retrospective study of consecutive DEN for WON was performed from 2012 to 2015. All DEN cases with gastric fundal varices noted on endoscopy, computed tomography(CT) or magnetic resonance imaging(MRI) during the admission for DEN were collected for analysis. In all cases, external urethral sphincter(EUS) with doppler was used to exclude the presence of intervening gastric varices or other vascular structures prior to 19 gauge fine-needle aspiration(FNA) needle access into the cavity. The tract was serially dilated to 20 mm and was entered with an endoscope for DEN. Pigtail stents were placed to facilitate drainage of the cavity. Procedure details were recorded. Comprehensive chart review was performed to evaluate for complications and WON recurrence. RESULTS: Fifteen patients who underwent DEN for WON had gastric varices at the time of their procedure. All patients had an INR 50. Of these patients, 11 had splenic vein thrombosis and 2 had portal vein thrombosis. Two patients had isolated gastric varices, type 1 and the remaining 13 had > 5 mm gastric submucosal varices on imaging by CT, MRI or EUS. No procedures were terminated without completing the DEN for any reason. One patient had self-limited intraprocedural bleeding related to balloon dilation of the tract. Two patients experienced delayed bleeding at 2 and 5 d post-op respectively. One required no therapy or intervention and the other received 1unit transfusion and had an EGD which revealed no active bleeding. Resolution rate of WON was 100%(after up to 2 additional DEN in one patient) and no patients required interventional radiology or surgical interventions. CONCLUSION: In patients with WON and gastric varices, DEN using EUS and doppler guidance may be performed safely. Successful resolution of WON does not appear to be

  9. Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia.

    Science.gov (United States)

    Lakhwani, M N; Ismail, A R; Barras, C D; Tan, W J

    2000-12-01

    Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit

  10. 奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血的Meta分析%Octretide joint proton pump inhibitors in treating non-variceal gastrointestinal bleeding: a Metaanalysis

    Institute of Scientific and Technical Information of China (English)

    张茶丽; 于红刚

    2012-01-01

    Objective To evaluate the efficacy of octretide joint proton pump inhibitors in treating non-variceal gastrointestinal bleeding. Methods All the randomized controlled trials (RCTs) about treating non-variceal gastrointestinal bleeding with octretide joint proton pump inhibitors were collected by searching Cochrane Library, Pubmed, Wang-fang. The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers, and Meta-analysis was conducted with Revman 5.0 software. Results A total of 6 studies involving 484 patients met inclusion criteria. The results of Meta-analysis showed that; octretide joint proton pump inhibitors was effective in treating non-variceal gastrointestinal bleeding. Conclusion Octretide joint proton pump inhibitors is effective in treating non-variceal gastrointestinal bleeding. Because of the lower methodological quality and publication bias of the included trials, it is necessary to perform more high-quality and large scale randomized controlled trials to make the conclusion more reliable.%目的 系统评价奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血的有效性.方法 计算机检索Cochrane Library、Pubmed、万方数据库,检索时间从建库至今,收集有关奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血的疗效的随机对照试验.由2名评价员独立对所纳入的文献进行资料提取、质量评价并交叉核对,然后采用使用Revman 5.0版软件进行数据统计分析.结果 共纳入文献6篇,包括484例患者.Meta分析结果:奥曲肽联合质子泵抑制剂治疗非静脉曲张上消化道出血较单用质子泵抑制剂止血率高.结论 奥曲肽联合质子泵抑制剂可有效治疗非静脉曲张上消化道出血,但由于纳入的文献质量不高,可能存在发表性偏倚,因此需要进行更大规模,多中心的随机临床对照研究,从而更客观、全面地评价其疗效.

  11. Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation

    Institute of Scientific and Technical Information of China (English)

    Liang Xu; Feng Ji; Qin-Wei Xu; Mie-Qing Zhang

    2011-01-01

    AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL). METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010. were included in this study. The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy. A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication. RESULTS: The incidence of early rebleeding after EVL was 7.60%, and the morbidity of rebleeding was 26.9%. Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83, 95% CI: 9.39-420.56, P 18 s (OR 11.35, 95% CI: 1.93-66.70, P = 0.007). CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites, number of rubber bands used to ligate, severity of varices and prolonged PT. Effective measures for prevention and treatment should be adopted before and after EVL.

  12. Trans-anastomotic porto-portal varices in patients with gastrointestinal haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, A.W.M.; Jackson, J.E

    2000-03-01

    AIM: Porto-portal varices are commonly seen in patients with segmental extra-hepatic portal hypertension and develop to provide a collateral circulation around an area of portal venous obstruction. It is not well recognized that such communications may also develop across surgical anastomoses and be the source of gastrointestinal haemorrhage. The possible mode of development of such communications has not been previously discussed. MATERIALS AND METHODS: Over a 3-year period between 1995 and 1998, porto-portal varices were demonstrated across surgical anastomoses in four patients who were referred for the investigation of acute (two), acute-on-chronic (one) and chronic gastrointestinal bleeding (one). Their medical notes and the findings at angiography were reviewed. RESULTS: Three patients had segmental portal hypertension due to extra-hepatic portal vein (one) or superior mesenteric vein (two) stenosis/occlusion. One patient had mild portal hypertension due to hepatic fibrosis secondary to congenital biliary atresia. At angiography all patients were shown to have varices crossing previous surgical anastomoses. These varices were presumed to be the cause of bleeding in three of the four patients; the site of bleeding in the fourth individual was not determined. CONCLUSIONS: Trans-anastomotic porto-portal varices are rare. They develop in the presence of extra-hepatic portal hypertension and presumably arise within peri-anastomotic inflammatory tissue. Such varices may be difficult to manage and their prognosis is poor when bleeding occurs. Mitchell, A.W.M., Jackson, J.E. (2000)

  13. Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy

    Science.gov (United States)

    Berkowitz, Joshua C.; Bhusal, Sushma; Desai, Deepak; Cerulli, Maurice A.

    2016-01-01

    Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices. PMID:27807564

  14. Endoscopic Management of Nonvariceal, Nonulcer Upper Gastrointestinal Bleeding

    NARCIS (Netherlands)

    Tjwa, E.T.; Holster, I.L.; Kuipers, E.J.

    2014-01-01

    Upper gastrointestinal bleeding (UGIB) is the most common emergency condition in gastroenterology. Although peptic ulcer and esophagogastric varices are the predominant causes, other conditions account for up to 50% of UGIBs. These conditions, among others, include angiodysplasia, Dieulafoy and Mall

  15. 贲周血管离断联合食管下端离断再钉合术治疗食管胃底静脉曲张出血疗效观察%Curative efficacy observation to re-stapling technique after pericardial-esophagogastric devascularization in patient with esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    李杰; 陈萃; 宋子华

    2013-01-01

    目的 探讨贲门周血管离断联合食管下端离断再钉合术治疗食管胃底静脉曲张出血的疗效.方法 对2008年1月至2011年12月在我院行贲门周血管离断联合食管下端离断再钉合术治疗的58例门静脉高压症食管胃底静脉曲张出血的临床资料进行回顾性分析.结果 58例均为肝炎(乙型病毒性肝炎或丙型病毒性肝炎)后肝硬化门静脉高压症患者,Child肝功能分级:A级35例,B级20例,C 级3例.随访3个月,其中术后发生吻合口瘘5例,吻合狭窄2例,继发出血2例,死亡3例,门静脉系统血栓1例.结论 该手术对近期继发出血疗效令人满意,如果术中及术后处理得当,以减少或避免其他并发症的发生,是治疗门静脉高压症食管胃底静脉曲张出血的一种理想术式.%Objective To explore the curative efficacy observation to re-stapling technique after pericardial-esophagogastric devascularization in patient with esophageal variceal bleeding. Methods From January 2008 to December 2011, 58 cases of portal hypertension associated with esophageal variceal bleeding underwent re-stapling technique after pericardial-esophagogastric devascularization in our hospital, and their clinical data were reviewed and analyzed. Results All 58 cases were diagnosed post-hepatitis (hepatitis B or hepatitis C) liver cirrhosis and portal hypertension and Child liver function classification was as follows: grade A in 35 cases, grade B in 20 cases, and grade C in 3 cases. During 3 months follow-up period in post-operation, anastomotic fistula occurred in 5 cases, anasto-motic stenosis in 2 cases, secondary hemorrhage in 2 cases, and death in 3 cases, as well portal vein thrombosis in 1 case. Conclusion Re-stapling technique after pericardial-esophagogastric devascularization is effective for controlling secondary bleeding. Properly intra-operative and post - operative management can help to reduce or avoid occurrence of complications, suggesting it is an

  16. Observations on oesophageal length.

    Science.gov (United States)

    Kalloor, G J; Deshpande, A H; Collis, J L

    1976-01-01

    The subject of oesophageal length is discussed. The great variations in the length of the oesophagus in individual patients is noted, and the practical use of its recognition in oesophageal surgery is stressed. An apprasial of the various methods available for this measurement is made; this includes the use of external chest measurement, endoscopic measurement, and the measurement of the level of the electrical mucosal potential change. Correlative studies of these various methods are made, and these show a very high degree of significance. These studies involved simultaneous measurement of external and internal oesophageal length in 26 patients without a hiatal hernia or gastro-oesophageal length in 26 patients without a hiatal hernia or gastro-oesophageal reflux symptoms, 42 patients with sliding type hiatal hernia, and 17 patients with a peptic stricture in association with hiatal hernia. The method of measuring oesophageal length by the use of the external chest measurement, that is, the distance between the lower incisor teeth and the xiphisternum, measured with the neck fully extended and the patient lying supine, is described in detail, its practical application in oesophageal surgery is illustrated, and its validity tested by internal measurements. The findings of this study demonstrate that the external chest measurement provides a mean of assessing the true static length of the oesophagus, corrected for the size of the individual. Images PMID:941114

  17. 国产奥美拉唑治疗急性非静脉曲张性上消化道出血的Meta分析%Effectiveness and Safety of China-Made Omeprazole in Treating Acute Non-Variceal Upper Gastrointestinal Bleeding: A Meta-Analysis

    Institute of Scientific and Technical Information of China (English)

    刘文平; 黄彩云

    2013-01-01

    目的 系统评价国产奥美拉唑治疗急性非静脉曲张性上消化道出血的疗效和安全性.方法 计算机检索PubMed、MEDLINE、Springer、The Cochrane Library、CNKI、VIP、CBM、WanFang Data等数据库,收集国产奥美拉唑治疗急性非静脉曲张性上消化道出血的随机对照试验(RCT),检索时限均为建库至2012年12月,并追溯纳入研究的参考文献.由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析.结果 纳入11个RCT,共1 075例患者(试验组544例,对照组531例).Meta分析结果显示,国产奥美拉唑与进口奥美拉唑相比,在急性非静脉曲张性上消化道出血的总有效率[OR=0.68,95%CI (0.35,1.33),P=0.26]和不良反应发生率[RR=1.33,95%CI (0.45,3.91),P=0.60]方面,两组差异无统计学意义.结论 国产奥美拉唑治疗急性非静脉曲张性上消化道出血疗效与进口奥美拉相当,安全有效.%Objective To systematically evaluate the effectiveness and safety of China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding.Methods Such databases as PubMed,MEDLINE,Springer,The Cochrane Library,CNKI,VIP,CBM and WanFang data were searched to collect the randomized controlled trials (RCTs)about China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding,and the references of included studies were also retrieved.The retrieval time was from inception to December 2012.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data,and assessed the quality,and then the meta-analysis was conducted by using RevMan 5.1 software.Results A total of 11 RCTs were included.Among all 1 075 patients,544 were in the treatment group,while the other 531 were in the control group.The results of metaanalysis showed that,there were no significant differences in the total effective rate (OR=0.68,95

  18. Acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Kurien, Matthew; Lobo, Alan J

    2015-10-01

    Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered medical emergency with an incidence of 84-160/100000 and associated with mortality of approximately 10%. Guidelines from the National Institute for Care and Care Excellence outline key features in the management of AUGIB. Patients require prompt resuscitation and risk assessment using validated tools. Upper gastrointestinal endoscopy provides accurate diagnosis, aids in estimating prognosis and allows therapeutic intervention. Endoscopy should be undertaken immediately after resuscitation in unstable patients and within 24 hours in all other patients. Interventional radiology may be required for bleeding unresponsive to endoscopic intervention. Drug therapy depends on the cause of bleeding. Intravenous proton pump inhibitors should be used in patients with high-risk ulcers. Terlipressin and broad-spectrum antibiotics should be used following variceal haemorrhage. Hospitals admitting patients with AUGIB need to provide well organised services and ensure access to relevant services for all patients, and particularly to out of hours endoscopy.

  19. Clinical Study of Esophageal Gastric Varices Bleeding Endoscopic Therapy Combined Percutaneous Liver Biopsy of Gastric Coronary Vein Embolization Curative Effect Analysis%食管胃底静脉曲张破裂出血内镜治疗联合经皮肝穿胃冠状静脉栓塞术疗效分析

    Institute of Scientific and Technical Information of China (English)

    余绪锋; 黎振林; 陈广林

    2014-01-01

    Objective: To investigate the endoscopic therapy (ligation, hardener and cyanoacrylate) rubber injection combined percutaneous by gastric coronary vein embolization (PTVE) to treat esophageal varicose vein rupture bleeding the long-term efficacy of stomach bottom.Method: A total of 38 patients with esophageal gastric varices first endoscopy and enhanced upper abdomen CT portal vein reconstruction. According to the stomach esophagus varicose vein severity by endoscopic ligation, curing agent and the tissue glue injection combined percutaneous liver gastric coronary vein embolization.Result: 10 cases of emergency stop bleeding, 38 patients undergoing elective treatment of 28 cases. The were followed up for 3-52 months, with an average follow-up of 15 months, the recurrence of bleeding in 5 cases (13.1%). Conclusion: Endoscopic therapy combined percutaneous liver gastric coronary vein embolization in the treatment of portal hypertension of gastrointestinal bleeding is a safe and reliable treatment, can significantly reduce the bleeding occurred again on curative effect analysis.%目的:探讨内镜治疗(套扎、硬化剂及组织胶注射术)联合经皮经肝胃冠状静脉栓塞术治疗食管胃底曲张静脉破裂出血的中远期疗效。方法:共38例食管胃底静脉曲张破裂出血患者先行内镜检查及上腹部增强CT门脉重建。根据食管胃底曲张静脉严重程度采取内镜下套扎、硬化剂及组织胶注射术联合经皮经肝胃冠状静脉栓塞。结果:本组38例患者急诊止血10例,择期治疗28例。随访3~52个月,平均随访15个月,复发出血5例(13.1%)。结论:内镜治疗联合经皮经肝胃冠状静脉栓塞术治疗门脉高压消化道大出血是一种安全、可靠的治疗方法,能够显著降低再次出血发生。

  20. Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage.

    Science.gov (United States)

    Loffroy, Romaric; Estivalet, Louis; Cherblanc, Violaine; Favelier, Sylvain; Pottecher, Pierre; Hamza, Samia; Minello, Anne; Hillon, Patrick; Thouant, Pierre; Lefevre, Pierre-Henri; Krausé, Denis; Cercueil, Jean-Pierre

    2013-10-07

    Acute variceal hemorrhage, a life-threatening condition that requires a multidisciplinary approach for effective therapy, is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy, the presence of large esophageal varices with recent stigmata of bleeding, or fresh blood visible in the stomach with no other source of bleeding identified. Transfusion of blood products, pharmacological treatments and early endoscopic therapy are often effective; however, if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs, transjugular intrahepatic portosystemic shunt (TIPS) is recommended as rescue treatment. The TIPS represents a major advance in the treatment of complications of portal hypertension. Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS, which has a 90% to 100% success rate. However, TIPS is associated with a mortality of 30% to 50% in such a setting. Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure, before the clinical condition worsens. Furthermore, admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively. This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage, particularly as a rescue therapy following failure of endoscopic approaches.

  1. Transcatheter Embolotherapy with N-Butyl Cyanoacrylate for Ectopic Varices

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Jae, Hwan Jun, E-mail: jaemdphd@gmail.com; Jung, Hyun-Seok; Hur, Saebeom; Lee, Myungsu; Chung, Jin Wook [Seoul National University Hospital, Department of Radiology, Seoul National University College of Medicine (Korea, Republic of)

    2015-04-15

    PurposeTo address technical feasibility and clinical outcome of transcatheter embolotherapy with N-butyl cyanoacrylate (NBCA) for bleeding ectopic varices.MethodsThe institutional review board approved this retrospective study and waived informed consent. From January 2004 to June 2013, a total of 12 consecutive patients received transcatheter embolotherapy using NBCA for bleeding ectopic varices in our institute. Clinical and radiologic features of the endovascular procedures were comprehensively reviewed.ResultsPreprocedural computed tomography images revealed ectopic varices in the jejunum (n = 7), stoma (n = 2), rectum (n = 2), and duodenum (n = 1). The 12 procedures consisted of solitary embolotherapy (n = 8) and embolotherapy with portal decompression (main portal vein stenting in 3, transjugular intrahepatic portosystemic shunt in 1). With regard to vascular access, percutaneous transhepatic access (n = 7), transsplenic access (n = 4), and transjugular intrahepatic portosystemic shunt tract (n = 1) were used. There was no failure in either the embolotherapy or the vascular accesses (technical success rate, 100 %). Two patients died within 1 month from the procedure from preexisting fatal medical conditions. Only one patient, with a large varix that had been partially embolized by using coils and NBCA, underwent rebleeding 5.5 months after the procedure. The patient was retreated with NBCA and did not undergo any bleeding afterward for a follow-up period of 2.5 months. The remaining nine patients did not experience rebleeding during the follow-up periods (range 1.5–33.2 months).ConclusionTranscatheter embolotherapy using NBCA can be a useful option for bleeding ectopic varices.

  2. Ektopiske varicer i den distale ileum som årsag til gastrointestinal blødning

    DEFF Research Database (Denmark)

    Thorup, Tine Juhl; Beier-Holgersen, Randi; Bruun, Jens

    2015-01-01

    Varices of the terminal ileum are not a common complication to portal hypertension but we describe a case where a 60-year-old male patient had massive, recurrent intestinal bleeding due to collateral blood supply from umbilical veins to varicose veins of the terminal ileum.......Varices of the terminal ileum are not a common complication to portal hypertension but we describe a case where a 60-year-old male patient had massive, recurrent intestinal bleeding due to collateral blood supply from umbilical veins to varicose veins of the terminal ileum....

  3. The use of hemospray in portal hypertensive bleeding; a case series.

    Science.gov (United States)

    Smith, L A; Morris, A J; Stanley, A J

    2014-02-01

    Hemospray is a haemostatic agent licensed for endoscopic haemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB) in Europe and Canada. Hemospray has been shown to be safe and effective in achieving haemostasis in bleeding peptic ulcers in a prospective clinical study and several further case series have described the use of hemospray in other non-variceal causes of gastrointestinal bleeding. Portal hypertensive gastropathy and colopathy are common in patients with portal hypertension. As hemospray is an easy to apply, non-contact method, which can cover large areas of mucosa, it may be of benefit in acute non-variceal portal hypertensive bleeding. We present data from the first four consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding treated with hemospray.

  4. Splenic duplication: a rare cause of acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Sharma, Pankaj; Alkadhi, Hatem; Gubler, Christoph; Bauerfeind, Peter; Pfammatter, Thomas

    2013-02-01

    Acute gastrointestinal bleeding represents a common medical emergency. We report the rare case of acute upper gastrointestinal bleeding caused by varices in the gastric fundus secondary to splenic duplication. Splenic duplication has been only rarely reported in the literature, and no case so far has described the associated complication of gastrointestinal bleeding, caused by venous drainage of the upper spleen via varices in the gastric fundus. We describe the imaging findings from endoscopy, endosonography, computed tomography (CT), flat-panel CT, and angiography in this rare condition and illustrate the effective role of intra-arterial embolization.

  5. Gastrointestinal bleeding in the pediatric patient.

    OpenAIRE

    Hillemeier, C.; Gryboski, J. D.

    1984-01-01

    Gastrointestinal hemorrhage in infants and children is a catastrophic event but is not associated with significant mortality except in those with a severe primary illness. Upper gastrointestinal bleeding in infants and young children is most often associated with stress ulcers or erosions, but in older children it may also be caused by duodenal ulcer, esophagitis, and esophageal varices. Lower gastrointestinal bleeding may be caused by a variety of lesions among which are infectious colitides...

  6. Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Hirohiko Tanihata; Tetsuo Sonomura; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Masaki Terada

    2006-01-01

    A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration (BRTO) was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

  7. Balloon-Occluded Antegrade Transvenous Sclerotherapy to Treat Rectal Varices: A Direct Puncture Approach to the Superior Rectal Vein Through the Greater Sciatic Foramen Under CT Fluoroscopy Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Ono, Yasuyuki, E-mail: onoyasy@hirakata.kmu.ac.jp; Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Kono, Yumiko, E-mail: kohnoy@hirakata.kmu.ac.jp; Kan, Naoki, E-mail: kanna@takii.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2015-10-15

    Rectal varices occur in 44.5 % of patients with ectopic varices caused by portal hypertension, and 48.6 % of these patients are untreated and followed by observation. However, bleeding occurs in 38 % and shock leading to death in 5 % of such patients. Two patients, an 80-year-old woman undergoing treatment for primary biliary cirrhosis (Child-Pugh class A) and a 63-year-old man with class C hepatic cirrhosis (Child-Pugh class A), in whom balloon-occluded antegrade transvenous sclerotherapy was performed to treat rectal varices are reported. A catheter was inserted by directly puncturing the rectal vein percutaneously through the greater sciatic foramen under computed tomographic fluoroscopy guidance. In both cases, the rectal varices were successfully treated without any significant complications, with no bleeding from rectal varices after embolization.

  8. Chemotherapy in Oesophageal Cancer

    NARCIS (Netherlands)

    M.B. Polee

    2004-01-01

    textabstractThe incidence of oesophageal cancer in the Netherlands has doubled in the period 1978-1996 (from 2.2 to 4.8 per 100.000 person-years) and at the end of this period the incidence of adenocarcinomas equalled the incidence of squamous cell carcinomas1• The main risk factors for squamous cel

  9. 急性非静脉曲张性上消化道出血诊治指南(2009,杭州)%Guideline on managements of acute non-variceal upper gastrointestinal bleeding(2009,Hangzhou)

    Institute of Scientific and Technical Information of China (English)

    《中华内科杂志》编委会; 《中华消化杂志》编委会; 《中华消化内镜杂志》编委会; 李兆申; 杜奕奇; 湛先保

    2009-01-01

    @@ 一、定义 急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)系指屈氏韧带以上消化道非静脉曲张性疾患引起的出血,包括胰管或胆管的出血和胃空肠吻合术后吻合口附近疾患引起的出血,年发病率为(50~150)/10万,病死率为6%~10%[2-3].

  10. Correlation Between Esophageal Varices and Lok Score as a Non-invasive Parameter in Liver Cirrhosis Patients

    Directory of Open Access Journals (Sweden)

    Iqbal Sungkar

    2016-09-01

    Full Text Available Bleeding from gastro-esophageal varices is the most serious and life-threatening complication of cirrhosis. Endoscopic surveillance of esophageal varices in cirrhotic patients is expensive and uncomfortable for the patients. Therefore, there is a particular need for non-invasive predictors for esophageal varices. The aim of the present study was to evaluate association of esophageal varices and Lok Score as non-invasive parameter in liver cirrhosis patients. This is a cross-sectional study of patients admitted at the Adam Malik hospital Medan between September to December 2014 with a diagnosis of cirrhosis based on clinical, biochemical examination, ultrasound, and gastroscopy. Lok Score was calculated for all patients, tabulated and analyzed. Among 76 patients with esophageal varices, 55.3% was due to hepatitis B virus (HBV. The majority of patients were Child C with only 13,2% being Child Pugh class A. Majority of the population had F2 esophageal varices (42.1%, F1 (32.9%, and F3 (25%. There is significance difference between Lok Score and grading of esophageal varices, in which Lok Score is higher in large esophageal varices compared with small esophageal varises (0.92 ± 0.14 vs. 0.70 ± 0.29; p = 0.001. Lok Score with cut-off point of > 0.9141 was highly predictive in the diagnosis large esophageal varices with a sensitivity of 74.5%, specificity of 72%, positive predictive value of 84%, negative predictive value 58%, and accuracy was 73.7%. Lok Score was significantly associated with esophageal varices. Lok Score is a good non-invasive predictor of large esophageal varices in cirrhotic patients.

  11. PREDICTORS OF LARGE ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS PRESENTING TO A TERTIARY CARE CENTRE IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Anita

    2015-11-01

    Full Text Available BACKGROUND Variceal bleeding is a major cause of morbidity and mortality in cirrhosis and endoscopic examination is not accessible in most rural centers. The aim of the study is to identify the clinical, hematological, biochemical, and ultrasonographic parameters that predict the presence of large esophageal varices in patients with cirrhosis. METHODOLOGY Seventy two patients fulfilling inclusion criteria were enrolled for this prospective observational study. Relevant clinical parameters like ascites, splenomegaly, jaundice and laboratory parameters like complete blood picture with absolute platelet count, prothrombin time, serum bilirubin, albumin, CTP class and ultrasonographic characteristics like spleen size, splenic vein size, portal vein diameter were recorded and assessed. Univariate and multivariate analysis was done for predictors of large esophageal varices. RESULTS Thirty one (43% patients in this study had varices, out of them 15 (48% had large varices. On multivariate analysis, presence of large esophageal varices was significantly associated with a spleen size >16cm (p value-0.001, platelet count 16cm and CTP class B and C can stongly predict the presence of large esophageal varices. PLC/SD ratio, SAAG, PVD and PVF did not have any statistical significance in predicting large esophageal varices in our study.

  12. Hemodynamic analysis of esophageal varices in patients with liver cirrhosis using color Doppler ultrasound

    Institute of Scientific and Technical Information of China (English)

    Feng-Hua Li; Jing Hao; Jian-Guo Xia; Hong-Li Li; Hua Fang

    2005-01-01

    AIM: To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patients with liver cirrhosis and portal hypertension.METHODS: One hundred and twenty cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the prospective study. During a 2-year observation period, 52 patients who had at least one episode of acute esophageal variceal hemorrhage constituted the bleeding group, and the remaining 68 patients without any previous hemorrhage constituted the non-bleeding group. All patients underwent endoscopy before or after color Doppler-ultrasonic examination, and images were interpreted independently by two endoscopists. The control group consisted of 30 healthy subjects, matched to the patient group in age and gender. Measurements of diameter,flow direction and flow velocity in the left gastric vein (LGV) and the portal vein (PV) were done in all patients and controls using color Doppler unit. After baseline measurements, 30 min after oral administration of 75 g glucose in 225 mL, changes of the diameter, flow velocity and direction in the PV and LGV were examined in 60 patients with esophageal varices and 15 healthy controls.RESULTS: The PV and LGV were detected successfully in 115 (96%) and 105 (88%) of 120 cirrhotic patients,respectively, and in 27 (90%) and 21 (70%) of 30 healthy controls, respectively. Among the 120 cirrhotic patients,37 had F1, 59 had F2, and 24 had F3 grade varices. Compared with the healthy controls, cirrhotic group had a significantly lower velocity in the PV, a significantly greater diameter of the PV and LGV, and a higher velocity in the LGV. In the cirrhotic group, no difference in portal flow velocity and diameter were observed between patients with or without esophageal variceal bleeding (EVB). However, the diameter and blood flow velocity of the LGV were

  13. A STUDY OF CORRELATION OF ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS WITH PORTAL HAEMODYNAMICS WITH SPECIAL REFERENCE TO PORTAL VEIN DIAMETER, PORTAL VEIN VELOCITY, CONGESTION INDEX, LIVER VASCULAR INDEX

    Directory of Open Access Journals (Sweden)

    Arvind

    2014-12-01

    Full Text Available OBJECTIVE : Approximately two thirds of patients with decompensated cirrhosis and one third of those with compensated cirrhosis have varices at the time of diagnosis. Therefore , it is essential to identify and treat those patients at highest risk because each episode of variceal hemorrhage carries a 20% to 30% risk of death , and 70% of patients not receiving treatment will die within 1 year of the initial bleeding episode . (1 METH OD S: For this study , patients with cirrhosis with or without the evidence of any upper Gastrointestinal bleed , admitted in the department of medicine , JA Group of Hospitals , GR Medical College were taken. The study was conducted between September 2011 and November 2012 and cases were evaluated on the basis of clinical , haematological , ultrasonographic and endoscopic findings. Total number of cases were 100. RESULT : The prevalence of esophageal varices was 75% in cirrhotic patients out of which 28% had bleeding. The prevalence of gastric varices was 1.33%. The portal vein diameter correlated with the presence of varices while portal vein velocity , congestion index and liver vascular index had no significant correlation with esophageal varices. The Portal vein diameter more than 1.4 cm can predict varices with sensitivity 76 % (p<0.05 and Portal vein diameter more than 1.5 cm can detect bleeding varices in cirrhotic patients with sensitivity 55.56% and specificity 80.70% . CONCLUSION : This study showed tha t duration of illness , spleen size and tense ascitis on ultrasonography and portal vein diameter correlated with the presence of esophageal varices. The duration of illness and portal vein diameter are also correlated with bleeding manifestation

  14. 非选择性β受体阻滞剂预防食管胃静脉曲张破裂出血的研究进展%Advances in Study on Preventive Efficacy of Non-selective beta-Blockers in Patients with Esophageal Gastric Variceal Bleeding

    Institute of Scientific and Technical Information of China (English)

    段旭红; 诸葛宇征; 张峰

    2015-01-01

    Esophageal gastric variceal bleeding(EGVB)is a serious complication of cirrhotic portal hypertension with high mortality rate. Prevention of EGVB is an important mean to improve the survival of patients. Non-selective beta-blockers(NSBBs)is one of the first-line drugs for primary and secondary prevention of EGVB,however,only about 1 / 3 of cirrhotic patients respond to this treatment when evaluated by hepatic venous pressure gradient( HVPG). This may be related to the genetic polymorphisms of NSBBs’receptors and the metabolic enzymes. This article reviewed the progress in study on therapeutic efficacy of NSBBs and its influencing factors for preventing EGVB in cirrhotic patients.%食管胃静脉曲张破裂出血(EGVB)是肝硬化门静脉高压的常见严重并发症,死亡率高,预防 EGVB 是提高患者生存期的重要手段。非选择性β受体阻滞剂(NSBBs)是 EGVB 一级和二级预防的主要方法之一,但仅1/3患者的肝静脉压力梯度对其治疗有应答;这可能与 NSBBs 受体及其代谢酶的基因多态性有关。本文就 NSBBs 预防 EGVB 的疗效和影响因素作一综述。

  15. Management of variceal hemorrhage:current status

    Institute of Scientific and Technical Information of China (English)

    BAI Yu; LI Zhao-shen

    2009-01-01

    @@ Despite much progress has been made in treatment and research in recent decades,variceal hemorrhage is still one of the most severe complications of liver cirrhosis.1 Studies of the natural history of gastroesophageal varices indicate that gastroesophageal varices are present in about half of cirrhotic patients when endoscopy is performed at the time of the diagnosis of cirrhosis.The presence of gastroesophageal varices correlates with the severity of liver disease.

  16. Treatment of ectopic varices with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Ectopic varices are unusual with portal hypertension andcan involve any site along the digestive tract outsidethe gastroesophageal region. Hemorrhage from ectopicvarices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequenttreatment is also difficult; the optimal treatment hasnot been established. Recently, interventional radiologyand endoscopic treatments have been carried outsuccessfully for hemorrhage from ectopic varices.

  17. Thrombosis of orbital varices; Trombosis de varices orbitarias

    Energy Technology Data Exchange (ETDEWEB)

    Boschi Oyhenart, J.; Tenyi, A.; Boschi Pau, J. [Hospital Italiano, Montevideo (Uruguay)

    2002-07-01

    Orbital varices are venous malformations produced by an abnormal dilatation of one or more orbital veins, probably associated with congenital weakness of the vascular wall. They are rare lesions, usually occurring in young patients, that produce intermittent proptosis related to the increase in the systemic venous pressure. The presence of hemorrhage or thrombosis is associated with rapid development of proptosis, pain and decreased ocular motility. We report the cases of two adult patients with orbital varices complicated by thrombosis in whom the diagnosis was based on computed tomography. The ultrasound and magnetic resonance findings are also discussed. (Author) 16 refs.

  18. Cost-effectiveness analysis of beta-blockers vs endoscopic surveillance in patients with cirrhosis and small varices

    Science.gov (United States)

    Di Pascoli, Lorenza; Buja, Alessandra; Bolognesi, Massimo; Montagnese, Sara; Gatta, Angelo; Gregori, Dario; Merkel, Carlo

    2014-01-01

    AIM: To evaluate the most cost-effectiveness strategy for preventing variceal growth and bleeding in patients with cirrhosis and small esophageal varices. METHODS: A stochastic analysis based on decision trees was performed to compare the cost-effectiveness of beta-blockers therapy starting from a diagnosis of small varices (Strategy 1) with that of endoscopic surveillance followed by beta-blockers treatment when large varices are demonstrated (Strategy 2), for preventing variceal growth, bleeding and death in patients with cirrhosis and small esophageal varices. The basic nodes of the tree were gastrointestinal endoscopy, inpatient admission and treatment for bleeding, as required. All estimates were performed using a Monte Carlo microsimulation technique, consisting in simulating observations from known probability distributions depicted in the model. Eight-hundred-thousand simulations were performed to obtain the final estimates. All estimates were then subjected to Monte Carlo Probabilistic sensitivity analysis, to assess the impact of the variability of such estimates on the outcome distributions. RESULTS: The event rate (considered as progression of varices or bleeding or death) in Strategy 1 [24.09% (95%CI: 14.89%-33.29%)] was significantly lower than in Strategy 2 [60.00% (95%CI: 48.91%-71.08%)]. The mean cost (up to the first event) associated with Strategy 1 [823 £ (95%CI: 106 £-2036 £)] was not significantly different from that of Strategy 2 [799 £ (95%CI: 0 £-3498 £)]. The cost-effectiveness ratio with respect to this endpoint was equal to 50.26 £ (95%CI: -504.37 £-604.89 £) per event avoided over the four-year follow-up. When bleeding episodes/deaths in subjects whose varices had grown were included, the mean cost associated with Strategy 1 was 1028 £ (95%CI: 122 £-2581 £), while 1699 £ (95%CI: 171 £-4674 £) in Strategy 2. CONCLUSION: Beta-blocker therapy turn out to be more effective and less expensive than endoscopic surveillance for

  19. Gastrointestinal bleeding

    Science.gov (United States)

    ... refers to any bleeding that starts in the gastrointestinal tract. Bleeding may come from any site along the GI tract, but is often divided into: Upper GI bleeding: The upper GI tract includes the ...

  20. A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Adrienne Lenhart

    2016-10-01

    Full Text Available Portal hypertension commonly arises in the setting of advanced liver cirrhosis and is the consequence of increased resistance within the portal vasculature. Less commonly, left-sided noncirrhotic portal hypertension can develop in a patient secondary to isolated obstruction of the splenic vein. We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena. On admission to hospital, he was found to have a hemoglobin level of 3.4 g/l. Emergent esophagogastroduodenoscopy showed isolated bleeding gastric varices (IGV1 by Sarin classification in the fundus and cardia with subsequent argon plasma coagulation injection. He was transferred to our tertiary center where work-up revealed normal liver function tests, and abdominal ultrasound showed patent hepatic/portal vasculature without cirrhosis. MRI demonstrated a large heterogeneously enhancing mass in the pancreatic tail, with invasion into the spleen and associated splenic vein thrombosis. Surgery consultation was obtained, but urgent splenectomy was not recommended. The patient instead underwent splenic artery embolization to prevent future bleeding from his known gastric varices. Pathology from a CT-guided biopsy was consistent with diffuse large B-cell lymphoma. PET imaging showed uptake in the splenic hilum/pancreatic tail region with no additional metastatic involvement. He was evaluated by the Hematology Department to initiate R-CHOP chemotherapy. During his outpatient follow-up, he reported no further episodes of melena or hematemesis. To the best of our knowledge, there have only been two published case reports of large B-cell lymphoma causing upper gastrointestinal bleeding from isolated gastric varices. These cases were treated with splenectomy or

  1. Pulmonary embolism after endoscopic injection with N-butyl-2-cyanoacrylate for gastric varices

    Directory of Open Access Journals (Sweden)

    Gabriela Robaina

    2016-12-01

    Full Text Available Gastric varices occur in one-third of patients with portal hypertension. Bleeding from gastric varices remains a significant cause of death. Currently the first-line of treatment for gastric varices is endoscopic obliteration with N-butyl-2-cyanoacrylate. Though relatively safe, this option has several well-known complications. We report the case of a 61-year-old male patient with cryptogenic cirrhosis, who presented with fever, tachycardia and hypoxemia after endoscopic obliteration with N-butyl-2-cyanoacrylate. Radiographic findings were consistent with pulmonary embolism of the sclerosing substance. The aim of this case report is to emphasize the clinical and radiological findings of this complication in order to distinguish it from other similar medical conditions and prevent a delay in diagnosis

  2. Study of Controlling Acute Hemorrhage from Esophageal Varices Rupture with Technique of Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To find a method for inducing Chinese drugs to adhere to the esophageal mucosa to control bleeding from ruptured esophageal varices. Methods: The site and time that the Chinese drugs adhere to esophageal mucosa were observed in 30 healthy volunteers under the specific condition of standing and lying posture. Seventy episodes bled with ruptured esophageal varices patients (treated group 36 episodes in 25 patients and control group 34 episodes in 27 patients) suffering from cirrhosis of liver were treated by the technique of drug adhesion. Results: (1) The adhesion of Chinese hemostatic drugs remained in the lower segment of esophagus for more than 15 minutes in lying posture, longer than that in standing posture (P0.05). Conclusion: This drug adhesion technique provides a new approach to control hemorrhage from ruptured esophageal varices.

  3. Surgical treatment of hepatocellular carcinoma with cirrhotic esophageal varices and hypersplenism:a 184 case report

    Institute of Scientific and Technical Information of China (English)

    JIANG Bin; CHEN Xiaoping; HUANG Zhiyong; ZHANG Zhiwei; HE Songqing; WANG Shaofa; WU Zaide; QIU Fazu

    2007-01-01

    In treating hepatocellular carcinoma (HCC)patients with advanced cirrhosis,one of the most difficult problems is concomitant esophageal varices and hypersplenism.Whether these conditions should be treated surgically in association with HCC resection is still in debate.To elucidate whether esophageal devascularization or splenectomy is beneficial when simultaneously performed with liver resection in HCC patients with both varices and hypersplenism,HCC patients (n = 184) with esophageal varices and hypersplenism received one of the three treatments:simultaneous liver resection and esophageal devascularization (Group Ⅰ,n=41);simultaneous liver resection and splenectomy (Group Ⅱ,n = 61);liver resection only (Group Ⅲ,n = 82).The incidences of postoperative complications of the three groups were 31.7%,29.5% and 24.4%,respectively,with no significant difference among them.The 5-year tumor-free survival rates for the group Ⅰ,group Ⅱ and group Ⅲ were 34.1%,36.1% and 37.8%,respectively.Variceal bleeding caused death by only 4.2% in group Ⅰ,but by 14.3% in group Ⅱ and 23.2% in group Ⅲ.The survival rates in the group Ⅰ and the group Ⅱ were comparable to those in the group Ⅲ,however,the recurrences of postoperative fatal variceal bleeding in group Ⅰ and group Ⅱ were significantly lower than those in group Ⅲ.The results suggest that HCC patients with esophageal varices and hypersplenism should undergo hepatic resection plus esophageal devascularization or splenectomy if radical resection of HCC can be expected.

  4. [Epidemiology of upper gastrointestinal bleeding in Gabon].

    Science.gov (United States)

    Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

    2014-01-01

    The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

  5. Prospective randomized comparison of sodium tetradecyl sulfate and polidocanol as variceal sclerosing agents.

    Science.gov (United States)

    Bhargava, D K; Singh, B; Dogra, R; Dasarathy, S; Sharma, M P

    1992-02-01

    A prospective randomized controlled study was designed to evaluate differences in efficacy and complication rate between the two most commonly used sclerosing agents, sodium tetradecyl sulfate (STD) and polidocanol. Of 52 patients with esophageal variceal bleeding, 26 were randomized to receive sclerotherapy with 1.5% STD and 26 to receive 1% polidocanol at weekly intervals. Eradication of varices was achieved in 88% patients each of the STD and polidocanol group. There was no significant difference between patients injected with STD and polidocanol with regard to re-bleeding (27% vs. 15%) and mortality (11.5% in both). The use of STD, in contrast to polidocanol, was associated with a higher incidence of complications in terms of severe retrosternal pain (27% vs. 4%), deep ulceration (53% vs. 23%), dysphagia (88% vs. 46%), and stricture formation (27% vs. 8%). It was concluded that these two agents were similar in efficacy. However, polidocanol was superior due to a lower incidence of complications.

  6. Bleeding disorders

    Science.gov (United States)

    ... can occur when certain factors are low or missing. Bleeding problems can range from mild to severe. Some bleeding disorders are present at birth and are passed through families (inherited). Others develop from: Illnesses such as vitamin ...

  7. Bleeding gums

    Science.gov (United States)

    ... periodontal exam. DO NOT use tobacco, since it makes bleeding gums worse. Control gum bleeding by applying pressure directly on the gums with a gauze pad soaked in ice water. If you have been diagnosed with a ...

  8. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Min Yung; Kim, Man Deuk; Shin, Won Seon; Shin, Min Woo; Kim, Gyoung Min; Won, Jong Yun; Park, Sung Il; Lee, Do Yun [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Tae Hwan [Dept. of Radiology, National Health Insurance Serivce Ilsan Hospital, Goyang (Korea, Republic of)

    2016-04-15

    To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

  9. A STUDY ON UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Salla Surya Prakasa Rao

    2016-10-01

    Full Text Available BACKGROUND Vomiting of blood almost always proximal to the ligament of Treitz is the upper gastrointestinal haemorrhage. The incidence of acute upper gastrointestinal haemorrhage has been estimated to be 50-100 per 1,00,000 person per year, with an annual hospitalization rate of approximately 100 per 1, 00,000 hospital admission. This study is to find out the prevalence of nature of lesion on Upper Gastrointestinal Endoscopy in patients admitted for Gastrointestinal bleeding. (UGI Bleed. MATERIALS AND METHODS Place of Study- Department of General Medicine, Andhra Medical College, Visakhapatnam, India. Type of Study- Prospective study. Period of Study- July 2015 to August 2016. RESULTS The Results Study on Endoscopic Findings in Upper Gastro Intestinal Bleed are 1. The peptic ulcer disease was the most common lesion found on endoscopy with prevalence of 54%. 2. Varices contributes second common lesion, next to peptic ulcer disease in UGI bleed with prevalence of 16%. 3. Minor UGI bleed was the commonest presentation. Majority of lesions (60% presented with minor UGI bleed, 28% lesions presented as moderate UGI bleed. Only 8% presented as major UGI bleed. 4. Varices account for the most common cause for major UGI bleed contributing 50%. 5. Gastric ulcer was commonest lesions accounting for 37 cases (37% among 72 cases having single acid peptic lesions on endoscopy. The second most common is duodenal ulcer (31%. 6. Multiple lesions were found in 10% of cases. Peptic ulcer lesions were found in 20% of total number of varices cases. CONCLUSION Peptic ulcer disease was found to be most common lesion causing UGI bleed, with most common presentation as minor UGI bleed and variceal bleed being most common cause of major UGI bleed.

  10. [Left predominance of varices: myth or reality?].

    Science.gov (United States)

    Cornu-Thénard, A; Maraval, M; Boivin, P; Parpex, P

    1986-01-01

    The study of 843 legs operated for major varices shows that they are equally distributed between the two lower limbs (48.6% on the right, 51.4% on the left). There is little sex-determined variation in this distribution (410 women - 184 men), the main difference being that found in men: +4.6% on the left. Other studies carried out in Europe come to much the same conclusion. Two of these studies do, however, note a much clearer predominance of left-leg varices in men (+10%). For some studies, the lack of information about the type of varices being considered has proved troublesome (for example the many isolated telangiectasis and varices) and means that it is impossible to come to any exact conclusion. Clinical quantification is therefore desirable: at least it takes into account the diameter of the varices studied.

  11. Advances in oesophageal cancer

    Directory of Open Access Journals (Sweden)

    Ben Knight

    2013-01-01

    Full Text Available Adenocarcinoma (AC of the oesophagus is an important disease in western communities in terms of its unprecedented recent increase in incidence and its relatively poor outcomes despite today′s variety of treatment options. The increasing incidence of this deadly disease is probably related to the changing lifestyle patterns within affluent societies, in terms of diet and sedentary practices, obesity and the prevalence of gastro-oesophageal reflux disease. Barrett′s oesophagus has been identified as a major risk factor and surveillance strategies for at-risk groups are being proposed, together with endoscopic management strategies for those with high-grade dysplasia or early and localised AC. It is recognised that the disease is better treated in high-volume centres under the guidance of a multidisciplinary team. Increasing availability and accuracy of sophisticated staging tools such as endoscopic ultrasound, endoscopic mucosal resection and positron-emission tomography (PET have helped define treatment strategies. Endoscopic tools can identify patients who might be suitable for some form of local ablative therapy and PET scanning will often pick up metastatic disease missed with other imaging investigations. Refinement of the pathological staging system has also helped define treatment modalities. Although surgery may still be seen as the mainstay of treatment, its use is now more in context with adjuvant therapies. With the unwavering epidemic of obesity, it is likely that AC of the oesophagus is going to remain an important disease confronting healthcare and this paper deals with some of the current issues.

  12. Isolated Gastric Varices and Use of Balloon-occlusive Retrograde Transvenous Obliteration: A Case Report and Literature Review.

    Science.gov (United States)

    McCarty, Thomas R; Bakhit, Mena; Rustagi, Tarun

    2016-03-01

    Isolated gastric varices are far less prevalent in Western countries where the rate of splenic thrombosis is much lower. However, in Asian countries the entity is more common and therefore a more robust treatment approach has been developed. Balloon-occlusive retrograde transvenous obliteration (BRTO) was first described in 1984 and then revived in 1996. The procedure, while uncommon in the U.S. and not recognized by the AASLD practice guidelines, allows for direct exclusion from the portosystemic system. Here we describe the case of a patient with alcoholic cirrhosis decompensated by bleeding gastric varices treated with BRTO.

  13. Precision prevention of oesophageal adenocarcinoma.

    Science.gov (United States)

    Vaughan, Thomas L; Fitzgerald, Rebecca C

    2015-04-01

    The incidence of oesophageal adenocarcinoma has risen rapidly over the past four decades. Unfortunately, treatments have not kept pace; unless their cancer is identified at a very early stage, most patients will not survive a year after diagnosis. The beginnings of this widespread problem were first recognized over 25 years ago, yet rates have continued to rise against a backdrop of much improved understanding and management of oesophageal adenocarcinoma. We estimate that only ∼7% of the 10,000 cases of oesophageal adenocarcinoma diagnosed annually in the USA are identified through current approaches to cancer control, and trace pathways by which the remaining 93% are 'lost'. On the basis of emerging data on aetiology and predictive factors, together with new diagnostic tools, we suggest a five-tier strategy for prevention and control that begins with a wide population base and triages individuals into progressively higher risk strata, each with risk-appropriate prevention, screening and treatment options.

  14. Preoperative evaluation of oesophageal adenocarcinoma.

    Science.gov (United States)

    Khanna, Lauren G; Gress, Frank G

    2015-02-01

    The preoperative evaluation of oesophageal adenocarcinoma involves endoscopic ultrasound (EUS), computed tomography (CT), and positron emission tomography (PET). With routine Barrett's oesophagus surveillance, superficial cancers are often identified. EUS, CT and PET have a limited role in the staging of superficial tumours. Standard EUS has limited accuracy, but high frequency ultrasound miniprobes are valuable for assessing tumour stage in superficial tumours. However, the best method for determining depth of invasion, and thereby stage of disease, is endoscopic mucosal resection. In contrast, in advanced oesophageal cancers, a multi-modality approach is crucial. Accurate tumour staging is very important since the treatment of advanced cancers involves a combination of chemotherapy, radiation, and surgery. EUS is very useful for staging of the tumour and nodes. High frequency ultrasound miniprobes provide the ability to perform staging when the lesion is obstructing the oesophageal lumen. CT and PET provide valuable information regarding node and metastasis staging.

  15. Treatment of Esophageal Variceal Hemorrhage with Self-Expanding Metal Stents as a Rescue Maneuver in a Swiss Multicentric Cohort

    Directory of Open Access Journals (Sweden)

    Fabienne C. Fierz

    2013-03-01

    Full Text Available Acute esophageal variceal bleeding in patients with portal hypertension remains a complication with a high mortality today. In cases refractory to standard therapy including endoscopic band ligation and pharmacological therapy, traditionally balloon tamponade has been used as salvage therapy. However, these techniques show several important limitations. Self-expanding metal stents (SEMS have been proposed as an alternative rescue treatment. The use of variceal stenting in 7 patients with a total of 9 bleeding episodes in three different Swiss hospitals is demonstrated. While immediate bleeding control is achieved in a high percentage of cases, the 5-day and 6-week mortality rate remain high. Mortality is strongly influenced by the severity of the underlying liver disease. Accordingly, our data represent a high-risk patient collective. Thanks to their safety and easy handling, SEMS are an interesting alternative to balloon tamponade as a bridging intervention to definitive therapy including the pre-hospital setting.

  16. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

    ... Patients About ACOG Perimenopausal Bleeding and Bleeding After Menopause Home For Patients Search FAQs Perimenopausal Bleeding and ... 2011 PDF Format Perimenopausal Bleeding and Bleeding After Menopause Gynecologic Problems What are menopause and perimenopause? What ...

  17. Reverse gastric tube oesophageal substitution for staged repair of oesophageal atresia and tracheo-oesophageal fistula

    Directory of Open Access Journals (Sweden)

    Christopher Olusanjo Bode

    2014-01-01

    Full Text Available The management of oesophageal atresia and tracheo-oesophageal atresia (OATOF is very challenging. While in developed countries survival of patients with this condition has improved, the outcome in many developing countries has been poor. Primary repair through a thoracotomy (or video-assisted thoracoscopic surgery where available is the gold standard treatment of OATOF. However, in our setting where patients typically present late and with minimum support resources such as Neonatal Intensive Care Unit and total parenteral nutrition; staged repair may be the only hope of survival of these patients and this communication highlights the essential steps of this mode of treatment.

  18. A case of idiopathic colonic varices: A rare cause of hematochezia misconceived as tumor

    Institute of Scientific and Technical Information of China (English)

    Joung-Ho Han; Won-Joong Jeon; Hee-Bok Chae; Seon-Mee Park; Sei-Jin Youn; Seok-Hyung Kim; Il-Hun Bae; Sang-Jeon Lee

    2006-01-01

    Colonic varices are a very rare cause of lower gastrointestinal bleeding. Fewer than 100 cases of colonic varices, and 30 cases of idiopathic colonic varices (ICV) have been reported in the English literature.Among these 30 cases of ICV, 19 cases were diagnosed by angiography, and 7 operated cases were diagnosed later as ileocecal vein deficit, hemangioma, and idiopathic in 1, 1, 5 cases, respectively. We report the case of a 24-year-old man who suffered from multiple episodes of hematochezia of varying degree at the age of 11 years. He had severe anemia with hemoglobin of 21 g/L. On colonoscopy, tortuously dilated submucosal vein and friable ulceration covered with dark necrotic tissues especially at the rectosigmoid region were seen from the rectum up to the distal descending colon. It initially appeared to be carcinoma with varices. Mesenteric angiographic study suggested a colonic hemangioma.Low anterior resection was done due to medically intractable and recurrent hematochezia. Other bowel and mesenteric vascular structures appeared normal.Microscopic examination revealed normal colonic mucosa with dilated veins throughout the submucosa and serosa without representing new vessel growth. Taken all of these findings together, the patient was diagnosed as ICV. His postoperative course was uneventful.

  19. Multiple esophageal variceal ruptures with massive ascites due to myelofibrosis-induced portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Koichi Tokai; Hiroyuki Miyatani; Yukio Yoshida; Shigeki Yamada

    2012-01-01

    A 75-year old man had been diagnosed at 42 years of age as having polycythemia vera and had been monitored at another hospital.Progression of anemia had been recognized at about age 70,and the patient was thus referred to our center in 2008 where secondary myelofibrosis was diagnosed based on bone marrow biopsy findings.Hematemesis due to rupture of esophageal varices occurred in January and February of 2011.The bleeding was stopped by endoscopic variceal ligation.Furthermore,in March of the same year,hematemesis recurred and the patient was transported to our center.He was in irreversible hemorrhagic shock and died.The autopsy showed severe bone marrow fibrosis with mainly argyrophilic fibers,an observation consistent with myelofibrosis.The liver weighed 1856 g the spleen 1572 g,indicating marked hepatosplenomegaly.The liver and spleen both showed extramedullary hemopoiesis.Myelofibrosis is often complicated by portal hypertension and is occasionally associated with gastrointestinal hemorrhage due to esophageal varices.A patient diagnosed as having myelofibrosis needs to be screened for esophageal/gastric varices.Myelofibrosis has a poor prognosis.Therefore,it is necessary to carefully decide the therapeutic strategy in consideration of the patient's concomitant conditions,treatment invasiveness and quality of life.

  20. Value of portal venous system radiological indices in predicting esophageal varices

    Directory of Open Access Journals (Sweden)

    Gaduputi V

    2015-02-01

    Full Text Available Vinaya Gaduputi,1 Harish Patel,1 Sailaja Sakam,1 Srivani Neshangi,1 Rafeeq Ahmed,1 Michael Lombino,2 Sridhar Chilimuri11Department of Medicine, 2Department of Radiology, Bronx Lebanon Hospital Center New York, NY, USAIntroduction: Portal hypertension results from increased resistance to portal blood flow and has the potential complications of variceal bleeding and ascites. The splenoportal veins increase in caliber with worsening portal hypertension, and partially decompress by opening a shunt with systemic circulation, ie, a varix. In the event of portosystemic shunting, there is a differential decompression across the portal vein and splenic vein (portal vein > splenic vein, with a resultant decrease in the ratio of portal vein diameter to that of splenic vein. Portal vein to splenic vein diameter ratio and gradient could be valuable tools in predicting the presence of portosystemic shunting.Methods: We retrospectively reviewed patients with cirrhosis who underwent esophagogastroduodenoscopy (EGD for variceal screening and had a computerized tomogram (CT of the abdomen within 6 months of the index endoscopic study, between January 2009 and December 2013. Patients on nonselective beta blockers, patients with presinusoidal portal hypertension (portal vein thrombosis or extrinsic compression, and patients who had undergone portosystemic shunting procedures (transjugular intrahepatic portosystemic shunt [TIPS] or balloon-occluded retrograde transvenous obliteration (BRTO were excluded from the study. Splenic and portal vein diameters were measured (in mm just proximal and distal to the splenomesenteric venous confluence, respectively.Results: A total of 164 patients were included in the study; of these, 60% (n=98 were male and 40% (n=66 were female. The mean age of the study population was 58.7 years. A total of 126 patients (77% had varices, while 38 patients (33% did not. The mean Model for End-Stage Liver Disease (MELD score was 5.9 for those

  1. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism.

    Science.gov (United States)

    Kiani, Mohammad Ali; Forouzan, Arash; Masoumi, Kambiz; Mazdaee, Behnaz; Bahadoram, Mohammad; Kianifar, Hamid Reza; Ravari, Hassan

    2015-01-01

    We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT) scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  2. Isolated Splenic Vein Thrombosis: 8-Year-Old Boy with Massive Upper Gastrointestinal Bleeding and Hypersplenism

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Kiani

    2015-01-01

    Full Text Available We present an 8-year-old boy who was referred to our center with the complaint of upper gastrointestinal bleeding and was diagnosed with hypersplenism and progressive esophageal varices. Performing a computerized tomography (CT scan, we discovered a suspicious finding in the venography phase in favor of thrombosis in the splenic vein. Once complementary examinations were done and due to recurrent bleeding and band ligation failure, the patient underwent splenectomy. And during the one-year follow-up obvious improvement of the esophageal varices was observed in endoscopy.

  3. Thrombocytopenia in Patients with Gastric Varices and the Effect of Balloon-occluded Retrograde Transvenous Obliteration on the Platelet Count

    Directory of Open Access Journals (Sweden)

    W E Saad

    2014-01-01

    Full Text Available Objectives: Gastric varices primarily occur in cirrhotic patients with portal hypertension and splenomegaly and thus are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Moreover, one-third of patients after balloon-occluded retrograde transvenous obliteration (BRTO have aggravated splenomegaly, which potentially may cause worsening thrombocytopenia. The aim of the study is to determine the prevalence and degree of thrombocytopenia in patients with gastric varices associated with gastrorenal shunts undergoing BRTO, to determine the prognostic factors of survival after BRTO (platelet count included, and to assess the effect of BRTO on platelet count over a 1-year period. Materials and Methods: This is a retrospective review of 35 patients who underwent BRTO (March 2008-August 2011. Pre- and post-BRTO platelet counts were noted. Potential predictors of bleeding and survival (age, gender, liver disease etiology, platelet count, model for end stage liver disease [MELD]-score, presence of ascites or hepatocellular carcinoma were analyzed (multivariate analysis. A total of 91% (n = 32/35 of patients had thrombocytopenia (90% of patients in patients undergoing BRTO. However, BRTO (with occlusion of the gastrorenal shunt has little effect on the platelet count. Long-term outcomes of BRTO for bleeding gastric varices using sodium tetradecyl sulfate in the USA are impressive with a 4-year variceal rebleed rate and transplant-free survival rate of 9% and 76%, respectively. Platelet count is not a predictor of higher rebleeding or patient survival after BRTO.

  4. Gastro-oesophageal Reflux Disease: An Update

    Directory of Open Access Journals (Sweden)

    T Murphy

    2015-09-01

    Full Text Available Gastro-oesophageal reflux disease (GERD is a disorder in which reflux of stomach contents causes troublesome symptoms and/or complications and which affects health-related quality of life. It is one of the commonest disorders and appears to be increasing in incidence. The mechanisms leading to reflux are complex and multifactorial. The lower oesophageal sphincter (LES is an important part of the gastro-oesophageal barrier. Transient LES relaxations (TLESRs lead to reflux as these vagally mediated motor patterns cause relaxation of the LES and also result in oesophageal shortening and inhibition of the crural diaphragm. Heartburn and regurgitation are the characteristic symptoms of GERD. A clinical diagnosis of GERD can be made with typical symptoms. Oesophagitis is seen in a minority of patients with GERD. Lifestyle modification is widely advocated for patients with GERD. For short-term relief of symptoms of mild GERD, antacids/alginates are frequently used but they do not heal oesophagitis. Both histamine 2 receptor antagonists (H2RA and proton pump inhibitors (PPI have been shown to heal and prevent relapse of oesophagitis, although PPIs have been shown to be superior. The PPIs are the recommended first-line therapy for erosive oesophagitis and initial management of non-erosive reflux disease. Maintenance PPI therapy should be given to patients with oesophagitis, those who have recurrence of symptoms after discontinuation of medication and for those with complications of GERD.

  5. Predictors of esophageal varices in patients with HBV-related cirrhosis: a retrospective study

    Directory of Open Access Journals (Sweden)

    Jiang Zen-cai

    2009-02-01

    Full Text Available Abstract Background All patients with liver cirrhosis are recommended to undergo an evaluation of esophageal varices (EV to assess their risk of bleeding. Predicting the presence of EV through non-invasive means may reduce a large number of unnecessary endoscopies. This study was designed to develop a predictive model for varices in patients with Hepatitis B virus-related cirrhosis. Methods The retrospective analysis was performed in 146 patients with Hepatitis B virus-related cirrhosis. The data were assessed by univariate analysis and a multivariate logistic regression analysis. In addition, the receiver operating characteristic curves were also applied to calculate and compare the accuracy of the model and other single parameters for the diagnosis of esophageal varices. Results We found the prevalence of EV in patients with Hepatitis B virus-related cirrhosis to be 74.7%. In addition, platelet count, spleen width, portal vein diameter and platelet count/spleen width ratio were significantly associated with the presence of esophageal varices on univariate analysis. A multivariate analysis revealed that only the spleen width and portal vein diameter were independent risk factors. The area under the receiver operating characteristic curve of regression function (RF model, which was composed of the spleen width and portal vein diameter, was higher than that of the platelet count. With a cut-off value of 0.3631, the RF model had an excellent sensitivity of 87.2% and an acceptable specificity of 59.5% with an overall accuracy of 80.1%. Conclusion Our data suggest that portal vein diameter and spleen width rather than platelet count may predict the presence of varices in patients with Hepatitis B virus-related cirrhosis, and that the RF model may help physicians to identify patients who would most likely benefit from screenings for EV.

  6. Long-term result of endoscopic Histoacryl(r) (N-butyl-2-cyanoacrylate) injection for treatment of gastric varices

    Institute of Scientific and Technical Information of China (English)

    Eun Jung Kang; Young Deok Cho; Hong Soo Kim; Boo Sung Kim; Soung Won Jeong; Jae Young Jang; Joo Young Cho; Sae Hwan Lee; Hyun Gun Kim; Sang Gyune Kim; Young Seok Kim; Young Koog Cheon

    2011-01-01

    AIM: To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl(R) for treatment of gastric variceal bleeding and prophylaxis. METHODS: Between January 1994 and March 2010 at SoonChunHyang University Hospital, a total of 127 patients with gastric varices received Histoacryl(R) injections endoscopically. One hundred patients underwent endoscopic Histoacryl(R) injections because of variceal bleeding, the other 27 patients received such injections as a prophylactic procedure. RESULTS: According to Sarin classification, 56 patients were GOV1, 61 patients were GOV2 and 10 patients were IGV. Most of the varices were large (F2 or F3, 111 patients). The average volume of Histoacryl(R) per each session was 1.7 ± 1.3 cc and mean number of sessions was 1.3 ± 0.6. (1 session-98 patients, 2 sessions-25 patients, ≥ 3 sessions-4 patients). Twenty-seven patients with high risk of bleeding (large or fundal or RCS+ or Child C) received Histoacryl(R) injection as a primary prophylactic procedure. In these patients, hepatitis B virus was the major etiology of cirrhosis, 25 patients showed GOV1 or 2 (92.6%) and F2 or F3 accounted for 88.9% (n = 24).The rate of initial hemostasis was 98.4% and recurrent bleeding within one year occurred in 18.1% of patients.Successful hemostasis during episodes of rebleeding was achieved in 73.9% of cases. Median survival was 50 mo (95% CI 30.5-69.5). Major complications occurred in 4patients (3.1%). The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other conditions. None of the 27 subjects who were treated prophylactically experienced treatment-related complications. Cumulative survival rates of the 127 patients at 6 mo, 1, 3, and 5 years were 92.1%, 84.2%,64.2%, and 45.3%, respectively. The 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.CONCLUSION: Histoacryl(R) injection therapy is an effective treatment for gastric varices and also

  7. Diagnosis and management of upper gastrointestinal bleeding in children.

    Science.gov (United States)

    Owensby, Susan; Taylor, Kellee; Wilkins, Thad

    2015-01-01

    Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable.

  8. Does catastrophic thinking enhance oesophageal pain sensitivity?

    DEFF Research Database (Denmark)

    Martel, M O; Olesen, A E; Jørgensen, D;

    2016-01-01

    that catastrophic thinking exerts an influence on oesophageal pain sensitivity, but not necessarily on the magnitude of acid-induced oesophageal sensitization. WHAT DOES THIS STUDY ADD?: Catastrophizing is associated with heightened pain sensitivity in the oesophagus. This was substantiated by assessing responses...

  9. Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease

    Directory of Open Access Journals (Sweden)

    Danielle Queiroz Bonilha

    2011-12-01

    Full Text Available CONTEXT: Band ligation (BL is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. OBJECTIVES: To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. METHODS: A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20 and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18. Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20. Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. RESULTS: After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 % positive cultures were found out of the 65 sessions of band ligation (P = 0.187. Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. CONCLUSIONS: There was no significant difference in bacteremia rate between these three groups. BL or CY

  10. Splenectomy with endoscopic variceal ligation is superior to splenectomy with pericardial devascularization in treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Nan Lin; Bo Liu; Rui-Yun Xu; He-Ping Fang; Mei-Hai Deng

    2006-01-01

    AIM: To investigate the therapeutic efficacy and complications of splenectomy with endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization (i.e. Hassab's operation) in patients with portal hypertension.METHODS: A total of 103 patients with liver cirrhosis and portal hypertension were randomly selected to receive either splenectomy with EVL (n = 53, group A) or Hassab's operation (n = 50, group B).RESULTS: The portal blood flow volume, the presence of portal vein thrombosis, gastric emptying time and free portal venous pressure (FPP) before and after the operation were determined. Patients were followed up for up to 64 mo with an average of 45 mo, and the Dagradi classification of variceal veins and the grading of portal hypertension gastropathy (PHG) were evaluated.It was found that all esophageal varices were occluded or decreased to grade Ⅱ or less in both groups. There was little difference in the recurrence rate of esophageal varices (11.9% vs13.2%) and the re-bleeding rate (7.1% vs 5.3%) between groups A and B. The incidence of complications and the percentage of patients with severe PHG after the operation were significantly higher in group B (60.0% and 52.0%) than in group A (32.1%and 20.8%, P < 0.05). No patients died of operationrelated complications. There was no significant difference in gastric emptying time, FPP and portal blood flow volume between the two groups.CONCLUSION: The results suggest that splenectomy with EVL achieves similar therapeutic efficacy to that of Hassab's operation interms of the recurrence rate of esophageal varices and the re-bleeding rate, but the former results in fewer and milder complications.

  11. Uncommon, undeclared oesophageal foreign bodies.

    Science.gov (United States)

    Akenroye, M I; Osukoya, A T

    2012-01-01

    We report two cases of unusual and undeclared oesophageal foreign bodies. A small double-rounded calabash or bottle gourd Lagenaria siceraria, stuffed with traditional medicine designed to acquire spiritual power. A whole tricotyledonous kola nut Cola nitida also designed to make medicine to gain love from a woman after passing it out in stool. Each case presented with a sudden onset of total dysphagia and history of ingestion of foreign bodies was not volunteered by any despite direct questioning. Plain radiograph of the neck and chest in either case did not reveal presence of foreign body. Both were successfully removed through rigid oesophagoscopy.

  12. Putting oesophageal cancer on the RACK A study of the RACK1 scaffolding protein in oesophageal adenocarcinoma

    OpenAIRE

    2015-01-01

    Purpose There is a need to identify new therapeutic targets for oesophageal adenocarcinoma. Deoxycholic acid is a component of gastro-oesophageal refluxate and is believed to promote oesophageal adenocarcinoma. RACK1 is an intracellular scaffolding protein whose expression is altered in many cancers. The role of RACK1 in oesophageal adenocarcinoma has not been investigated. The purpose of this study is to examine the expression of RACK1 in oesophageal adenocarcinoma and to a...

  13. Factors affecting hospital mortality in acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Alam Mohammed

    2000-01-01

    Full Text Available This retrospective analysis studied the records of 564 consecutive patients admitted to Gastrointestinal Bleeding Unit of Riyadh Medical Complex with acute upper gastrointestinal bleeding over a 2-year period (May 1996-April 1998. The purpose of the study was to analyze the mortality with an aim to identify the risk factors affecting mortality in these patients. Majority of patients were men (82% and Saudis (54%. Their mean age was 52.46 + 17.8 years. Esophageal varices (45% were the main causes of bleeding followed by duodenal ulcers (24%. Overall mortality in this series was 15.8% (89 patients. Comorbid diseases were responsible for death in 68 (76% patients, whereas, bleeding was considered to be directly responsible for death in 21 (24% patients. On analysis of data from this study, old age (>60 years, systolic pressure < 90 mm Hg on admission, comorbid disease, variceal bleeding and Child′s grade C in patients with chronic liver disease were associated with adverse outcome.

  14. Strategies for the prevention of oesophageal adenocarcinoma.

    Science.gov (United States)

    Almond, L Max; Old, Oliver; Barr, Hugh

    2014-01-01

    The incidence of oesophageal adenocarcinoma has increased by 500% over the past 30 years [1]. Improved understanding of the mechanisms of neoplastic progression provides an opportunity to reverse this trend. A thorough review of emerging strategies aiming to prevent the formation of oesophageal malignancy is presented. These include dietary modification, chemoprevention, early endoscopic identification and treatment of premalignant disease, and the potential for a non-endoscopic screening test. Oesophageal adenocarcinoma has become a major public health problem in the West and it is essential that clinicians are fully informed of risk reduction strategies so that they can be actively promoted in the community.

  15. Modern issues on the treatment of peptic ulcer bleedings

    Directory of Open Access Journals (Sweden)

    Potakhin S.N.

    2014-03-01

    Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

  16. Traumatic oesophageal perforation due to haematoma

    DEFF Research Database (Denmark)

    Grønhøj Larsen, Christian; Brandt, Bodil

    2014-01-01

    INTRODUCTION: Traumatic oesophageal perforation is a rare, life-threatening emergency that requires early recognition and prompt surgical management. PRESENTATION OF CASE: We present an unusual case of a patient on warfarin treatment developed an intramural oesophageal haematoma following blunt......; or the intramural hematoma gradually lysed and causing late perforation. CONCLUSION: Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain....... thoracic trauma leading to perforation on the 18th day. DISCUSSION: In treatment of oesophageal haematoma in patients on vitamin-K antagonists, strict control of the International Normalized Ratio (INR) is essential along with total parenteral nutrition therapy and refrainment through nasogastric tubes...

  17. Congenital oesophageal hiatal hernia in a pug

    OpenAIRE

    Keeley B; Puggioni A; Pratschke K

    2008-01-01

    Abstract Congenital sliding, oesophageal or type I hiatal hernia was diagnosed in a five-month-old pug puppy presented for evaluation of dyspnoea post feeding. The diagnosis was confirmed using plain film radiography. Surgical reduction of the hernia followed by plication of the oesophageal hiatus, oesophagopexy and left flank gastropexy permitted restoration of normal function. At 12 months of age, the dog was asymptomatic. This article describes the diagnosis and treatment of a congenital t...

  18. Vascular plug-assisted retrograde transvenous obliteration for the management of gastric varices: Comparative effectiveness between gelatin sponge embolization and permanent sclerosant

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Jo, Jeong Hyun; Park, Jae Hyung; Park, Byeong Ho [Dept. of Radiology, Dong A University Hospital, Dong A University College of Medicine, Busan (Korea, Republic of); Jung, Gyoo Sik [Dept. of Radiology, Gospel Hospital, Kosin University College of Medicine, Busan (Korea, Republic of)

    2016-08-15

    To evaluate the short-term outcome of plug-assisted retrograde transvenous obliteration (PARTO) using vascular plugs and gelatin sponges in comparison with balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. From January 2005 to October 2014, 171 patients were referred for management of gastric varices, of which, 52 patients with hemodynamically stable gastric varices (48 recent bleeding; 4 primary prophylaxes) were evaluated. Of these, 38 received BRTO (men/women 23/15; mean age 61.3; Child-Pugh classes A/B/C = 11/25/2) and 14 underwent PARTO (men/women 11/3; mean age 63.4; Child-Pugh classes A/B/C = 9/4/1). The technical success rate, complications, variceal changes, liver function, and exacerbation of ascites/pleural effusion were compared between the 2 groups within 3 months after the procedure. The technical success rates were 92.1% in the BRTO and 100% in the PARTO group. Procedure-related early complications occurred in the BRTO group alone (8%, n = 3). Among patients with technical success, follow-up CT at 1 month was available for 98% (n = 48/49). Complete thrombosis of gastric varices was achieved in 97.1% in the BRTO and 100% in the PARTO group. Worsening of esophageal varices was observed in 24% of the BRTO group alone (n = 8). The albumin level increased significantly in both groups and aspartate aminotransferase/alanine aminotransferase level improved significantly in the PARTO group (p < 0.05). Exacerbation of ascites/pleural effusion was observed in both groups (35.2% vs. 21.4%, both p > 0.05). PARTO appears to be equivalent to BRTO for short-term management of gastric varices.

  19. Evaluation of magnetic resonance angiography in detection of gastric varices

    Energy Technology Data Exchange (ETDEWEB)

    Sato, Takahiro; Yamazaki, Katsu; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi; Suga, Toshihiro [Sapporo Kosei General Hospital (Japan)

    1999-06-01

    We evaluated the detection of gastric varices, inflowing blood vessels to gastric varices, and outflowing blood vessels from gastric varices via magnetic resonance (MR) angiography in 31 patients with gastric varices. Twenty-four patients had F{sub 2} type varices and 7 had F{sub 3} type, classified according to the Japanese Research Society for Portal Hypertension. Seventeen patients had cardiofornical varices, and 14 had fundal varices. All patients were examined with an MR system operating at 1.5 T. MR angiography was performed using the two-dimensional time-of-flight method. With MR angiography, the imaging of gastric varices was clearly delineated in 28 of the 31 patients (90.3%). From the images of MR angiography, flow direction itself cannot be determined. The outflowing blood vessels of gastric varices were reported to be the gastro-renal shunt and the subphrenic vein, and angiographic findings have shown the inflowing blood vessels to be the left gastric vein (LGV), the short gastric vein (SGV), and the posterior gastric vein (PGV). In 25 of the 31 patients (80.7%), the outflowing blood vessels from gastric varices were detected (gastro-renal shunt in 24; subphrenic vein in 1). MR angiography provided clear images of the inflowing blood vessels to gastric varices in 18 of the 31 patients (58.1%). These inflowing vessels were categorized as SGV in 7 patients, LGV in 5, LGV and SGV in 4, and LGV and PGV in 2. We suggest that MR angiography be used as a routine method for detecting and diagnosing collateral veins in patients with gastric varices. (author)

  20. Esophageal varices before and after endoscopic variceal ligation: evaluation using helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, T.; Namba, R.; Matsuoka, T.; Tabuchi, K.; Yamamoto, K.; Uesugi, Y.; Matsui, R.; Sueyoshi, K.; Narabayashi, I. [Dept. of Radiology, Osaka Medical College (Japan)

    1999-10-01

    The purpose of this study was to demonstrate the utility of helical CT in assessing the therapeutic effects of endoscopic variceal ligation (EVL). Twenty-four patients with esophageal varices were examined. Helical scanning was initiated 60 s after intravenous injection (Iopamidol 300 mgI/ml, total 120 ml, 3 ml/s) was started. Esophageal varices were clearly depicted as high-density areas. Multiplanar reformation and 3D images demonstrated collateral circulation three-dimensionally. After EVL, mucosal high-density areas had diminished markedly, but collateral veins around the esophagus, and gastro- and/or spleno-renal shunts, were unchanged in all patients. Of 21 patients with collateral circulation, esophageal varices recurred endoscopically in 6 patients within 12 months. In 3 patients without collateral circulation, esophageal varices did not recur within 12 months. From these findings, we conclude that helical CT is a useful method for assessing the therapeutic effects of EVL. (orig.) With 3 figs., 1 tab., 14 refs.

  1. Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population.

    Science.gov (United States)

    Lee, Yeong Yeh; Noridah, Nordin; Syed Hassan, Syed Abdul Aziz; Menon, Jayaram

    2014-01-01

    Aim. Helicobacter pylori (H. pylori) infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI) bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years). In-hospital mortality (3.6%), recurrent bleeding (9.6%) and need for surgery (4.0%) were uncommon in this population with a largely low risk score (85.2% with score ≤5). Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01) especially in the presence of duodenal ulcers (P = 0.04) despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

  2. Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

    Directory of Open Access Journals (Sweden)

    Yeong Yeh Lee

    2014-02-01

    Full Text Available Aim. Helicobacter pylori (H. pylori infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years. In-hospital mortality (3.6%, recurrent bleeding (9.6% and need for surgery (4.0% were uncommon in this population with a largely low risk score (85.2% with score ≤5. Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01 especially in the presence of duodenal ulcers (P = 0.04 despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

  3. The epidemic of oesophageal carcinoma: Where are we now?

    Science.gov (United States)

    Thrift, Aaron P

    2016-04-01

    Since the early 1970s, the incidence of oesophageal adenocarcinoma has increased dramatically in most Western populations. In contrast, the incidence of oesophageal squamous-cell carcinoma has decreased in these same populations. Epidemiological studies conducted over the past decade have provided great insights into the etiology of oesophageal cancer. These studies have identified gastro-oesophageal reflux disease, obesity and cigarette smoking as risk factors for oesophageal adenocarcinoma, while use of nonsteroidal anti-inflammatory drugs and infection with Helicobacter pylori are associated with reduced risk of oesophageal adenocarcinoma. For oesophageal squamous-cell carcinoma, alcohol and cigarette smoking are the two major risk factors underlying most cases. This review combines a synthesis of these studies with an analysis of data from the United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program to discuss the change in incidence of oesophageal cancer and summarize current knowledge of risk factors.

  4. Does adding variceal status to the Child–Turcotte–Pugh score improve its performance in predicting mortality in cirrhosis?

    Science.gov (United States)

    Fan, Xiaoli; Wen, Maoyao; Shen, Yi; Wang, Wanqin; Yang, Xiaoxue; Yang, Li

    2016-01-01

    Abstract The Child–Turcotte–Pugh (CTP) score is widely used worldwide to predict outcomes across a broad spectrum of liver diseases, mainly cirrhosis. Portal hypertension and variceal bleed are significant causes of morbidity and mortality in cirrhotic patients, although the variceal status is not incorporated into the classical CTP score. We sought to determine whether the inclusion of variceal status, specifically the Child–Turcotte–Pugh–Kumar (CTPK) score, would improve the utility of the classical CTP score to predict the clinical outcomes of cirrhotic patients in a single but high-volume center in China. We retrospectively analyzed the records of 253 patients from January 1, 2014 to December 31, 2014 and performed follow-up for at least 12 months. The CTPK score and the CTP score were obtained as soon as possible after the patient's admission. Telephone follow-up was performed to assess survival situations. At 3 and 12 months, the cumulative number of deaths was 9.1% (n = 23) and 13.8% (n = 35), respectively. In the multivariate Cox proportional hazards models, the CTPK score was independently associated with death within 3 and 12 months after adjusting for potential confounders. The predictive ability related to the 2 scores was evaluated by the area under the receiver operating characteristic curve (AUC-ROC) respectively. At 3 months of enrollment, the AUCs of CTPK and CTP were 0.814 and 0.838, respectively. At 12 months of enrollment, the AUCs of CTPK and CTP were 0.825 and 0.840, respectively. No significant difference between time points was observed. Both the CTPK score and the CTP score displayed prognostic value in cirrhotic patients, as the Kaplan–Meier analysis showed that the CTPK score could clearly discriminate patients in the intermediate term (P < 0.001). The CTPK score provides reliable prediction of mortality in Chinese cirrhotic patients for both short-term and medium-term prognoses, although it is not superior to the CTP

  5. Does adding variceal status to the Child-Turcotte-Pugh score improve its performance in predicting mortality in cirrhosis?

    Science.gov (United States)

    Fan, Xiaoli; Wen, Maoyao; Shen, Yi; Wang, Wanqin; Yang, Xiaoxue; Yang, Li

    2016-09-01

    The Child-Turcotte-Pugh (CTP) score is widely used worldwide to predict outcomes across a broad spectrum of liver diseases, mainly cirrhosis. Portal hypertension and variceal bleed are significant causes of morbidity and mortality in cirrhotic patients, although the variceal status is not incorporated into the classical CTP score. We sought to determine whether the inclusion of variceal status, specifically the Child-Turcotte-Pugh-Kumar (CTPK) score, would improve the utility of the classical CTP score to predict the clinical outcomes of cirrhotic patients in a single but high-volume center in China.We retrospectively analyzed the records of 253 patients from January 1, 2014 to December 31, 2014 and performed follow-up for at least 12 months. The CTPK score and the CTP score were obtained as soon as possible after the patient's admission. Telephone follow-up was performed to assess survival situations.At 3 and 12 months, the cumulative number of deaths was 9.1% (n = 23) and 13.8% (n = 35), respectively. In the multivariate Cox proportional hazards models, the CTPK score was independently associated with death within 3 and 12 months after adjusting for potential confounders. The predictive ability related to the 2 scores was evaluated by the area under the receiver operating characteristic curve (AUC-ROC) respectively. At 3 months of enrollment, the AUCs of CTPK and CTP were 0.814 and 0.838, respectively. At 12 months of enrollment, the AUCs of CTPK and CTP were 0.825 and 0.840, respectively. No significant difference between time points was observed. Both the CTPK score and the CTP score displayed prognostic value in cirrhotic patients, as the Kaplan-Meier analysis showed that the CTPK score could clearly discriminate patients in the intermediate term (P < 0.001).The CTPK score provides reliable prediction of mortality in Chinese cirrhotic patients for both short-term and medium-term prognoses, although it is not superior to the CTP score. Therefore, the CTP

  6. Renal varices. Diagnosis with CT scan and treatment with embolization; Varices renales. Deagnostic tomodensitometrique et traitement par embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Lenoir, S.; Strauss, Ch.; Fontanelle, L.; Bouzar, N.; Veillon, B.; Vallancien, G.; Palou, R. [Institut Mutualiste Montsouris, 75 - Paris (France)

    1997-09-01

    Two cases of recurrent macroscopic Hematuria in which the diagnosis of left renal vein varices was suggested on CT are described. Bloody efflux was seen from the left ureteric orifice. On CT scans, tubulated contrast-enhanced densities in left perirenal fat were seen. Selective renal angiography was normal. Selective left renal phlebography demonstrated intra and perirenal varices. In the two cases, embolization with metallic coil was successfully performed during left renal phlebography, to stop renal varices flux. Diagnostic and therapeutic modalities of renal varices are discussed with predominant place for CT and phlebography. (authors). 13 refs.

  7. Morphometric evaluation of oesophageal wall in patients with nutcracker oesophagus and ineffective oesophageal motility.

    Science.gov (United States)

    Kim, H S; Park, H; Lim, J H; Choi, S H; Park, C; Lee, S I; Conklin, J L

    2008-08-01

    The pathogenesis of nutcracker oesophagus (NE) and ineffective oesophageal motility (IEM) is unclear. Damage to the enteric nervous system or smooth muscle can cause oesophageal dysmotility. We tested the hypothesis that NE and IEM are associated with abnormal muscular or neural constituents of the oesophageal wall. Oesophageal manometry was performed in patients prior to total gastrectomy for gastric cancer. The oesophageal manometries were categorized as normal (n = 7), NE (n = 13), or IEM (n = 5). Histologic examination of oesophageal tissue obtained during surgery was performed after haematoxylin and eosin (H&E) and trichrome staining. Oesophageal innervation was examined after immunostaining for protein gene product-9.5 (PGP-9.5), choline acetyltransferase (ChAT) and neuronal nitric oxide synthase (nNOS). There were no significant differences in inner circular smooth muscle thickness or degree of fibrosis among the three groups. Severe muscle fibre loss was found in four of five patients with IEM. The density of PGP-9.5-reactive neural structures was not different among the three groups. The density of ChAT immunostaining in the myenteric plexus (MP) was significantly greater in patients with NE (P myenteric neurones are seen in NE. Myopathy and/or increased number of nNOS neurones may contribute to the hypocontractile motor activity of IEM.

  8. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Zhi-yu LI; Bin LI; Yu-lian WU; Qiu-ping XIE

    2013-01-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal (GI) bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article.The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography.After embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe complications.In conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  9. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review.

    Science.gov (United States)

    Li, Zhi-yu; Li, Bin; Wu, Yu-lian; Xie, Qiu-ping

    2013-06-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  10. Oesophageal adenocarcinoma: the new epidemic in men?

    Science.gov (United States)

    Rutegård, Martin; Lagergren, Pernilla; Nordenstedt, Helena; Lagergren, Jesper

    2011-07-01

    The last decades have witnessed an unprecedented rise in the incidence of oesophageal adenocarcinoma. This rise has mainly affected men, and current male-to-female sex ratio estimates range from 7-10 to 1. Major risk factors for oesophageal adenocarcinoma are gastro-oesophageal reflux disease and obesity, especially in combination. The prevalence of these risk factors has increased during the last decades, but there does not seem to be a marked differential distribution among men and women. However, reflux among men is more often associated with erosive reflux disease than it is among women. There is also evidence that male-type obesity, with a prominent abdominal distribution of fat, confers a greater risk increase for oesophageal adenocarcinoma than the female equivalent. Due to the marked male predominance and the finding that women tend to develop specialized intestinal metaplasia (Barrett's oesophagus) and adenocarcinoma at a later age than men, interest has been directed towards a potential aetiological role of reproductive factors and sex hormones. Breastfeeding has been found to be a protective factor for the development of adenocarcinoma, while no association has hitherto been established with other reproductive factors. Taken together, the male predominance in the incidence of oesophageal adenocarcinoma may partly be explained by the differential effect of the major risk factors reflux disease and obesity, but the mechanisms whereby this occurs need to be elucidated. Moreover, the association with breastfeeding indicates a need for extensive epidemiological studies to clarify a possible role of sex hormonal influence in the aetiology of oesophageal adenocarcinoma.

  11. Menorrhagia (Heavy Menstrual Bleeding)

    Science.gov (United States)

    Diseases and Conditions Menorrhagia (heavy menstrual bleeding) By Mayo Clinic Staff Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy ...

  12. [Why oesophageal adenocarcinoma is occurring more frequently].

    Science.gov (United States)

    Doorakkers, Eva; Brusselaers, Nele

    2015-01-01

    The incidence of oesophageal adenocarcinoma has increased rapidly over the past decades in the Western world. The prognosis is poor with a mean 5-year survival rate of 19% in the Netherlands. Important risk factors that might account for this rising incidence are reflux, obesity and the absence of Helicobacter pylori. Oesophageal adenocarcinoma is 9 times more likely in men than in women. The reason for this much higher incidence of adenocarcinoma in men is still unclear, but sex hormones may play a role.

  13. Therapeutic consequences of oesophageal function studies in patients with benign oesophageal disease

    DEFF Research Database (Denmark)

    Jakobsen, Erik; Kruse-Andersen, S; Wallin, Lene

    1988-01-01

    . In all cases where an anatomical diagnosis was replaced by a diagnosis of disordered function, the treatment was in accordance with the findings of the motility studies. None of the patients with oesophageal spasm were suspected of having this disease. It is concluded, that not only anatomical features......Evaluation of oesophageal function was performed in 91 patients referred to a specialized department of cardiothoracic surgery for surgical treatment of benign oesophageal disease. Standard manometry was used in addition to radiology and endoscopy, and in some patients, an acid perfusion test......, an acid clearing test, and a prolonged monitoring of pH in the distal oesophagus were additionally performed. The aim of this study was to evaluate whether assessment of oesophageal function is needed in such a patient group, and whether the results of these investigations were taken into account when...

  14. Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

    Energy Technology Data Exchange (ETDEWEB)

    Kodama, Hideaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Aikata, Hiroshi, E-mail: aikata@hiroshima-u.ac.jp [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Takaki, Shintaro; Azakami, Takahiro; Katamura, Yoshio; Kawaoka, Tomokazu; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Takahashi, Shoichi [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Toyota, Naoyuki; Ito, Katsuhide [Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Chayama, Kazuaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan)

    2010-11-15

    Objective: To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment. Methods: Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates. Results: The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435). Conclusion: Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.

  15. Radiologic diagnosis of gastro-oesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, S.G.; Soekjer, H.; Johansson, K.E.; Tibbling, L.

    In 149 patients, a standardized radiologic method for the detection of gastro-oesophageal reflux was applied and compared with the results obtained at endoscopy and by a manometric reflux test. Radiologic reflux was recorded in 53 patients, of whom 25 had reflux without abdominal compression and 51 with compression. At least one of the other two types of examination disclosed pathologic conditions in all but 2 of 53 patients. Oesophagitis was significantly more severe among the patients with reflux observed at radiography. The presence of hiatal incompetence with reflux only to the hiatal hernia but not to the oesophagus was not a strong indicator of gastro-oesophageal reflux disease. Hiatal hernia was present in a significantly larger number of the patients with reflux at radiography than in those without reflux. Increased width of the hiatus gave stronger evidence for reflux disease than in patients with a normal hiatus. Thus, the width of the hiatus also had a bearing on the diagnosis of gastro-oesophageal reflux disease.

  16. Epidemiology and risk factors for oesophageal adenocarcinoma.

    Science.gov (United States)

    Lepage, Côme; Drouillard, Antoine; Jouve, Jean-Louis; Faivre, Jean

    2013-08-01

    Oesophageal adenocarcinoma will soon cease to be a rare form of cancer for people born after 1940. In many Western countries, its incidence has increased more rapidly than other digestive cancers. Incidence started increasing in the Seventies in England and USA, 15 years later in Western Europe and Australia. The cumulative risk between the ages of 15 and 74 is particularly striking in the UK, with a tenfold increase in men and fivefold increase in women in little more than a single generation. Prognosis is poor with a 5-year relative survival rate of less than 10%. The main known risk factors are gastro-oesophageal reflux, obesity (predominantly mediated by intra-abdominal adipose tissues) and smoking. Barrett's oesophagus is a precancerous lesion, however, the risk of degeneration has been overestimated. In population-based studies the annual risk of adenocarcinoma varied between 0.12% and 0.14% and its incidence between 1.2 and 1.4 per 1000 person-years. Only 5% of subjects with Barrett's oesophagus die of oesophageal adenocarcinoma. On the basis of recent epidemiological data, new surveillance strategies should be developed. The purpose of this review is to focus on the epidemiology and risk factors of oesophageal adenocarcinoma.

  17. Therapeutic effects of endoscopic variceal ligation combined with partial splenic embolization for portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Rui-Yun Xu; Bo Liu; Nan Lin

    2004-01-01

    AIM: To evaluate the feasibility of a new strategy of endoscopic variceal ligation combined with partial splenic embolization (EVL-PSE) for patients with cirrhosis and portal hypertension.METHODS: From May 1999 to May 2002, 41 cases with cirrhosis and portal hypertension underwent EVL-PSE.Hemodynamics of the main portal vein (MPV), the left gastric vein (LGV) and azygos vein, including maximum velocity,flow rate and vein diameter, were assessed by Doppler ultrasonography.RESULTS: One case died from pulmonary artery embolism.One case complicated with splenic abscess was successfully managed by laparotomy. The esophageal varices and hypersplenism were well controlled after EVL-PSE in other patients. After EVL-PSE, the flow rate and velocity of MPV was significantly reduced (P<0.05), as well as the flow rate of the LGV and azygos vein. During the follow-up, no recurrent bleeding was found.CONCLUSION: Being more convenient and less invasive,EVL-PSE is hopeful to be a proper intervention strategy for portal hypertensive patients with impaired hepatic function or those intolerant to shunting or devascularization surgery.

  18. Association of visceral adiposity with oesophageal and junctional adenocarcinomas.

    LENUS (Irish Health Repository)

    Beddy, P

    2012-02-01

    BACKGROUND: Obesity is associated with an increased incidence of oesophageal and oesophagogastric junction adenocarcinoma, in particular Siewert types I and II. This study compared abdominal fat composition in patients with oesophageal\\/junctional adenocarcinoma with that in patients with oesophageal squamous cell carcinoma and gastric adenocarcinoma, and in controls. METHOD: In total, 194 patients (110 with oesophageal\\/junctional adenocarcinoma, 38 with gastric adenocarcinoma and 46 with oesophageal squamous cell carcinoma) and 90 matched control subjects were recruited. The abdominal fat area was assessed using computed tomography (CT), and the total fat area (TFA), visceral fat area (VFA) and subcutaneous fat area (SFA) were calculated. RESULTS: Patients with oesophageal\\/junctional adenocarcinoma had significantly higher TFA and VFA values compared with controls (both P < 0.001), patients with gastric adenocarcinoma (P = 0.013 and P = 0.006 respectively) and patients with oesophageal squamous cell carcinoma (both P < 0.001). For junctional tumours, the highest TFA and VFA values were seen in patients with Siewert type I tumours (respectively P = 0.041 and P = 0.033 versus type III; P = 0.332 and P = 0.152 versus type II). CONCLUSION: Patients with oesophageal\\/junctional adenocarcinoma, in particular oesophageal and Siewert type I junctional tumours, have greater CT-defined visceral adiposity than patients with gastric adenocarcinoma or oesophageal squamous cell carcinoma, or controls.

  19. Peptic oesophageal stricture in children: Management problems

    Directory of Open Access Journals (Sweden)

    Mohamed Zouari

    2014-01-01

    Full Text Available Background: Peptic oesophageal stricture (PES is a serious complication of gastroesophageal reflux disease (GERD in childhood. The treatment of PES is still controversial, ranging from simple oesophageal dilations to resection/anastomosis of the stenotic portion of the oesophagus. In this study, we want to share our experience with 11 children with GERD and PES. Patients and Methods: A retrospective review of clinical data obtained from children who underwent dilation and antireflux surgery for PES was performed. Results: A total of 11 patients were diagnosed with PES. The clinical picture was dominated by dysphagia. Barium swallow showed hiatal hernia in nine cases (82%. Oesophageal strictures were located most commonly in the lower third of the oesophagus (91%. Three Children (27% with PES had a neurologic impairment and patients had a mean duration of symptoms of 20 months (range, 3 month to 6.2 years before intervention. Children received a median of four dilations (range, 1-21 dilations for PES. Time to first dilation from age of diagnosis was a mean of 4.5 months (range, 2-14 months. Antireflux surgery was performed in all patients. Post-operatively, seven patients required repeat oesophageal dilation. Patients were followed with serial dilation for a median of 6 years (range, 1-9 years and only one patient has a continued requirement of oesophageal dilation for PES. Conclusion: GERD complicated by PES is an important condition affecting a significant number of children. Early and effective treatment of both stricture and GERD is required to improve the prognosis of this serious condition.

  20. Post-TIPS change of esophagogastric variceal size on endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Joo; Park, Aw Hwan; Kang, Duk Sik [School of Medicine, Kyungpook National University, Taegu (Korea, Republic of); Shin, Hyun Woong [Andong General Hospital, Andong (Korea, Republic of)

    2000-05-01

    To evaluate the relationship between endoscopic change in esophagogastric varices and post transjugular intrahepatic portosystemic shunt (TIPS) portal pressure reduction, and to study any difference in post-TIPS endoscopic change between esophageal and gastric varices. Sixty four patients who had undergone pre- and post-TIPS endoscopic examination were analysed. They were divided into two groups, Group 1 (n=3D40) and Group 2 (n=3D24), according to whether they had not or had, respectively, undergone post-TIPS residual variceal embolization. The varices were classified as either esophageal (n=3D54) or gastric (n=3D60). Post TIPS endoscopic change was evaluated as Grade 1 (complete disappearance), Grade 2 (partial disappearance), or Grade 3 (no change). Mean pressure reduction between the pre and post TIPS portosystemic pressure gradient was checked, and statistical correlation between mean portal pressure reduction and endoscopic change in Group 1 and Group 2 was evaluated using the ANOVA test. By means of the X{sup 2} test, post-TIPS endoscopic change between esophageal and gastric varices was also evaluated. In Group 1, a significant statistical relationship was found between endoscopic change and mean portal pressure reduction (p less than 0.001), but in Group 2, no such relationship was found (p greater than 0.05). No significant statistical difference was found between endoscopic change in esophageal and in gastric varices (p greater than 0.05). In patients who had not undergone post-TIPS residual variceal embolization, endoscopic change in gastroesophageal varices correlated significantly with post-TIPS portal pressure reduction. With regard to post-TIPS endoscopic change, these was no significant difference between esophageal and gastric varices. (author)

  1. Noncirrotisk intrahepatisk portal hypertension

    DEFF Research Database (Denmark)

    Dam Fialla, Annette; Havelund, Troels

    2007-01-01

    Non-cirrhotic intrahepatic portal hypertension is characterized by portal hypertension in the absence of liver cirrhosis or portal vein thrombosis. The disease is common in the East and rarely seen in the West. Two cases with oesophageal varices are described. The histopathology is heterogeneous...... but includes vascular lesions and portal fibrosis. Patient management follows the current recommendations for variceal bleeding....

  2. Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Johansson, K.E.; Ask, P.; Boeryd, B.; Fransson, S.G.; Tibbling, L.

    1986-01-01

    In a study comprising 100 patients referred to a surgical clinic with symptons suggestive of gastro-oesophageal reflux disease, the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly corelated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux, and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensivity for radiologic, manometric and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.

  3. Submucosal electrocoagulation for prolapsed hemorrhoids:a new operative approach to hemorrhoidal varices

    Directory of Open Access Journals (Sweden)

    Yada,Yoshihiko

    2010-12-01

    Full Text Available The results of submucosal electrocoagulation (SEC, a new radical operation for prolapsed hemorrhoids, in 403 patients with third- or fourth-degree hemorrhoids are reported. After resecting the anal skin tags that coexisted with prolapsed hemorrhoids, the hemorrhoidal varices could be resected and electrically coagulated through the wound without cutting the anal canal epithelium by using a fine needle-type electric knife. The results of this series indicated that SEC could dramatically reduce the incidence of the postoperative complications that sometimes occur after conventional hemorrhoid-ectomy, such as severe anal pain, massive anal bleeding and anal stenosis. Moreover, SEC could ensure that operated patients make an early return to social activities and have a satisfactory quality of life. Relapse of prolapsed hemorrhoids after SEC was rare.

  4. Barrett's oesophagus and oesophageal adenocarcinoma: time for a new synthesis.

    Science.gov (United States)

    Reid, Brian J; Li, Xiaohong; Galipeau, Patricia C; Vaughan, Thomas L

    2010-02-01

    The public health importance of Barrett's oesophagus lies in its association with oesophageal adenocarcinoma. The incidence of oesophageal adenocarcinoma has risen at an alarming rate over the past four decades in many regions of the Western world, and there are indications that the incidence of this disease is on the rise in Asian populations in which it has been rare. Much has been learned of host and environmental risk factors that affect the incidence of oesophageal adenocarcinoma, and data indicate that patients with Barrett's oesophagus rarely develop oesophageal adenocarcinoma. Given that 95% of oesophageal adenocarcinomas arise in individuals without a prior diagnosis of Barrett's oesophagus, what strategies can be used to reduce late diagnosis of oesophageal adenocarcinoma?

  5. Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation

    Directory of Open Access Journals (Sweden)

    Seung Woon Park

    2016-01-01

    Full Text Available Background and Aims. Cardiac varices (CVs in patients with type 1 gastroesophageal varices (GOV1s usually disappear with treatment for esophageal varices (EVs by endoscopic injection sclerotherapy (EIS. However, whether this applies to patients treated with endoscopic band ligation (EBL for EVs remains unclear. We evaluated the effect of EVs eradication by EBL on CVs. Methods. We included cirrhotic patients whose EVs had been eradicated using EBL and excluded those who had been treated using EIS, those who had received endoscopic therapy for CVs, and those who were combined with hepatocellular carcinoma. Results. A total of 123 patients were enrolled. The age was 59.7 ± 11.7 years, and 96 patients (78.0% were men. Thirty-eight patients (30.9% had EVs only, while 85 (69.1% had GOV1s. After EVs eradication, the CVs disappeared in 55 patients (64.7%. EVs recurred in 40 patients, with recurrence rates at 1, 2, and 3 years of 16.0%, 29.6%, and 35.6%, respectively, the recurrence being more frequent in patients who had undergone EBL for secondary prophylaxis and in those with persisting CVs after EVs eradication (P=0.003. Conclusions. CVs frequently disappeared when EVs were eradicated using EBL in patients with GOV1s. Persistence of CVs after EVs eradication by EBL was associated with EVs recurrence.

  6. Oesophageal achalasia: an argument for primary surgical management.

    LENUS (Irish Health Repository)

    Leonard, D S

    2009-04-01

    Achalasia is a primary oesophageal motility disorder resulting from damage to the ganglion cells of the myenteric plexus. Impaired relaxation of the lower oesophageal sphincter and aperistalsis causes its cardinal symptoms of dysphagia, chest pain and reflux-type symptoms. Management is somewhat controversial, with options including systemic and local pharmacotherapy, dilatation and oesophagomyotomy. We review the presentation, investigation and management of oesophageal achalasia and make an argument for primary surgical management.

  7. Late results of oesophageal and oesophagogastric resection in the treatment of oesophageal cancer

    Science.gov (United States)

    Ward, A. S.; Collis, J. Leigh

    1971-01-01

    Oesophageal resection with oesophagogastric anastomosis is said to be followed by severe oesophagitis. Little is known, however, of the late results of this technique in patients with oesophageal carcinoma and the present communication records our experience with 23 long-term survivors. Except for one patient with recurrent carcinoma, all were in good health and taking a normal diet. Loss of weight, which is a normal sequel to oesophagogastric resection, was prevented by inserting two extra meals a day. Anaemia was not a problem and there was no evidence of vitamin B12 or folate deficiency. None of the patients had any symptoms of oesophagitis, though all exhibited free reflux on recumbency. After operation patients are advised to sleep propped up and to avoid stooping or lying flat. These measures are thought to be largely responsible for the absence of oesophagitis in our series. Five patients were achlorhydric and 10 hypochlorhydric in response to intravenous pentagastrin (6 μg/kg per hour). Mean basal output was 0·6 mEq/hour and mean maximal output 8·8 mEq/hour. PMID:5101265

  8. The oesophageal microbiome: an unexplored link in obesity-associated oesophageal adenocarcinoma.

    Science.gov (United States)

    Kaakoush, Nadeem O; Morris, Margaret J

    2016-10-01

    The influence of diets rich in saturated fats and simple sugars on the intestinal microbiota plays a central role in obesity. Being overweight or obese predisposes individuals to several diseases including oesophageal adenocarcinoma (OAC), which develops through a cascade of events starting with gastro-oesophageal reflux disease, progressing to Barrett's oesophagus (BO), and then OAC. A range of mechanisms for the increased risk of OAC in obese individuals have been proposed; however, a role for the oesophageal microbiota has been largely ignored. This is despite the fact that it is clear that the composition of the oesophageal microbiota shifts with the development of OAC. Given the well-established impact that unhealthy diets have on the intestinal microbiota, it is plausible that exposure to unhealthy foods, and the ensuing obesity, would result in an imbalance in the oesophageal microbiota. It is also likely that these changes may mimic the changes observed in the intestinal microbiota (i.e. increase in short-chain fatty acid (SCFA) producers and bile acid biosynthesis). The modulation of SCFAs and bile acids in the oesophagus by diet could promote the transdifferentiation from squamous to intestinal-like columnar cells observed in BO, given that intestinal cells proliferate in the presence of SCFAs.

  9. Praediktion af blødningsrisiko og død ved cirrose ud fra haemodynamiske og metaboliske variabler. Studie af esophagusvaricepatienter uden tidligere blødning

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Christensen, E;

    1995-01-01

    As identification of patients with liver cirrhosis who are at risk of bleeding or death is essential in terms of prophylaxis, we have determined the prognostic influence of various patient characteristics on risk of bleeding and death. Fifty-five cirrhotic patients with oesophageal varices without...... analysis the following variables showed a significant relation to an increased risk of bleeding or death: high plasma volume (p varices (p

  10. National variation in transfusion strategies in patients with upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin J; Svenningsen, Peter; Fabricius, Rasmus;

    2016-01-01

    INTRODUCTION: An optimal transfusion strategy for patients with upper gastrointestinal bleeding (UGIB) has yet to be established. The national guidelines contain recommendations for patients with life-threating bleeding in general, but no specific recommendations for patients with UGIB. We...... in Denmark in order to discover regional differences. RESULTS: A total of 5,292 admissions with treatment for non-variceal UGIB were identified, and analysis was made for the total group and a massive transfusions group (330 admissions). In the Capital Region, transfusion of platelets was more likely than...

  11. [Obscure gastrointestinal bleeding].

    Science.gov (United States)

    Pastor, J; Adámek, S

    2013-08-01

    Obscure gastrointestinal bleeding represents 5% of all cases of bleeding into the gastrointestinal tract (GIT). The cause of this type of bleeding cannot be found by gastroscopy or colonoscopy - the most common cause being bleeding from the source in the small intestine. In other cases it is bleeding from other parts of the digestive tube which has already stopped or was not noticed during admission endoscopy. Imaging methods (X-ray, CT, MRI, scintigraphy) and endoscopic methods (flexible or capsule enteroscopy) are used in the diagnosis and treatment. If, despite having used these methods, the source of bleeding is not found and the bleeding continues, or if the source is known but the bleeding cannot be stopped by radiologic or endoscopic intervention, surgical intervention is usually indicated. The article provides an overview of current diagnostic and treatment options, including instructions on how to proceed in these diagnostically difficult situations.

  12. Cachexia in patients with oesophageal cancer.

    Science.gov (United States)

    Anandavadivelan, Poorna; Lagergren, Pernilla

    2016-03-01

    Oesophageal cancer is a debilitating disease with a poor prognosis, and weight loss owing to malnutrition prevails in the majority of patients. Cachexia, a multifactorial syndrome characterized by the loss of fat and skeletal muscle mass and systemic inflammation arising from complex host-tumour interactions is a major contributor to malnutrition, which is a determinant of tolerance to treatment and survival. In patients with oesophageal cancer, cachexia is further compounded by eating difficulties owing to the stage and location of the tumour, and the effects of neoadjuvant therapy. Treatment with curative intent involves exceptionally extensive and invasive surgery, and the subsequent anatomical changes often lead to eating difficulties and severe postoperative malnutrition. Thus, screening for cachexia by means of percentage weight loss and BMI during the cancer trajectory and survivorship periods is imperative. Additionally, markers of inflammation (such as C-reactive protein), dysphagia and appetite loss should be assessed at diagnosis. Routine assessments of body composition are also necessary in patients with oesophageal cancer to enable assessment of skeletal muscle loss, which might be masked by sarcopenic obesity in these patients. A need exists for clinical trials examining the effectiveness of therapeutic and physical-activity-based interventions in mitigating muscle loss and counteracting cachexia in these patients.

  13. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding.

  14. Transjugular intrahepatic portosystemic shunt vs endoscopic therapy in preventing variceal rebleeding

    Institute of Scientific and Technical Information of China (English)

    Hui Xue; Meng Zhang; Jack XQ Pang; Fei Yan; Ying-Chao Li; Liang-Shan Lv; Jia Yuan

    2012-01-01

    AIM:To compare early use of transjugular intrahepatic portosystemic shunt (TIPS) with endoscopic treatment (ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years; previously received surgical treatment or endoscopic therapy for variceal bleeding; and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS (TIPS group) while 62 patients received endoscopic therapy (ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rate and cost of treatment were compared between the two groups.RESULTS:During the follow-up period (median,20.7and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group (Kaplan-Meier analysis and log-rank test,P=0.000).Rebleeding rates at any time point (6 wk,1year and 2 year) in the TIPS group were lower than in the ET group (Bonferroni correction o' =o/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test x2=4.864,P =0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates (Bonferroni correction a' =a/3).However,significant differences were observed between the two groups in the 1-year survival rates (92% and 79%) and the 2-year survival rates (89% and 64.9%)(Bonferroni correction a' =o/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy (12 patients in TIPS

  15. Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices

    Institute of Scientific and Technical Information of China (English)

    Edward Wolfgang Lee; Naomi So; Ryan Chapman; Justin P McWilliams; Christopher T Loh; Ronald W Busuttil; Stephen T Kee

    2016-01-01

    AIM:To evaluate whether intra-procedural conebeam computed tomography(CBCT)performed during modified balloon-occluded retrograde transvenous obliteration(mB RTO)can accurately determine technical success of complete variceal obliteration.METHODS:From June 2012 to December 2014,15 patients who received CBCT during m BRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated.Three-dimensional(3D)CBCT images were performed and evaluated prior to the end of the procedure,and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of m BRTO including:Complete occlusion/obliteration of:(1)gastrorenal shunt(GRS);(2)gastric varices;and(3)afferent feeding veins.Post-mB RTO contrast-enhanced CT was used to confirm the accuracy and diagnostic value of CBCT within 2-3 d.RESULTS:Intra-procedural 3D-CBCT images were 100% accurate in determining the technical success of m BRTO in all 15 cases.CBCT demonstrated complete occlusion/obliteration of GRS,gastric varices,collaterals and afferent feeding veins during m BRTO,which was confirmed with post-m BRTO CT.Two patients showed incomplete obliteration of gastric varices and feeding veins on CBCT,which therefore required additional gelfoam injections to complete the procedure.No patient required additional procedures or other interventions during their follow-up period(684 ± 279 d).CONCLUSION:CBCT during mB RTO appears to accurately and immediately determine the technical success of mB RTO.This may improve the technical and clinical success/outcome of m BRTO and reduce additional procedure time in the future.

  16. Respiratory Care of Infants and Children with Congenital Tracheo-Oesophageal Fistula and Oesophageal Atresia.

    Science.gov (United States)

    Sadreameli, Sara C; McGrath-Morrow, Sharon A

    2016-01-01

    Despite acute respiratory and chronic respiratory and gastro-intestinal complications, most infants and children with a history of oesophageal atresia / trachea-oesophageal fistula [OA/TOF] can expect to live a fairly normal life. Close multidisciplinary medical and surgical follow-up can identify important co-morbidities whose treatment can improve symptoms and optimize pulmonary and nutritional outcomes. This article will discuss the aetiology, classification, diagnosis and treatment of congenital TOF, with an emphasis on post-surgical respiratory management, recognition of early and late onset complications, and long-term clinical outcomes.

  17. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    Ahmet Karaman; Mevlut Baskol; Sebnem Gursoy; Edip Torun; Alper Yurci; Banu Demet Ozel; Kadri Guven; Omer Ozbakir; Mehmet Yucesoy

    2011-01-01

    AIM: To compare the effectiveness of argon plasma coagulation (APC) and heater probe coagulation (HPC) in non-variceal upper gastrointestinal bleeding. METHODS: Eighty-five (18 female, 67 male) patients admitted for acute gastrointestinal bleeding due to gastric or duodenal ulcer were included in the study. Upper endoscopy was performed and HPC or APC were chosen randomly to stop the bleeding. Initial hemostasis and rebleeding rates were primary and secondary end-points of the study. RESULTS: Initial hemostasis was achieved in 97.7% (42/43) and 81% (36/42) of the APC and HPC groups, respectively (P 0.05). CONCLUSION: APC is an effective hemostatic method in bleeding peptic ulcers. Larger multicenter trials are necessary to confirm these results.

  18. Tracheo-oesophageal fistula diagnosed with multidetector computed tomography.

    LENUS (Irish Health Repository)

    Hodnett, Pa

    2009-04-01

    This case highlights important issues in investigation of patients with suspected tracheo-oesophageal fistula including the value of multidetector computed tomography, the importance of thorough imaging evaluation when high clinical suspicion of tracheo-oesophageal fistula exists and the value of close interaction between radiologists and intensive care physicians in the investigation of these patients.

  19. Acoustic Markers of Syllabic Stress in Spanish Excellent Oesophageal Speakers

    Science.gov (United States)

    Cuenca, Maria Heliodora; Barrio, Marina M.; Anaya, Pablo; Establier, Carmelo

    2012-01-01

    The purpose of this investigation is to explore the use by Spanish excellent oesophageal speakers of acoustic cues to mark syllabic stress. The speech material has consisted of five pairs of disyllabic words which only differed in stress position. Total 44 oesophageal and 9 laryngeal speakers were recorded and a computerised designed "ad hoc"…

  20. New insights into aerophagia, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Hemmink, G.J.M.

    2009-01-01

    Gastro-oesophageal reflux is a physiological phenomenon and occurs in every healthy subject approximately 40 times every day. Twenty percent of the general western population experiences reflux symptoms such as heartburn, regurgitation, and retrosternal pain at least once a week. Gastro-oesophageal

  1. Visualization of gastric varices using angiographic C-arm CT during retrograde transvenous sclerotherapy

    Directory of Open Access Journals (Sweden)

    Iwazawa Jin

    2010-01-01

    Full Text Available During retrograde transvenous sclerotherapy for gastric varices, sufficient opacification of the target varices on venography is essential for successful treatment. However, venography sometimes cannot identify target varices due to overlapping adjacent collateral vessels or leakage of contrast medium to other outflow veins. We report how C-arm CT images acquired using a flat-panel detector angiography system helped to identify target varices and predict the distribution of a sclerosant, which resulted in safer sclerotherapy and increased operator confidence.

  2. Natural history of a randomized trial comparing distal spleno-renal shunt with endoscopic sclerotherapy in the prevention of variceal rebleeding: A lesson from the past

    Institute of Scientific and Technical Information of China (English)

    Roberto Santambrogio; Enrico Opocher; Mara Costa; Savino Bruno; Andrea Pisani Ceretti; Gian Paolo Spina

    2006-01-01

    AIM: To compare endoscopic sclerotherapy (ES) with distal splenorenal shunt (DSRS) in the prevention of recurrent variceal bleeding in cirrhotic patients during a long-term follow-up period.METHODS: In 1984 we started a prospective, controlled study of patients with liver cirrhosis. Long-term follow-up presents a natural history of liver cirrhosis complicated by advanced portal hypertension. In this study the effects of 2 types of treatment, DSRS or ES, were evaluated. The study population included 80 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1991. These patients were drawn from a pool of 282 patients who underwent either elective surgery or ES during the same period of time. Patients were assigned to one of the 2groups according to a random number table: 40 to DSRS and 40 to ES using polidocanol.RESULTS: During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS and another patient suffered duodenal ulcer rebleeding. Eight ES patients suffered at least one episode of gastrointestinal bleeding: 4 from varices and 4 from esophageal ulcerations. Eight ES patients developed transitory dysphagia. Long-term followup was completed in all patients except for 5 cases (2DSRS and 3 ES patients). Five-year survival rates for shunt (73%) and ES (56%) groups were statistically different: in this follow-up period and in subsequent follow-ups this difference decreased and ceased to be of statistical relevance. The primary cause of death became hepatocellular carcinoma (HCC). Four DSRS patients rebled due to duodenal ulcer, while eleven ES patients had recurrent bleeding from esophago-gastric sources (seven from varices, three from hypertensive gastropathy, one from esophageal ulcerations) and two from unknown sources. Nine DSRS and 2 ES patients developed a chronic

  3. Validation of an Endoscopic Fibre-Optic Pressure Sensor for Noninvasive Measurement of Variceal Pressure

    Directory of Open Access Journals (Sweden)

    Bin Sun

    2016-01-01

    Full Text Available In this study, the authors have developed endoscopic fibre-optic pressure sensor to detect variceal pressure and presented the validation of in vivo and in vitro studies, because the HVPG requires catheterization of hepatic veins, which is invasive and inconvenient. Compared with HVPG, it is better to measure directly the variceal pressure without puncturing the varices in a noninvasive way.

  4. Color doppler findings of gastric varices compared with findings on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Sato, Takahiro; Yamazaki, Katsu; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi; Suga, Toshihiro [Sapporo Kosei General Hospital (Japan)

    2002-08-01

    The aim of this study was to evaluate the hemodynamics of gastric varices. We evaluated the detection rates of gastric varices, inflowing vessels to gastric varices, and outflowing vessels from gastric varices in 24 patients with gastric varices, using color Doppler sonography, and compared these findings with computed tomography findings. Eighteen patients had F2-type varices and 6 had F3-type, classified according to the Japanese Research Society for Portal Hypertension. Fourteen patients had fundal varices, and 10 had cardiac and fundal varices. The detection rates of collateral veins using color Doppler sonography were as follows: gastric varices were detected in all 24 patients (100%); inflowing vessels, in 21 of the 24 patients (87.5%); and outflowing vessels, in 18 of the 24 patients (75.0%). The detection rates of collateral veins, using computed tomography, were: gastric varices were detected in all 24 patients (100%); inflowing vessels, in all 24 patients (100%); and outflowing vessles, in 21 of the 24 patients (87.5%). The color Doppler findings agreed perfectly with the computed tomography findings in 13 of the 24 patients (54.2%). Although color Doppler sonography is a useful, noninvasive modality for evaluating the hemodynamics of gastric varices, it falls short in visualizing the detailed hemodynamics of the inflowing and outflowing vessels of gastric varices in half of the patients when compared with computed tomography. (author)

  5. Appearances are Deceptive - Passing a Nasogastric Tube does Not Always Rule Out Oesophageal Atresia.

    Science.gov (United States)

    Kumar, Manish; Thomas, Niranjan

    2016-04-01

    Oesophageal atresia/trachea-Oesophageal fistula is commonly diagnosed in the newborn period by inability to pass a nasogastric tube (NGT). We present the instance of a newborn baby where the diagnosis of oesophageal atresia was delayed because of an apparent successful passage of nasogastric tube to the stomach. Failure to reinsert the NGT raised the suspicion of oesophageal atresia which was confirmed by contrast study showing blind upper oesophageal pouch.

  6. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  7. The clinical observation of endoscopic variceal ligation and tissue glue injection therapy in the treatment of patients with esophageal and gastric fundal varices%内镜下套扎和组织胶注射分别治疗食管和胃底静脉曲张患者的临床观察

    Institute of Scientific and Technical Information of China (English)

    王红建; 陈永忠; 冯百岁; 魏岩岩; 李建生

    2011-01-01

    Objective To explore the therapeutic effects and value of endoscopic variceal ligation and tissue glue injection therapy in esophageal and gastric fundal varices.Methods 184 patients with severe esophageal varices underwent endoscopic variceal ligation treatment,and 32 cases of those accompanied with gastric fundal varices were treated with tissue glue injection therapy.All patients were followed-up for 6-months to observe the therapeutic effects and complication of endoscopic variceal ligation and tissue glue injection therapy.Results The effective rate of endoscopic variceal ligation in severe esophageal varices was 71.74 % ( 132/184 ),the rate of acute hemostasis was 95.00%(57/60)and the rate of complication was 2.17 % (4/184).The effective rate of tissue glue injection in gastric fundal varices was 100% (32/32) and the rate of complication was 21.88% (7/32) (7 cases with refractory ulcers in injection site,2 of refractory ulcers cases with bleeding).There was no perforation and severe infection complications.Conclusion Endoscopic variceal ligation and tissue glue injection therapy have good therapeutic effects in esophageal and gastric fundal varices.%目的 探讨内镜下套扎和组织胶注射治疗食管胃底静脉曲张的疗效和价值.方法 予184例重度食管静脉曲张患者内镜下套扎治疗,其中32例伴胃底静脉曲张者还进行内镜下组织胶注射治疗.随访6个月并观察内镜下套扎和组织胶注射治疗的疗效和并发症.结果 内镜下套扎治疗重度食管静脉曲张的有效率为71.74%(132/184),急诊止血率为95.00%(57/60),并发症(食管套扎部位瘢痕狭窄需行扩张治疗)发生率为2.17%(4/184).内镜下组织胶注射治疗胃底静脉曲张的有效率为100%(32/32),并发症(注射部位难治性溃疡7例,其中难治性溃疡并出血2例)发生率为21.88%(7/32).均无穿孔、重度感染并发症发生.结论 内镜下套扎和组织胶注射治疗食管和胃底静脉曲张疗效良好.

  8. Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia

    Directory of Open Access Journals (Sweden)

    Nagpal Anish

    2009-01-01

    Full Text Available Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures.

  9. Control of belching by the lower oesophageal sphincter.

    Science.gov (United States)

    Wyman, J B; Dent, J; Heddle, R; Dodds, W J; Toouli, J; Downton, J

    1990-06-01

    The mechanism that controls venting of gas from the stomach into the oesophagus was studied manometrically in 14 healthy subjects. The stomach was distended abruptly with one litre of carbon dioxide. Gas reflux was characterised by an abrupt increase in basal oesophageal body pressure to intragastric pressure. Reflux of gas from the stomach into the oesophagus occurred during transient lower oesophageal sphincter relaxations that generally had a pattern distinctly different from swallow-induced lower oesophageal sphincter relaxation. Thus, at the onset of an episode of gas reflux lower oesophageal sphincter pressure had relaxed to 3 mmHg, or less, in 96% of instances. After gas loading of the stomach the prevalence of gas reflux was significantly less when the subjects were supine (1.2/10 min) than when they were sitting (6.8/10 min) (p less than 0.001). The lower oesophageal sphincter relaxations associated with most episodes of gas reflux had a distinctive pattern that resembled those of the lower oesophageal sphincter relaxations associated with acid gastro-oesophageal reflux.

  10. Three benefits of microcatheters for retrograde transvenous obliteration of gastric varices

    Institute of Scientific and Technical Information of China (English)

    Tetsuo Sonomura; Wataru Ono; Morio Sato; Shinya Sahara; Kouhei Nakata; Hiroki Sanda; Nobuyuki Kawai

    2012-01-01

    AIM:To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices.METHODS:Fifty-six patients with gastric varices underwent BRTOs using microcatheters.A balloon catheter was inserted into gastrorenal or gastrocaval shunts.A microcatheter was navigated close to the varices,and sclerosant was injected into the varices through the microcatheter during balloon occlusion.The next morning,thrombosis of the varices was evaluated by contrast enhanced computed tomography (CE-CT).In patients with incomplete thrombosis of the varices,a second BRTO was performed the following day.Patients were followed up with CE-CT and endoscopy.RESULTS:In all 56 patients,sclerosant was selectively injected through the microcatheter close to the varices.In 9 patients,microcoil embolization of collateral veins was performed using a microcatheter.In 12 patients with incomplete thrombosis of the varices,additional injection of sclerosant was performed through the microcatheter that remained inserted overnight.Complete thrombosis of the varices was achieved in 51 of 56 patients,and the remaining 5 patients showed incomplete thrombosis of the varices.No recurrence of the varices was found in the successful 51 patients after a median follow up time of 10.5 mo.We experienced one case of liver necrosis,and the other complications were transient.CONCLUSION:The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedures.

  11. Haemoperitoneurn Secondary to Rupture of Retroperitoneal Variceal

    Directory of Open Access Journals (Sweden)

    M. Molina-Perez

    1997-01-01

    Full Text Available A 45-year-old alcoholic male patient presented with hypovolemic shock and intense anemia (Hemoglobin 04.7 g/dl, and was operated on. A bleeding retroperitoneal varix located near the right colon was responsible for the clinical picture and was sutured. After operation the patient developed haemodynamic instability and pneumonia a situation which was reverted with intensive medical therapy. The patient is now doing well.

  12. Gastrointestinal Bleeding in Athletes.

    Science.gov (United States)

    Eichner, Edward R.

    1989-01-01

    Describes the scope and importance of gastrointestinal bleeding in runners and other athletes, discussing causes, sites, and implications of exercise-related bleeding. Practical tips to mitigate the problem, potentially more troublesome in women because of lower iron stores, are presented (e.g., gradual conditioning and avoidance of prerace…

  13. Electrical stimulation therapy of the lower oesophageal sphincter for refractory gastro-oesophageal reflux disease - interim results of an international multicentre trial

    NARCIS (Netherlands)

    Kappelle, W.F.; Bredenoord, A.J.; Conchillo, J.M.; Ruurda, J.P.; Bouvy, N.D.; Henegouwen, M.I. van Berge; Chiu, P.W.; Booth, M.; Hani, A.; Reddy, D.N.; Bogte, A.; Smout, A.J.P.M.; Wu, J.C.; Escalona, A.; Valdovinos, M.A.; Torres-Villalobos, G.; Siersema, P.D.

    2015-01-01

    BACKGROUND: A previous single-centre study showed that lower oesophageal sphincter electrical stimulation therapy (LES-EST) in gastro-oesophageal reflux disease (GERD) patients improves reflux symptoms and decreases oesophageal acid exposure. AIM: To evaluate safety and efficacy of LES-EST in GERD p

  14. Surgical bleeding in microgravity

    Science.gov (United States)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  15. Prevalence of eosinophilic oesophagitis in adults presenting with oesophageal food bolus obstruction

    Institute of Scientific and Technical Information of China (English)

    Neel; Heerasing; Shok; Yin; Lee; Sina; Alexander; Damian; Dowling

    2015-01-01

    AIM: To look at the relationship between eosinophilic oesophagitis(EO) and food bolus impaction in adults. METHODS: We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital with oesophageal food bolus obstruction(FBO) between 2012 and 2014. In this cohort, 96 were adults(64% male), and 4 paediatric patients were excluded from the analysis as our centre did not have paediatric gastroenterologists. Eighty-five adult patients underwent emergency gastroscopy. The food bolus was either advanced into the stomach using the push technique or retrieved using a standard retrieval net. Biopsies were obtained in 51 patients from the proximal and distal parts of the oesophagus at initial gastroscopy. All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, University Hospital Geelong. The diagnosis of EO was defined and established by the presence of the following histological features:(1) peak eosinophil counts > 20/hpf;(2) eosinophil microabscess;(3) superficial layering of eosinophils;(4) extracellular eosinophil granules;(5) basal cell hyperplasia;(6) dilated intercellular spaces; and(7) subepithelial or lamina propria fibrosis. The histology results of the biopsy specimens were accessed from the pathology database of the hospital and recorded for analysis. RESULTS: Our cohort had a median age of 60. Seventeen/51(33%) patients had evidence of EO on biopsy findings. The majority of patients with EO were male(71%). Classical endoscopic features of oesophageal rings, furrows or white plaques and exudates werefound in 59% of patients with EO. Previous episodes of FBO were present in 12/17 patients and 41% had a history of eczema, hay fever or asthma. Reflux oesophagitis and benign strictures were found in 20/34 patients who did not have biopsies. CONCLUSION: EO is present in approximately one third of patients who are admitted with FBO. Biopsies should be performed

  16. Reflux symptom questionnaire in the diagnosis of reflux oesophagitis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li; MENG Ling-mei; ZHANG Dong-hong; HUANG Shu-mei; QU Xue-fu; ZHOU Li-ya; LIN San-ren; DING Shi-gang; HUANG Yong-hui; GU Fang; LI Yuan; ZHANG Jing; YAN Xiu-e

    2007-01-01

    @@ Reflux symptom questionnaire (RSQ) is a useful tool in epidemiological study of gastroesophageal reflux disease (GERD),(1,2) but the correlation between RSQ and the refluX oesophagitis (RE) is still unclear.

  17. Discovery of new molecular subtypes in oesophageal adenocarcinoma.

    Science.gov (United States)

    Berg, Daniela; Wolff, Claudia; Langer, Rupert; Schuster, Tibor; Feith, Marcus; Slotta-Huspenina, Julia; Malinowsky, Katharina; Becker, Karl-Friedrich

    2011-01-01

    A large number of patients suffering from oesophageal adenocarcinomas do not respond to conventional chemotherapy; therefore, it is necessary to identify new predictive biomarkers and patient signatures to improve patient outcomes and therapy selections. We analysed 87 formalin-fixed and paraffin-embedded (FFPE) oesophageal adenocarcinoma tissue samples with a reverse phase protein array (RPPA) to examine the expression of 17 cancer-related signalling molecules. Protein expression levels were analysed by unsupervised hierarchical clustering and correlated with clinicopathological parameters and overall patient survival. Proteomic analyses revealed a new, very promising molecular subtype of oesophageal adenocarcinoma patients characterised by low levels of the HSP27 family proteins and high expression of those of the HER family with positive lymph nodes, distant metastases and short overall survival. After confirmation in other independent studies, our results could be the foundation for the development of a Her2-targeted treatment option for this new patient subgroup of oesophageal adenocarcinoma.

  18. Oesophageal carcinoma presenting with a synchronous asymptomatic colon carcinoma

    OpenAIRE

    Alok Gupta; Bharat Chauhan; V Rangarajan; Saral Desai; Vanita Noronha; Kumar Prabhash

    2013-01-01

    The advancement in diagnostic techniques has resulted in increased incidence of occult second primary in cancer patients. Here, we report a case of symptomatic oesophageal carcinoma and synchronous asymptomatic colon carcinoma diagnosed through Positron Emission Tomography-Computed Tomography imaging.

  19. Discovery of new molecular subtypes in oesophageal adenocarcinoma.

    Directory of Open Access Journals (Sweden)

    Daniela Berg

    Full Text Available A large number of patients suffering from oesophageal adenocarcinomas do not respond to conventional chemotherapy; therefore, it is necessary to identify new predictive biomarkers and patient signatures to improve patient outcomes and therapy selections. We analysed 87 formalin-fixed and paraffin-embedded (FFPE oesophageal adenocarcinoma tissue samples with a reverse phase protein array (RPPA to examine the expression of 17 cancer-related signalling molecules. Protein expression levels were analysed by unsupervised hierarchical clustering and correlated with clinicopathological parameters and overall patient survival. Proteomic analyses revealed a new, very promising molecular subtype of oesophageal adenocarcinoma patients characterised by low levels of the HSP27 family proteins and high expression of those of the HER family with positive lymph nodes, distant metastases and short overall survival. After confirmation in other independent studies, our results could be the foundation for the development of a Her2-targeted treatment option for this new patient subgroup of oesophageal adenocarcinoma.

  20. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    There are many causes of abnormal vaginal bleeding. HORMONES Most often, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the cause, doctors call the problem dysfunctional uterine bleeding (DUB) . DUB is more ...

  1. Telemetric real-time sensor for the detection of acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Schostek, Sebastian; Zimmermann, Melanie; Keller, Jan; Fode, Mario; Melbert, Michael; Schurr, Marc O; Gottwald, Thomas; Prosst, Ruediger L

    2016-04-15

    Acute upper gastrointestinal bleedings from ulcers or esophago-gastric varices are life threatening medical conditions which require immediate endoscopic therapy. Despite successful endoscopic hemostasis, there is a significant risk of rebleeding often requiring close surveillance of these patients in the intensive care unit (ICU). Any time delay to recognize bleeding may lead to a high blood loss and increases the risk of death. A novel telemetric real-time bleeding sensor can help indicate blood in the stomach: the sensor is swallowed to detect active bleeding or is anchored endoscopically on the gastrointestinal wall close to the potential bleeding source. By telemetric communication with an extra-corporeal receiver, information about the bleeding status is displayed. In this study the novel sensor, which measures characteristic optical properties of blood, has been evaluated in an ex-vivo setting to assess its clinical applicability and usability. Human venous blood of different concentrations, various fluids, and liquid food were tested. The LED-based sensor was able to reliably distinguish between concentrated blood and other liquids, especially red-colored fluids. In addition, the spectrometric quality of the small sensor (size: 6.5mm in diameter, 25.5mm in length) was comparable to a much larger and technically more complex laboratory spectrophotometer. The experimental data confirm the capability of a miniaturized sensor to identify concentrated blood, which could help in the very near future the detection of upper gastrointestinal bleeding and to survey high-risk patients for rebleeding.

  2. Vulvar varices: an uncommon entity in surgical pathology.

    Science.gov (United States)

    Bell, Diana; Kane, Philip B; Liang, Sharon; Conway, Christine; Tornos, Carmen

    2007-01-01

    Varicose veins in the vulvar and perivulvar area are seen in 4% of women. Most of them are secondary to pregnancy and usually regress spontaneously. Vulvar varicose veins are rare in nonpregnant women. When present, they can be seen alone, associated with leg varices or associated with venous malformations of the labia, clitoral area, or vagina with or without arteriovenous malformations on the limbs or trunk (Klippel-Trenaunay-Weber syndrome and Parkes-Weber syndrome). In some cases, vulvar varices are seen as part of the so-called "pelvic congestion syndrome." Clinically, vulvar varices may present as small isolated protrusions, mainly in the labia majora, or as large masses, involving the vulva and even the perivulvar area. The treatment of choice of vulvar varices seen during pregnancy is conservative and symptomatic. Surgical pathologists need to be aware of the existence of vulvar varicose veins and its possible presence in biopsy specimens. Vulvar varicose veins can be misdiagnosed clinically as cysts or masses mainly in the Bartholin gland area. Correct diagnosis of the lesion is important to determine appropriate therapy and to recognize the possibility of associated anatomical or pathological problems.

  3. Transabdominal sonographic findings of the distal esophagus in esophageal varices

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Yong Seok; Kim, Jun Young; Ko, Myoung Kwan; Kim, Dong Hyun; Byun, Ju Nam; Kim, Young Suk; Kim, Young Cheol; Oh, Jae Hee [Chosun University College of Medicine, Kwangju (Korea, Republic of)

    2000-03-15

    To assess transabdominal sonographic findings of the distal esophagus in the patients with esophageal varices. Transabdominal sonography was performed on two groups which considered of 42 normal subjects (25 males and 17 female, age: 20-65) and 45 cirrhotic patients (34 males and 11 females, age: 30-70) with esophageal varices. The thickness of the anterior wall of the distal esophagus (AWDE) was measured and the shape of its surface was observed. Then these findings were compared between the two groups. The mean thickness of the AWDE in the 42 normal subjects was 2.4 {+-} 0.62 mm (2-4 mm), while that of the 45 cirrhotic patients was 6.0 {+-} 1.27 mm (3-10 mm). Whereas the irregular surface of the AWDE was observed in 4 of the 42 normal subjects (9.5%), it was seen in 30 of the 45 cirrhotic patients with esophageal varices (66.7%). When as AWDE having more than 5 mm in thickness was used as a diagnostic criterion for the esophageal varices, the sensitivity, specificity, and accuracy was 89%, 100% and 94% respectively. When an irregular wall surface was used as a diagnostic standard, the results were 67%, 90% and 70% respectively. In the cirrhotic patients, esophageal varix can be presumed with reasons of the thickening AWDE (more than 5 mm) and irregularity of its surface in the transabdominal sonography.

  4. Control of belching by the lower oesophageal sphincter.

    OpenAIRE

    Wyman, J. B.; Dent, J; Heddle, R; Dodds, W J; Toouli, J; Downton, J

    1990-01-01

    The mechanism that controls venting of gas from the stomach into the oesophagus was studied manometrically in 14 healthy subjects. The stomach was distended abruptly with one litre of carbon dioxide. Gas reflux was characterised by an abrupt increase in basal oesophageal body pressure to intragastric pressure. Reflux of gas from the stomach into the oesophagus occurred during transient lower oesophageal sphincter relaxations that generally had a pattern distinctly different from swallow-induc...

  5. Curative surgical management of isolated adrenal recurrence of oesophageal adenocarcinoma.

    LENUS (Irish Health Repository)

    O'Sullivan, K E

    2013-01-01

    Adrenal metastases of oesophageal adenocarcinoma are rarely detected in the clinical setting, more frequently being found as an incidental postmortem finding in the presence of widespread metastases. With improvements in the sensitivity of radiological diagnostic modalities, the incidence of adrenal tumour detection is on the rise. We report herein a particularly rare case of primary operative management by adrenalectomy for an isolated right-sided adrenal metastasis secondary to oesophageal adenocarcinoma, with a long-term survival.

  6. Assessment of the rapid pullthrough technique in oesophageal manometry.

    OpenAIRE

    Goodall, R J; Hay, D. J.; Temple, J. G.

    1980-01-01

    The lower oesophageal sphincter pressure was measured by infusion manometry using the rapid pullthrough technique in two studies designed to evaluate this technique. The first study performed was an assessment of its reproducibility in individual subjects on separate occasions. We conclude that the rapid pullthrough technique does not give reproducible results. The second study compared the lower oesophageal sphincter pressure obtained by this technique with that by the standard station pullt...

  7. Combined endovascular treatment of aorto-oesophageal fistula with mediastinitis

    Science.gov (United States)

    Berna, Pascal; Pequignot, Aurélien; De Temmerman, Pierre; De Dominicis, Florence

    2013-01-01

    False aortic aneurysm is an uncommon complication after oesophageal perforation and results in a high rate of mortality. A 63-year-old patient presented with acute chest pain. Biochemical tests (cardiac enzymes) and electrocardiogram were normal. A thoracic and abdominal CT scan was performed, and showed a foreign body in the posterior mediastinum, with mediastinal cellulitis and a false aortic aneurysm. Surgical endovascular management was performed, with stenting of the thoracic aorta and oesophageal exploration. PMID:23042800

  8. Curative surgical management of isolated adrenal recurrence of oesophageal adenocarcinoma.

    Science.gov (United States)

    O'Sullivan, K E; Moriarty, A R; Larkin, J O; Reynolds, J V

    2013-04-29

    Adrenal metastases of oesophageal adenocarcinoma are rarely detected in the clinical setting, more frequently being found as an incidental postmortem finding in the presence of widespread metastases. With improvements in the sensitivity of radiological diagnostic modalities, the incidence of adrenal tumour detection is on the rise. We report herein a particularly rare case of primary operative management by adrenalectomy for an isolated right-sided adrenal metastasis secondary to oesophageal adenocarcinoma, with a long-term survival.

  9. Varizes gástricas: retrospectiva na esquistossomose mansônica hepato-esplênica Gastric varices: a retrospective appraisal in hepatosplenic schistosomiasis mansoni

    Directory of Open Access Journals (Sweden)

    Saul Goldenberg

    2003-06-01

    Full Text Available Realiza-se um retrospecto sobre as varizes gástricas na esquistossomose mansônica a fim de rever as contribuições publicadas entre 1963 e 1973, destacando o pioneirismo do autor sobre o tema. A primazia foi assegurada em nota prévia publicada na Revista da Associação Médica Brasileira em 1972 indexada no Medline. Seguiram-se outras publicações, igualmente pioneiras, mostrando investigações pormenorizadas sobre os aspectos radiológicos, esplenoportográficos, gastroscópicos e os obtidos mediante gastrotomia no tratamento cirúrgico destas varizes. Apesar de decorridos mais de 30 anos das publicações, que estão indexadas, não há justificativa para desconhecê-las como se constatou em publicação recente sobre o tema.A retrospective data about gastric varices in patients with schistosomiasis mansoni was done. The purpose was to present effective contributions published by the author about the subject between 1963 and 1973. The primacy was assured by a preliminary note published in 1972 in the journal Revista da Associação Médica Brasileira, indexed in MEDLINE. Other pionner works were published showing several aspects of gastric varices in schistosomiasis mansoni: radiological, splenoportographic, gastroscopic and photos of gastric varices obtained by opening the stomach during surgical treatment of bleeding varices. In spite that the articles were published 30 years ago, there is no excuse to unknown and not to quote the pioneer publications, as was seen in recent article published in a brazilian journal.

  10. Scintigraphic evaluation of oesophageal transit during radiotherapy to the mediastinum

    Directory of Open Access Journals (Sweden)

    Cuccurullo Vincenzo

    2008-11-01

    Full Text Available Abstract Background To quantitatively evaluate radiation-induced impaired oesophageal transit with oesophageal transit scintigraphy and to assess the relationships between acute oesophagitis symptoms and dysmotility. Methods Between January 1996 and November 1998, 11 patients affected by non-small-cell carcinoma of the lung not directly involving the oesophagus, requiring adjuvant external beam radiotherapy (RT to the mediastinum were enrolled. Oesophageal transit scans with liquid and semisolid bolus were performed at three pre-defined times: before (T0 and during radiation at 10 Gy (T1 and 30 Gy (T2. Two parameters were obtained for evaluation: 1 mean transit time (MTT; and 2 ratio between peak activity and residual activity at 40 seconds (ER-40s. Acute radiation toxicity was scored according to the joint EORTC-RTOG criteria. Mean values with standard deviation were calculated for all parameters. Analysis of variance (ANOVA tests and paired t-Tests for all values were performed. Results An increase in the ER-40s from T0 to T1 or T2 was seen in 9 of 11 patients (82%. The mean ER-40s value for all patients increased from 0.8306 (T0 to 0.8612 (T1 and 0.8658 (T2. These differences were statistically significant (p 0.05. Conclusion Using oesophageal scintigraphy we were able to detect early alterations of oesophageal transit during the third week of thoracic RT.

  11. Outpatient experience with oesophageal endoscopic dilation.

    Science.gov (United States)

    Jani, P G; Mburugu, P G

    1998-07-01

    Between March 1990 and August 1997, outpatient endoscopic balloon dilation was performed for oesophageal strictures which developed secondary to malignancies, peptic strictures, post surgical narrowing, achalasia cardia, corrosive ingestion and other causes. A total of 169 dilations were performed in the 92 cases with an average of 1.8 dilation/case (Range 1 to 8). Dilation was possible in all 92 cases without the need for fluoroscopic monitoring. Twenty three (13.6%) of the dilations were performed using pneumatic balloon while in 146(86.4%) cases wire guided metal olives were used. There were nine minor complications which were treated with medication on an outpatient basis and four major complications which required inpatient care. Three of these had perforation of the oesophagus and one died. One other patient developed aspiration pneumonia and subsequently died.

  12. Endoscopic Color Doppler Ultrasonographic Evaluation of Gastric Varices Secondary to Left-Sided Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Takahiro Sato

    2014-06-01

    Full Text Available Gastric varices that arise secondary to the splenic vein occlusion can result in gastrointestinal hemorrhaging. Endoscopic color Doppler ultrasonography (ECDUS was performed in 16 patients with gastric varices secondary to splenic vein occlusion. This study retrospectively evaluated the role of ECDUS in the diagnosis of gastric varices secondary to splenic vein occlusion. Thirteen patients had co-existing pancreatic diseases: 8 with chronic pancreatitis, 4 with cancer of the pancreatic body or tail and 1 with severe acute pancreatitis. Of the remaining 3 patients, 1 had myeloproliferative disease, 1 had advanced gastric cancer, and the third had splenic vein occlusion due to an obscure cause. The endoscopic findings of gastric varices were: variceal form (F classified as enlarged tortuous (F2 in 12 cases and large, coil-shaped (F3 in 4 cases, and positive for erosion or red color sign of the variceal surface in 4 cases and negative in 12 cases. ECDUS color flow images of gastric variceal flow clearly depicted a round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body in all 16 cases. The velocities of F3 type gastric varices were significantly higher than those of the F2 type. The wall thickness of varices positive for erosion or red color sign was significantly less than the negative cases. I conclude that ECDUS color flow images of gastric variceal flow depicted specific findings of gastric varices secondary to splenic vein occlusion at the round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body.

  13. Role of endoscopy in early oesophageal cancer.

    Science.gov (United States)

    Mannath, Jayan; Ragunath, Krish

    2016-12-01

    Incidence of oesophageal adenocarcinoma has increased exponentially in the West over the past few decades. Following detection of advanced cancers, 5-year survival rates remain bleak, making identification of early neoplasia, which has a better outcome, important. Detection of subtle oesophageal lesions during endoscopy can be challenging, and advanced imaging techniques might improve their detection. High-definition endoscopy has become a standard in most endoscopy centres, and this technology probably provides better delineation of mucosal features than standard-definition endoscopy. Various image enhancement techniques are now available with the development of new electronics and software systems. Image enhancement with chromoendoscopy using dyes has been a cost-effective option for many years, yet these techniques have been replaced in some contexts by electronic chromoendoscopy, which can be used with the press of a button. However, Lugol's chromoendoscopy remains the gold standard to identify squamous dysplasia. Identification and characterization of subtle neoplastic lesions could help to target biopsies and perform endoscopic resection for better local staging and definitive therapy. In vivo histology with techniques such as confocal endomicroscopy could make endotherapy feasible within a shorter timescale than when relying on histology on tissue samples. Once early neoplasia is identified, treatments include endoscopic resection, endoscopic submucosal dissection or various ablative techniques. Endotherapy has the advantage of being a less invasive technique than oesophagectomy, and is associated with lower mortality and morbidity. Endoscopic ablation therapies have evolved over the past few years, with radiofrequency ablation showing the best results in terms of success rates and complications in Barrett dysplasia.

  14. Heavy Menstrual Bleeding (Menorrhagia)

    Science.gov (United States)

    ... related to pregnancy, such as a miscarriage or ectopic pregnancy, can cause abnormal bleeding. A miscarriage is when ... called a fetus) dies in the uterus. An ectopic pregnancy is when a baby starts to grow outside ...

  15. Lower gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    This article examines causes of occult, moderate and severe lower gastrointestinal (GI) bleeding. The difference in the workup of stable vs unstable patients is stressed. Treatment options ranging from minimally invasive techniques to open surgery are explored.

  16. Avoiding Winter Nose Bleeds

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    WINTER is the best season for peopleto do cold-endurance exercises. But thedry, windy weather makes the moisturein the nasal mucosa evaporate quickly,reducing the elasticity of capillaries andmaking for frequent nose-bleeds.

  17. Emerging aspects of oesophageal and gastro-oesophageal junction cancer histopathology – an update for the surgical oncologist

    Directory of Open Access Journals (Sweden)

    Mapstone Nicholas P

    2006-11-01

    Full Text Available Abstract Adenocarcinoma of the oesophagus and gastro-oesophageal junction are rapidly increasing in incidence and have a well described sequence of carcinogenesis: the Barrett's metaplasia-dysplasia-adenocarcinoma sequence. During recent years there have been changes in the knowledge surrounding disease progression, cancer management and histopathology specimen reporting. Tumours around the gastro-oesophageal junction (GOJ pose several specific challenges. Numerous difficulties arise when the existing TNM staging systems for gastric and oesophageal cancers are applied to GOJ tumours. The issues facing the current TNM staging and GOJ tumour classification systems are reviewed in this article. Recent evidence regarding the importance of several histopathologically derived prognostic factors, such as circumferential resection margin status and lymph node metastases, have implications for specimen reporting. With the rising use of multimodal treatments for oesophageal cancer it is important that the response of the tumour to this therapy is carefully documented pathologically. In addition, several controversial and novel areas such as endoscopic mucosal resection, lymph node micrometastases and the sentinel node concept are being studied. We aim to review these aspects, with special relevance to oesophageal and gastro-oesophageal cancer specimen reporting, to update the surgical oncologist with an interest in upper gastrointestinal cancer.

  18. Post traumatic intra thoracic spleen presenting with upper GI bleed! – a case report

    Directory of Open Access Journals (Sweden)

    Kinra Sonali

    2006-11-01

    Full Text Available Abstract Background Isolated splenic vein thrombosis with left sided portal hypertension is a rare cause of upper gastrointestinal bleed. Diagnosis is difficult and requires a high index of suspicion, especially in patients presenting with gastrointestinal bleed in the presence of splenomegaly and normal liver function tests. Case presentation A 64 year old male presented with haematemesis and melaena. An upper gastrointestinal endoscopy revealed the presence of antral erosions in the stomach and fundal varices. A computerised tomography scan of abdomen confirmed the presence of a diaphragmatic tear and the spleen to be lying in the left hemi thorax. The appearances of the splenic vein on the scan were consistent with thrombosis. Conclusion Left sided portal hypertension as a result of isolated splenic vein thrombosis secondary to trauma is rare. The unusual presentation of our case, splenic herniation into the left hemithorax, causing fundal varices leading to upper gastrointestinal bleed 28 years after the penetrating injury, makes this case most interesting. We believe that this has not been reported in literature before.

  19. Dysfunctional Uterine Bleeding

    OpenAIRE

    1987-01-01

    Dysfunctional uterine bleeding (DUB) is defined as abnormal uterine bleeding that results from an ovarian endocrinopathy. It may be associated with ovulatory and anovulatory cycles. The diagnosis of DUB depends on a thorough history and physical examination to exclude organic disorders. In older women, endometrial biopsy should be done before starting therapy. The treatment depends on an understanding of the menstrual cycle. In less urgent cases, anovulatory cycles are managed using progester...

  20. Late presentation of gastric tube ulcer perforation after oesophageal atresia repair.

    Science.gov (United States)

    Hazebroek, Eric J; Hazebroek, Frans W J; Leibman, Steven; Smith, Garett S

    2008-07-01

    Ulcer formation in intrathoracic grafts after oesophageal replacement is considered an infrequent complication of the procedure. We present a rare case of a gastric tube ulcer with perforation, more than 30 years after gastric tube interposition for oesophageal atresia.

  1. State-of-the-art management of acute bleeding peptic ulcer disease

    Directory of Open Access Journals (Sweden)

    Hisham Al Dhahab

    2013-01-01

    Full Text Available The management of patients with non variceal upper gastrointestinal bleeding has evolved, as have its causes and prognosis, over the past 20 years. The addition of high-quality data coupled to the publication of authoritative national and international guidelines have helped define current-day standards of care. This review highlights the relevant clinical evidence and consensus recommendations that will hopefully result in promoting the effective dissemination and knowledge translation of important information in the management of patients afflicted with this common entity.

  2. Superior mesenteric arteriovenous fistula presenting as gastrointestinal bleeding: case report and literature review

    Directory of Open Access Journals (Sweden)

    Chong Wang

    Full Text Available Superior mesenteric arteriovenous fistula (SMAVF is a rare vascular disorder usually following penetrating abdominal trauma or gastrointestinal surgery. Percutaneous endovascular treatment such as embolization, has been widely used to treat this disease. We report a patient, who was presented with melena at the onset of his symptoms, then an acute hematemesis in shock. A SMAVF was diagnosed on an angiogram after a large mesenteric vein was seen on CT. The patient had a successful emergency endoscopic variceal ligation (EVL to stop bleeding. Then the patient received fistula embolization with covered stent.

  3. Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy

    Institute of Scientific and Technical Information of China (English)

    Cheol Woong Choi; Dae Hwan Kang; Hyung Wook Kim; Su Bum Park; Kee Tae Park; Gwang Ha Kim; Geun Am Song; Mong Cho

    2011-01-01

    AIM: To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB).METHODS: We performed a retrospective analysis of a prospective database in a tertiary care university hospital. From October 2006 to October 2008, we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy. Within 24 h of hospital admission,all patients underwent endoscopic therapy. After successful endoscopic hemostasis, all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion (8 mg/h for 72 h). The somatostatin adjunct group (n = 49) also received a 250-μg bolus of somatostatin, followed by continuous infusion (250 μg/h for 72 h). Early rebleeding rates, disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS: Early rebleeding rates were not significantly different between treatment groups (12.2% vs 14.3%, P = 0.766). Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups (94.2% vs 95.9%, P = 0.696). Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding (P = 0.044, OR: 9.080, 95% CI: 1.062-77.595).CONCLUSION: The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.

  4. Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices

    Institute of Scientific and Technical Information of China (English)

    Catherine T Frenette; John G Kuldau; Donald J Hillebrand; Jill Lane; Paul J Pockros

    2008-01-01

    AIM: To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices.METHODS: Cirrhotic patients who were undergo-ing esophagogastroduodenoscopy (EGD) for variceal screening or surveillance underwent capsule endos-copy. Two separate blinded investigators read each capsule endoscopy for the following results: variceal grade, need for treatment with variceal banding or prophylaxis with beta-blocker therapy, degree of portal hypertensive gastropathy, and gastric varices.RESULTS: Fifty patients underwent both capsule and EGD. Forty-eight patients had both procedures on the same day, and 2 patients had capsule endoscopy within 72 h of EGD. The accuracy of capsule endos-copy to decide on the need for prophylaxis was 74%,with sensitivity of 63% and specificity of 82%. Inter-rater agreement was moderate (kappa = 0.56). Agree-ment between EGD and capsule endoscopy on grade of varices was 0.53 (moderate). Inter-rater reliability was good (kappa = 0.77). In diagnosis of portal hyper.tensive gastropathy, accuracy was 57%, with sensitiv-ity of 96% and specificity of 17%. Two patients had gastric varices seen on EGD, one of which was seen on capsule endoscopy. There were no complications from capsule endoscopy.CONCLUSION: We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker thera-py. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices.

  5. Diagnostic yield of oesophageal pH monitoring in patients with chronic unexplained cough

    NARCIS (Netherlands)

    Bogte, Auke; Bredenoord, Arjan J.; Smout, Andre J. P. M.

    2008-01-01

    Objective. One of the main causes of persistent cough is gastro-oesophageal reflux. In these patients, excessive oesophageal acid exposure and/or a temporal association between gastro-oesophageal reflux and cough can be demonstrated during 24-h pH monitoring. Impedance pH monitoring may have a highe

  6. Haemophilus ducreyi detection by polymerase chain reaction in oesophageal lesions of HIV patients.

    Science.gov (United States)

    Borges, M C; Colares, J K B; Lima, D M; Fonseca, B A L

    2009-04-01

    HIV patients frequently have opportunistic oesophageal infections. We report Haemophilus ducreyi genetic material detected by polymerase chain reaction in biopsies of oesophageal lesions in three HIV-1-infected patients. This finding may be an indication of its aetiopathological role in oesophageal lesions of HIV patients.

  7. Drinking hot beverages is not associated with risk of oesophageal cancers in a Western population

    OpenAIRE

    2001-01-01

    We performed a nationwide population-based case-control study of hot beverage consumption and oesophageal cancer in Sweden. Drinking beverages very hot did not increase the risk for oesophageal squamous cell carcinoma, oesophageal adenocarcinoma, or gastric cardia adenocarcinoma. © 2001 Cancer Research Campaign http://www.bjcancer.com

  8. Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most?

    Science.gov (United States)

    Rodríguez-Castro, Kryssia Isabel; Antonello, Alessandro; Ferrarese, Alberto

    2015-07-18

    The more modern and accurate concept of a rebalanced hemostatic status in cirrhosis is slowly replacing the traditional belief of patients with cirrhosis being "auto-anticoagulated", prone only to bleeding complications, and protected from thrombotic events. With greater attention to clinical thrombotic events, their impact on the natural history of cirrhosis, and with the emergence and increased use of point-of-care and global assays, it is now understood that cirrhosis results in profound hemostatic alterations that can lead to thrombosis as well as to bleeding complications. Although many clinical decisions are still based on traditional coagulation parameters such as prothrombin (PT), PT, and international normalized ratio, it is increasingly recognized that these tests do not adequately predict the risk of bleeding, nor they should guide pre-emptive interventions. Moreover, altered coagulation tests should not be considered as a contraindication to the use of anticoagulation, although this therapeutic or prophylactic approach is not at present routinely undertaken. Gastroesophageal variceal bleeding continues to be one of the most feared and deadly complications of cirrhosis and portal hypertension, but great progresses have been made in prevention and treatment strategies. Other bleeding sites that are frequently part of end-stage liver disease are similar to clinical manifestations of thrombocytopenia, with gum bleeding and epistaxis being very common but fortunately only rarely a cause of life-threatening bleeding. On the contrary, manifestations of coagulation factor deficiencies like soft tissue bleeding and hemartrosis are rare in patients with cirrhosis. As far as thrombotic complications are concerned, portal vein thrombosis is the most common event in patients with cirrhosis, but venous thromboembolism is not infrequent, and results in important morbidity and mortality in patients with cirrhosis, especially those with decompensated disease. Future

  9. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  10. [Oesophageal diseases: gastroesophageal reflux disease, Barrett's disease, achalasia and eosinophilic oesophagitis].

    Science.gov (United States)

    Calvet, Xavier

    2015-09-01

    The most important novel findings presented on oesophageal disease in DDW 2015 were the following: 1) GERD: a) hypervigilance seems to be a key pathogenic factor in reflux symptoms refractory to PPI; b) post-reflux swallowing-induced peristaltic waves could be an excellent diagnostic criterion for GERD; c) laryngeal pH-metry is not useful in the diagnosis of extra-oesophageal symptoms; d) the recommendation of weight loss adequately recorded in the clinical reports of patients with GERD and obesity or overweight is an excellent quality indicator and is associated with better outcomes. 2) Barrett's oesophagus: a) persistent low-grade dysplasia in more than one endoscopy and a diagnosis of "indefinite for dysplasia" are associated with a high risk of neoplastic progression; b) narrow-band imaging allows areas of dysplasia on Barrett's oesophagus to be identified with high sensitivity and specificity; c) initial endoscopy fails to identify a high percentage of advanced neoplasms in Barrett's oesophagus. Early re-endoscopy should be considered; d) endoscopists specialized in Barret's oesophagus obtain a much higher yield in the diagnosis of advanced lesions. Patients at high risk-men, older patients, smokers and those with long-segment Barrett's oesophagus-could benefit from follow-up in a referral center. 3) Achalasia: POEM seems safe and effective, independently from patient characteristics (age, comorbidity) and the technical variations used. 4) Eosinophilic esophagitis: topical budesonide and exclusion diets are reasonably effective in PPI non-responders.

  11. Distal thoracic oesophageal perforation secondary to blunt trauma: Case report

    Directory of Open Access Journals (Sweden)

    Tandon Ruchi

    2007-03-01

    Full Text Available Abstract Background Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries. Case report We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death. Conclusion Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition.

  12. A case of oesophageal ulcer developed after taking homeopathic pill in a young woman

    Institute of Scientific and Technical Information of China (English)

    Vito D Corleto; Lidia D'Alonzo; Ermira Zykaj; Antonella Carnuccio; Francesca Chiesara; Cristiano Pagnini; Salvatore Di Somma; Gianfranco Delle Fave

    2007-01-01

    Oesophageal ulcers occur mainly as a result of gastrooesophageal reflux disease (GERD). However, pillinduced oesophageal ulcers are a fairly common event.The lesion is mainly due to entrapment of the pill and/or its chemical composition thereof. This case report describes an oesophageal mucosa ulcer occurred in a healthy 35-year old woman who had no previous history of oesophageal disorders and received homeopathic medication. The present case reveals that pill entrapment can occur even in the oesophagus of healthy young individuals and that oesophageal mucosal ulcer can be triggered by substances generally thought devoid of any potentially mucosal aggressive effect.

  13. Bleeding during Pregnancy

    Science.gov (United States)

    ... FAQ090 “Early Pregnancy Loss”). What is an ectopic pregnancy? An ectopic pregnancy occurs when the fertilized egg does not implant ... vaginal bleeding is the only sign of an ectopic pregnancy. Other symptoms may include abdominal, pelvic, or shoulder ...

  14. Optimal subband Kalman filter for normal and oesophageal speech enhancement.

    Science.gov (United States)

    Ishaq, Rizwan; García Zapirain, Begoña

    2014-01-01

    This paper presents the single channel speech enhancement system using subband Kalman filtering by estimating optimal Autoregressive (AR) coefficients and variance for speech and noise, using Weighted Linear Prediction (WLP) and Noise Weighting Function (NWF). The system is applied for normal and Oesophageal speech signals. The method is evaluated by Perceptual Evaluation of Speech Quality (PESQ) score and Signal to Noise Ratio (SNR) improvement for normal speech and Harmonic to Noise Ratio (HNR) for Oesophageal Speech (OES). Compared with previous systems, the normal speech indicates 30% increase in PESQ score, 4 dB SNR improvement and OES shows 3 dB HNR improvement.

  15. The ionic components of normal human oesophageal epithelium.

    Science.gov (United States)

    Hopwood, D; Milne, G; Curtis, M; Nicholson, G

    1979-11-01

    The distribution of cations and anions in normal human oesophageal epithelium has been investigated with the pyroantimonate and silver-osmium tetroxide techniques. There is a discontinuous distribution of both ions in the intercellular space. The ions are associated with various organelles, as has already been described in the literature. Specifically, in the oesophageal epithelium, there are a few deposits of pyroantimonate and occasional silver in the membrane coating granules, but here is no apparent relationship of either ion with the tonofilaments or glycogen particles. The superficial cells are leaky and contain fewer ions than the deeper functional layer cells.

  16. Idiopathic giant oesophageal ulcer and leucopoenia after renal transplantation.

    Science.gov (United States)

    van Boekel, G A J; Volbeda, M; van den Hoogen, M W F; Hilbrands, L B; Berden, J H M

    2012-10-01

    A 45-year-old male recipient of a renal allograft was admitted because of a giant oesophageal ulcer coinciding with leucopoenia. An extensive workup revealed no explanation for the ulcer and leucopoenia. Our final diagnosis by exclusion was an idiopathic giant oesophageal ulcer and late-onset neutropenia as consequences of rituximab induction therapy given during the transplant procedure. The patient fully recovered after treatment with prednisone. However, after four months, the ulcer and leucopoenia recurred and again successfully responded to treatment with prednisone.

  17. Maturation of the lower oesophageal sphincter in the preterm baby.

    OpenAIRE

    1988-01-01

    There are few reported studies of the lower oesophageal sphincter in preterm infants and none has investigated babies of less than 34 weeks gestation. Using a modified manometric technique suitable for use on very low birth weight infants we have measured sphincter pressures on 68 occasions in 25 infants of postconceptional age between 27 and 41 weeks. In even the most preterm infants the lower oesophageal sphincter could be defined. The mean effective sphincter pressure rose from 3.8 mmHg in...

  18. Isolated axillary lymph node metastasis in oesophageal adenocarcinoma.

    Science.gov (United States)

    Toh, Vi Vien; Shirley, Rebecca; Duffy, John; Starley, Ian Francis

    2015-03-01

    Oesophageal adenocarcinoma metastatic to the axilla is a rare occurrence. The authors present a case of a woman who developed an axillary metastasis from a completely excised oesophageal adenocarcinoma with no prior evidence of nodal disease. With aggressive local treatment, including multiple local operations and radiotherapy, she remains alive and disease-free 12 years after her diagnosis following surgical resection of her axillary metastasis with adjuvant radiotherapy. This case report suggests that there are occasions when aggressive local treatment of apparently isolated metastases can result in a cure.

  19. Serum type IV collagen level is predictive for esophageal varices in patients with severe alcoholic disease

    Institute of Scientific and Technical Information of China (English)

    Satoshi Mamori; Yasuyuki Searashi; Masato Matsushima; Kenichi Hashimoto; Shinichiro Uetake; Hiroshi Matsudaira; Shuji Ito; Hisato Nakajima; Hisao Tajiri

    2008-01-01

    AIM: To determine factors predictive for esophageal varices in severe alcoholic disease (SAD).METHODS: Abdominal ultrasonography (US) was performed on 444 patients suffering from alcoholism. Forty-four patients found to have splenomegaly and/ or withering of the right liver lobe were defined as those with SAD. SAD patients were examined by upper gastrointestinal (UGI) endoscopy for the presence of esophageal varices. The existence of esophageal varices was then related to clinical variables.RESULTS: Twenty-five patients (56.8%) had esophageal varices. A univariate analysis revealed a significant difference in age and type IV collagen levels between patients with and without esophageal varices. A logistic regression analysis identified type IV collagen as the only independent variable predictive for esophageal varices (P = 0.017). The area under the curve (AUC) for type IV collagen as determined by the receiver operating characteristic (ROC) for predicting esophageal varices was 0.78.CONCLUSION: This study suggests that the level of type IV collagen has a high diagnostic accuracy for the detection of esophageal varices in SAD.

  20. Balloon-occluded percutaneous transheptic obliteration of isolated vesical varices causing gross hematuria

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Dong Hoon; Kim, Dong Hyun; Kim, Min Seok; Kim, Chul Sung [Department of Urology, College of Medicine, Chosun University, Gwangju (Korea, Republic of)

    2013-01-15

    Gross hematuria secondary to vesical varices is an unusual presentation. We report such a case recurrent gross hematuria in a male patient who had a history of bladder substitution with ileal segments that had been treated by balloon-occluded percutaneous transhepatic obliteration of vesical varices.

  1. Autoimmune pancreatitis complicated by gastric varices: A report of 3 cases

    Institute of Scientific and Technical Information of China (English)

    Norihiro Goto; Jun Mimura; Toshinao Itani; Motohito Hayashi; Yukari Shimada; Tomoaki Matsumori

    2012-01-01

    We present three cases of autoimmune pancreatitis (AIP) complicated by gastric varices.Case 1:A 57-yearold man was diagnosed with AIP complicated by gastric varices and splenic vein obstruction.Splenomegaly was not detected at the time of the diagnosis.The AIP improved using steroid therapy,the splenic vein was reperfused,and the gastric varices disappeared; case 2:A 55-year-old man was diagnosed with AIP complicated by gastric varices,splenic vein obstruction,and splenomegaly.Although the AIP improved using steroid therapy,the gastric varices and splenic vein obstruction did not resolve; case 3:A 68-year-old man was diagnosed with AIP complicated by gastric varices,splenic vein obstruction,and splenomegaly.The gastric varices,splenic vein obstruction,and AIP did not improve using steroid therapy.These three cases suggest that gastric varices or splenic vein obstruction without splenomegaly may be an indication for steroid therapy in patients with AIP because the complications will likely become irreversible over time.

  2. Retroperitoneal Leiomyosarcoma Presenting as Lower Gastrointestinal Bleeding: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Dominic G. Ventura

    2011-01-01

    Full Text Available We report the first known case of a retroperitoneal leiomyosarcoma that presented with an endoscopically defined source of gastrointestinal bleeding in the colon. A 68-year-old male with a history of diverticulosis, hypertension, and hypercholesterolemia who complained of a 3-month history of abdominal pain, nausea, and intermittent hematochezia presented for evaluation of large volume hematochezia and lightheadedness. Colonoscopy revealed left-sided diverticulosis and rectal varices without stigmata of recent bleed. CT scan showed a 26 × 20 × 13 cm heterogeneous retroperitoneal mass and multiple hypodense hepatic lesions. Liver biopsy revealed leiomyosarcoma. In summary, although surgery is the mainstay of treatment, resectability has not improved significantly. Early recognition and aggressive surgery are keys to long-term survival.

  3. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

    Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival and deve......Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival...... and development in connection with ascites, HCC and variceal bleeding. Measurement of HVPG is a simple and safe method and it can, moreover, be used to guide pharmacotherapy for primary and secondary prophylaxis of variceal bleeding. Assessment of HVPG should be available in larger centres that manage portal...

  4. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

    Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival and deve......Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival...... and development in connection with ascites, HCC and variceal bleeding. Measurement of HVPG is a simple and safe method and it can, moreover, be used to guide pharmacotherapy for primary and secondary prophylaxis of variceal bleeding. Assessment of HVPG should be available in larger centres that manage portal...... hypertensive patients....

  5. Approach to the bleeding newborn

    OpenAIRE

    1998-01-01

    Bleeding in the newborn can lead to serious cardiovascular and neurological effects. Routine administration of vitamin K has reduced the incidence of hemorrhagic disease of the newborn, but abnormal bleeding can occur in babies from many causes. A practical approach to the diagnosis and treatment of bleeding in the newborn is described in this article.

  6. Platelet function in bleeding disorders

    NARCIS (Netherlands)

    van Bladel, E.R.

    2013-01-01

    The first bleeding diathesis we studied was hemophilia A. Since FVIII activity level does not always correlate with the bleeding tendency in individual patients, bleeding tendency must also be influenced by other factors. Earlier studies excluded the remaining clotting factors and FVIII genotype as

  7. Transjugular intrahepatic portosystemic shunt combined with esophagogastric variceal embolization in the treatment of a large gastrorenal shunt

    Institute of Scientific and Technical Information of China (English)

    Qin; Jiang; Ming-Quan; Wang; Guo-Bing; Zhang; Qiong; Wu; Jian-Ming; Xu; De-Run; Kong

    2016-01-01

    AIM: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) combined with stomach and esophageal variceal embolization(SEVE) in cirrhotic patients with a large gastrorenal vessel shunt(GRVS).METHODS: Eighty-one cirrhotic patients with gastric variceal bleeding(GVB) associated with a GRVS were enrolled in the study and accepted TIPS combined with SEVE(TIPS + SEVE), by which portosystemic pressuregradient(PPG), biochemical, TIPS-related complications, shunt dysfunction, rebleeding, and death were evaluated. RESULTS: The PPGs before TIPS were greater than 12 mmH g in 81 patients. TIPS + SEVE treatment caused a significant decrease in PPG(from 37.97 ± 6.36 mmH g to 28.15 ± 6.52 mm Hg, t = 19.22, P < 0.001). The percentage of reduction in PPG was greater than 20%from baseline. There were no significant differences in albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin, prothrombin time, or Child-Pugh score before and after operation. In all patients, rebleeding rates were 3%, 6%, 12%, 18%, and 18% at 1,3, 6, 12, and 18 mo, respectively. Five patients(6.2%)were diagnosed as having hepatic encephalopathy. The rates of shunt dysfunction were 0%, 4%, 9%, 26%,and 26%, at 1, 3, 6, 12, and 18 mo, respectively. The cumulative survival rates in 1, 3, 6, 12, and 18 mo were100%, 100%, 95%, 90%, and 90%, respectively.CONCLUSION: Our preliminary results indicated that the efficacy and safety of TIPS + SEVE were satisfactory in cirrhotic patients with GVB associated with a GRVS(GVB + GRVS).

  8. Perforating oesophageal carcinoma presenting as necrotizing fasciitis of the neck.

    Science.gov (United States)

    Francque, S M; Van Laer, C; Struyf, N; Vermeulen, P; Corthouts, B; Jorens, P G

    2001-10-01

    A patient with a history of schizophrenia was admitted to our hospital in an already severe stage of necrotizing fasciitis of the neck, complicated with mediastinitis and gangrene. Later on, he also developed a vena cava superior syndrome and sepsis. In the few cases and small series described in the literature, necrotizing fasciitis of the neck is usually associated with surgery or trauma. Less frequently, an orodental or pharyngeal infection, often innocuous, is the underlying cause. None of these causes could be identified in our patient. Initially, on computer-assisted tomography (CT) scan, a tracheal rupture was suspected, but this diagnosis could not be confirmed on bronchoscopic examination. On gastroscopy, a stenotic oesophageal segment was discovered. Biopsy of this segment showed a poorly differentiated squamous cell carcinoma. The patient died in sepsis. Autopsy confirmed the presence of a large proximal oesophageal tumour with perforation. As far as we know, no case of a necrotizing fasciitis of the neck caused by perforation of a formerly unknown oesophageal carcinoma has been reported. Even mediastinitis, with or without gangrene, is rarely associated with oesophageal cancer, and in the few cases reported it is always due to fistulization after surgery.

  9. Spontaneous oesophageal rupture with duodenal atresia in a newborn infant.

    OpenAIRE

    1981-01-01

    A newborn infant with spontaneous oesophageal rupture associated with duodenal atresia is described. The diagnosis was established by the pattern of hydropneumothorax on the chest x-ray film and by the aspiration of gastric juice by thoracocentesis. Necropsy showed a tear, which extended from the oesophagogastric junction to the upper portion of the stomach.

  10. Progressive silencing of p14ARF in oesophageal adenocarcinoma.

    Science.gov (United States)

    Huang, Yinghui; Peters, Christopher J; Fitzgerald, Rebecca C; Gjerset, Ruth A

    2009-02-01

    The frequency of oesophageal adenocarcinoma is increasing in Western countries for unknown reasons, and correlates with a corresponding increase in the pre-malignant condition, Barrett's Oesophagus, which raises the risk of adenocarcinoma by some 40- to 125-fold. We have examined how disease progression correlates with changes in expression of the p14ARF (ARF) tumour suppressor, a key regulator of the p53 tumour suppressor pathway that is silenced in some 30% of cancers overall, but for which a role in oesophageal cancer is unclear. We have used quantitative PCR, RT-PCR, methylation-specific PCR and chromatin-immunoprecipitation to examine the regulation and function of ARF in oesophageal adenocarcinoma tissue specimens and cell lines. We find highly significant reductions (Poesophageal epithelium to Barrett's Oesophagus to adenocarcinoma, with 57/76 (75%) adenocarcinomas displaying undetectable levels of ARF expression. Retention of ARF expression in adenocarcinoma is a highly significant indicator of increased survival (Padenocarcinoma cell lines and can be reversed by 5-aza-2'-deoxycytidine. The results suggest that silencing of ARF is involved in the pathogenesis of oesophageal adenocarcinoma and show that either DNA or histone methylation can provide the primary mechanism for ARF gene silencing. Silencing of ARF could provide a useful marker for increased risk of progression and poor prognosis.

  11. GATA6 expression in Barrett's oesophagus and oesophageal adenocarcinoma

    NARCIS (Netherlands)

    Pavlov, Kirill; Honing, Judith; Meijer, Coby; Boersma-van Ek, Wytske; Peters, Frans T. M.; van den Berg, Anke; Karrenbeld, Arend; Plukker, John T. M.; Kruyt, Frank A. E.; Kleibeuker, Jan H.

    2015-01-01

    Background: Barrett's oesophagus can progress towards oesophageal adenocarcinoma through a metaplasia-dysplasia-carcinoma sequence, but the underlying mechanisms are poorly understood. The transcription factor GATA6 is known to be involved in columnar differentiation and proliferation, and GATA6 gen

  12. GATA6 expression in Barrett's oesophagus and oesophageal adenocarcinoma

    NARCIS (Netherlands)

    Pavlov, Kirill; Honing, Judith; Meijer, Coby; Boersma-van Ek, Wytske; Peters, Frans T.M.; van den Berg, Anke; Karrenbeld, Arend; Plukker, John T.M.; Kruyt, Frank A.E.; Kleibeuker, Jan H.

    2015-01-01

    BACKGROUND: Barrett's oesophagus can progress towards oesophageal adenocarcinoma through a metaplasia-dysplasia-carcinoma sequence, but the underlying mechanisms are poorly understood. The transcription factor GATA6 is known to be involved in columnar differentiation and proliferation, and GATA6 gen

  13. Impact of gastro-oesophageal reflux on microRNA expression, location and function

    Directory of Open Access Journals (Sweden)

    Smith Cameron M

    2013-01-01

    Full Text Available Abstract Background Ulceration of the oesophageal squamous mucosa (ulcerative oesophagitis is a pathological manifestation of gastro-oesophageal reflux disease, and is a major risk factor for the development of Barrett’s oesophagus. Barrett’s oesophagus is characterised by replacement of reflux-damaged oesophageal squamous epithelium with a columnar intestinal-like epithelium. We previously reported discovery of microRNAs that are differentially expressed between oesophageal squamous mucosa and Barrett’s oesophagus mucosa. Now, to better understand early steps in the initiation of Barrett’s oesophagus, we assessed the expression, location and function of these microRNAs in oesophageal squamous mucosa from individuals with ulcerative oesophagitis. Methods Quantitative real-time PCR was used to compare miR-21, 143, 145, 194, 203, 205 and 215 expression levels in oesophageal mucosa from individuals without pathological gastro-oesophageal reflux to individuals with ulcerative oesophagitis. Correlations between microRNA expression and messenger RNA differentiation markers BMP-4, CK8 and CK14 were analyzed. The cellular localisation of microRNAs within the oesophageal mucosa was determined using in-situ hybridisation. microRNA involvement in proliferation and apoptosis was assessed following transfection of a human squamous oesophageal mucosal cell line (Het-1A. Results miR-143, miR-145 and miR-205 levels were significantly higher in gastro-oesophageal reflux compared with controls. Elevated miR-143 expression correlated with BMP-4 and CK8 expression, and elevated miR-205 expression correlated negatively with CK14 expression. Endogenous miR-143, miR-145 and miR-205 expression was localised to the basal layer of the oesophageal epithelium. Transfection of miR-143, 145 and 205 mimics into Het-1A cells resulted in increased apoptosis and decreased proliferation. Conclusions Elevated miR-143, miR-145 and miR-205 expression was observed in

  14. Ineffective oesophageal motility: Manometric subsets exhibit different symptom profiles

    Institute of Scientific and Technical Information of China (English)

    Horst Gunter Haack; Ross David Hansen; Allison Malcolm; John Edward Kellow

    2008-01-01

    AIM: To compare the demographic and clinical features of different manometric subsets of ineffective oesophageal motility (IOM; defined as ≥30% wet swallows with distal contractile amplitude <30 mmHg), and to determine whether the prevalence of gastro-oesophageal reflux differs between IOM subsets.METHODS: Clinical characteristics of manometric subsets were determined in 100 IOM patients (73 female, median age 58 years) and compared to those of 100 age-and gender-matched patient controls with oesophageal symptoms, but normal manometry. Supine oesophageal manometry was performed with an eight-channel DentSleeve water-perfused catheter, and an ambulatory pH study assessed gastrooesophageal reflux.RESULTS: Patients in the IOM subset featuring a majority of low-amplitude simultaneous contractions (LASC) experienced less heartburn (prevalence 26%), but more dysphagia (57%) than those in the IOM subset featuring low-amplitude propagated contractions (LAP; heartburn 70%, dysphagia 24%; both P≤0.01). LASC patients also experienced less heartburn and more dysphagia than patient controls (heartburn 68%, dysphagia 11%; both P<0.001). The prevalence of heartburn and dysphagia in IOM patients featuring a majority of non-transmitted sequences (NT) was 54% (P=0.04 vs LASC) and 36% (P<0.01 vs controls), respectively. No differences in age and gender distribution, chest pain prevalence, acid exposure time (AET) and symptom/reflux association existed between IOM subsets, or between subsets and controls.CONCLUSION: IOM patients with LASC exhibit a different symptom profile to those with LAP, but do not differ in gastro-oesophageal reflux prevalence. These findings raise the possibility of different pathophysiological mechanisms in IOM subsets, which warrants further investigation.

  15. Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study

    Science.gov (United States)

    Goenka, Mahesh Kumar; Rai, Vijay Kumar; Goenka, Usha; Tiwary, Indrajit Kumar

    2017-01-01

    Background/Aims The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC. Methods Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip. Results All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding. Conclusions In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding. PMID:27802375

  16. Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    B.F. Kessing; J.M. Conchillo; A.J. Bredenoord; A.J.P.M. Smout; A.A.M. Masclee

    2011-01-01

    P>Background Transient lower oesophageal sphincter relaxations (TLOSR) are considered the physiological mechanism that enables venting of gas from the stomach and appear as sphincter relaxations that are not induced by swallowing. It has become increasingly clear that most reflux episodes occur duri

  17. A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: A report from a working group on gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Y. Vandenplas (Yvan); A. Ashkenazi (A.); D. Belli (D.); N. Boige (N.); J. Bouquet (Jan); S. Cadranel (S.); J.P. Cezard (J.); S. Cucchiara (S.); C. Dupont (C.); K. Geboes (K.); F. Gottrand; H.S.A. Heymans (Hugo); C. Jasinski (C.); C.M.F. Kneepkens (Frank); S. Koletzko (Sybille); P. Milla (Peter); J.F. Mougenot (J.); D. Nusslé (D.); J. Navarro (J.); S.J. Newell (S.); E. Olafsdottir (E.); S. Peeters (S.); A. Ravelli (A.); I. Polanco (I.); B. Sandhu; J.J. Tolboom (Jules)

    1993-01-01

    textabstractIn this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesoph

  18. Doppler assessment of hepatic venous waves for predicting large varices in cirrhotic patients

    Directory of Open Access Journals (Sweden)

    Thomas Joseph

    2011-01-01

    Full Text Available Background/Aim: Color Doppler examination of changes in hepatic venous waveforms is being evaluated as a means of prediction of severity of portal hypertension and presence of esophageal varices. Normal hepatic venous waveform shows a triphasic pattern. In cirrhosis, this pattern changes to a biphasic or monophasic pattern. We aimed to study the sensitivity of loss of normal hepatic venous waveforms in predicting large varices in a cross-sectional analysis. Materials and Methods: All patients, admitted or attending the outpatient department, with a diagnosis of cirrhosis were included in the study. All patients were subjected to oesophagogastroduodenoscopy and Color Doppler examination, and waveform patterns in hepatic vein were recorded. The sensitivity and specificity of changes in waveform in detecting large varices were studied. Results : A total of 51 cases were examined. Triphasic waves were seen in 4 (7.8% cases, biphasic in 26 (51% cases, and monophasic in 21 (41.2% cases. Small varices were seen in 30 (58.8% cases and large varices in 21 (41.2% cases. The sensitivity of loss of the triphasic wave pattern in detecting significant varices (Grade 3 or 4 was very high (95.23% and negative predictive value was also high (75%. Severity of liver disease as indicated by Child-Pugh and MELD scores did not correlate with changes in hepatic venous waveforms. Conclusion : Loss of triphasic hepatic venous waveform is highly sensitive in predicting significant varices in patients with cirrhosis.

  19. Association of left renal vein variations and pelvic varices in abdominal MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Koc, Zafer [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey); Baskent Universitesi Adana Hastanesi, Adana (Turkey); Ulusan, Serife; Oguzkurt, Levent [Baskent University, Adana Teaching and Medical Research Center, Department of Radiology, Adana (Turkey)

    2007-05-15

    The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women. (orig.)

  20. Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension(26 years clinical observation)

    Institute of Scientific and Technical Information of China (English)

    CHEN Jisheng; HUO Jinshan; ZHANG Hongwei; SHANG Changzhen; CHEN Rufu; ZHANG Jie; Obetien Mapudengo; CHEN Yajin; ZHANG Lei

    2007-01-01

    The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated.In this study,we evaluated the effectiveness of a new treatment strategy:splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects:clinical observation,splenic immunology and portal dynamics.From 1979 to 2005,274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes,which were then compared with those of the traditional surgery treatment.From 1999 to 2002,a randomized control trial (RCT) was performed on 40 patients to compare their immune function after operation.From 1994 to 2004,another RCT.was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography (3D DEC MR.A) investigation after operation.Among 274 patients (mean age 41.8 years),the emergency operative mortality (4.4%),selective operative mortality (2.2%),complication rate (17.9%),morbidity of hepatic encephalopathy ( < 1%),bleeding rate of portal hypertension gastritis (PHG) (9.1%),and morbidity of hepatic carcinoma (8%) were similar to those under traditional operation;the spleen immunology function (Tuftsin,IgM)decreased among the groups 2 months after operation.Through 3D DCE MRA,the cross section area,the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups,the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group.Splenic auto transplantation and esophageal transection anastomosis are a safe,effective,and reasonable treatment strategy for portal hypertension with varicial bleeding.It can not only correct hypersplenism but also completely stanch blood,and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

  1. Oesophagus side effects related to the treatment of oesophageal cancer or radiotherapy of other thoracic malignancies.

    Science.gov (United States)

    Adebahr, Sonja; Schimek-Jasch, Tanja; Nestle, Ursula; Brunner, Thomas B

    2016-08-01

    The oesophagus as a serial organ located in the central chest is frequent subject to "incidental" dose application in radiotherapy for several thoracic malignancies including oesophageal cancer itself. Especially due to the radiosensitive mucosa severe radiotherapy induced sequelae can occur, acute oesophagitis and strictures as late toxicity being the most frequent side-effects. In this review we focus on oesophageal side effects derived from treatment of gastrointestinal cancer and secondly provide an overview on oesophageal toxicity from conventional and stereotactic fractionated radiotherapy to the thoracic area in general. Available data on pathogenesis, frequency, onset, and severity of oesophageal side effects are summarized. Whereas for conventional radiotherapy the associations of applied doses to certain volumes of the oesophagus are well described, the tolerance dose to the mediastinal structures for hypofractionated therapy is unknown. The review provides available attempts to predict the risk of oesophageal side effects from dosimetric parameters of SBRT.

  2. Chemotherapy-Induced Oesophageal Stricture in a Child with Osteosarcoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Daichi Ishimaru

    2010-01-01

    Full Text Available Treatment with a combination of chemotherapy and radiotherapy is known to be associated with oesophageal stricture in both children and adults with malignancies. However, oesophageal stricture resulting from chemotherapy alone is a rare complication, with few reports on it. We experienced a rare paediatric case of oesophageal stricture caused by chemotherapy for osteosarcoma of the left distal femur. After completion of the chemotherapy course, the patient showed dysphagia caused by the oesophageal stricture and underwent balloon dilatation for the oesophageal stricture. After balloon dilatation, he was able to ingest solid foods, and the oesophagus was normal without any strictures at the last follow-up (20 months after ballooning. Therefore, oesophageal stricture should be considered as a complication of treatment with chemotherapy alone in children with malignancies.

  3. Story: A Bleeding Watermelon

    Directory of Open Access Journals (Sweden)

    Nor bzang

    2010-12-01

    Full Text Available A Bleeding Watermelon was written by Norsang (Nor bzang;b. 1988, a native of Dpa ris (Rab rgyas (Huazangsi 华藏寺 Township, Tianzhu 天祝 Tibetan Autonomous County,Gansu 甘肃 Province. Norsang writes: I heard that a university student opened an elevator door in a campus building still under construction. The elevator shaft was empty and he fell to his death. Many people had questions about his death. This inspired me to write this story.

  4. Vitamin D, calcium and dairy intake, and risk of oesophageal adenocarcinoma and its precursor conditions.

    Science.gov (United States)

    Mulholland, Helen G; Murray, Liam J; Anderson, Lesley A; Cantwell, Marie M

    2011-09-01

    Evidence is accumulating that vitamin D may be protective against carcinogenesis, although exceptions have been observed for some digestive tract neoplasms. The aim of the present study was to explore the association between dietary vitamin D and related nutrients and the risk of oesophageal adenocarcinoma and its precursor conditions, Barrett's oesophagus and reflux oesophagitis. In an all-Ireland case-control study conducted between March 2002 and July 2005, 218 oesophageal adenocarcinoma patients, 212 Barrett's oesophagus patients, 208 reflux oesophagitis patients and 252 population-based controls completed a 101-item FFQ, and provided lifestyle and demographic information. Multiple logistic regression analysis was applied to examine the association between dietary intake and disease risk. Oesophageal adenocarcinoma risk was significantly greater for individuals with the highest compared with the lowest tertile of vitamin D intake (OR 1·99, 95 % CI 1·03, 3·86; P for trend = 0·02). The direct association could not be attributed to a particular vitamin D food source. Vitamin D intake was unrelated to Barrett's oesophagus and reflux oesophagitis risk. No significant associations were observed for Ca or dairy intake and oesophageal adenocarcinoma, Barrett's oesophagus or reflux oesophagitis development. High vitamin D intake may increase oesophageal adenocarcinoma risk but is not related to reflux oesophagitis and Barrett's oesophagus. Ca and dairy product intake did not influence the development of these oesophageal lesions. These findings suggest that there may be population subgroups at an increased risk of oesophageal adenocarcinoma if advice to improve vitamin D intake from foods is implemented. Limited work has been conducted in this area, and further research is required.

  5. Barrett’s oesophagus and oesophageal adenocarcinoma: time for a new synthesis

    OpenAIRE

    2010-01-01

    The public health importance of Barrett’s oesophagus lies in its association with oesophageal adenocarcinoma. The incidence of oesophageal adenocarcinoma has risen at an alarming rate over the past four decades in many regions of the Western world and there are indications that the incidence of this disease is on the rise in Asian populations where it has been rare. Much has been learned of host and environmental risk factors that affect the incidence of oesophageal adenocarcinoma and data in...

  6. Behandling af blødende øsofagusvaricer med selvekspanderende metalstenter

    DEFF Research Database (Denmark)

    Dahlerup, Jens F; Kruse, Aksel; Grønbaek, Henning;

    2007-01-01

    We report that haemostasis was obtained by the use of SEMS in two patients with bleeding oesophageal varices which failed conventional therapy (vasoactive drugs, antibiotics, endoscopy, and Sengstaken balloon tamponade). One patient subsequently died of sepsis; the other was treated with TIPS...

  7. Splanchnic haemodynamics after intravenous terlipressin in anaesthetised healthy pigs

    DEFF Research Database (Denmark)

    Hansen, EF; Strandberg, C; Højgaard, L;

    1999-01-01

    BACKGROUND/AIMS: Terlipressin is used for the treatment of bleeding oesophageal varices. We evaluated the effects of terlipressin on hepatic haemodynamics, with special focus on the interactions between portal venous flow and hepatic arterial flow over time. Secondly, we evaluated the estimated h...

  8. Svær hyponatriæmi ved terlipressinbehandling

    DEFF Research Database (Denmark)

    Poulsen, Anja; Krag, Aleksander

    2013-01-01

    to terlipressin treatment. A 60-year-old woman with bleeding oesophageal varices was treated with terlipressin 2 mg every fourth hour. After 24 hours of treatment she was somnolent, and the sodium concentration had dropped from 127 mmol/l to 107 mmol/l. Hyponatraemia is an important adverse event in terlipressin...

  9. Svær hyponatriæmi ved Terlipressin behandling

    DEFF Research Database (Denmark)

    Poulsen, Anja; Krag, Aleksander

    2013-01-01

    to terlipressin treatment. A 60-year-old woman with bleeding oesophageal varices was treated with terlipressin 2 mg every fourth hour. After 24 hours of treatment she was somnolent, and the sodium concentration had dropped from 127 mmol/l to 107 mmol/l. Hyponatraemia is an important adverse event in terlipressin...

  10. Bacterial translocation and cardiovascular complications of cirrhosis. Authors' response to letter

    DEFF Research Database (Denmark)

    Møller, Søren; Henriksen, Jens Henrik

    2008-01-01

    dysfunction have been somewhat unpredictable.3-5 In two conditions, however, a direct relationship between bacterial infection and increased mortality have been proved, namely infections in relation to bleeding from oesophageal varices and spontaneous bacterial peritonitis.6-8 In both of these complications...

  11. Splanchnic haemodynamics after intravenous terlipressin in anaesthetised healthy pigs

    DEFF Research Database (Denmark)

    Hansen, E F; Strandberg, C; Højgaard, L;

    1999-01-01

    Terlipressin is used for the treatment of bleeding oesophageal varices. We evaluated the effects of terlipressin on hepatic haemodynamics, with special focus on the interactions between portal venous flow and hepatic arterial flow over time. Secondly, we evaluated the estimated hepatic blood flow...

  12. Effect of octreotide on systemic, central, and splanchnic haemodynamics in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Brinch, K; Henriksen, Jens Henrik Sahl;

    1997-01-01

    BACKGROUND/AIMS: Cirrhosis with portal hypertension is associated with changes in the splanchnic and systemic haemodynamics, and subsequent complications, such as bleeding from oesophageal varices, have led to the introduction of long-acting somatostatin analogues in the treatment of portal...

  13. Oesophageal food impaction in achalasia treated with Coca-Cola and nifedipine.

    Science.gov (United States)

    Koumi, Andriani; Panos, Marios Zenon

    2010-01-01

    Achalasia is characterised by the loss of peristaltic movement in the distal oesophagus and failure of the lower oesophageal sphincter relaxation, which results in impaired oesophageal emptying. We report a case of a 92-year-old frail woman with a history of achalasia, who presented with acute oesophageal obstruction due to impaction of a large amount of food material. She was treated successfully with nifedipine, in combination with Coca-Cola (original product, not sugar free), so avoiding the risks associated with repeated endoscopic intubation and piecemeal removal of the oesophageal content.

  14. Dietary factors and the risks of oesophageal adenocarcinoma and Barrett's oesophagus.

    Science.gov (United States)

    Kubo, Ai; Corley, Douglas A; Jensen, Christopher D; Kaur, Rubinder

    2010-12-01

    Incidence rates for oesophageal adenocarcinoma have increased by over 500% during the past few decades without clear reasons. Gastro-oesophageal reflux disease, obesity and smoking have been identified as risk factors, although the demographic distribution of these risk factors is not consistent with the demographic distribution of oesophageal adenocarcinoma, which is substantially more common among whites and males than any other demographic groups. Numerous epidemiological studies have suggested associations between dietary factors and the risks of oesophageal adenocarcinoma and its precursor, Barrett's oesophagus, though a comprehensive review is lacking. The main aim of the present review is to consider the evidence linking dietary factors with the risks of oesophageal adenocarcinoma, Barrett's oesophagus, and the progression from Barrett's oesophagus to oesophageal adenocarcinoma. The existing epidemiological evidence is strongest for an inverse relationship between intake of vitamin C, β-carotene, fruits and vegetables, particularly raw fruits and vegetables and dark green, leafy and cruciferous vegetables, carbohydrates, fibre and Fe and the risk of oesophageal adenocarcinoma and Barrett's oesophagus. Patients at higher risk for Barrett's oesophagus and oesophageal adenocarcinoma may benefit from increasing their consumption of fruits and vegetables and reducing their intake of red meat and other processed food items. Further research is needed to evaluate the relationship between diet and the progression of Barrett's oesophagus to oesophageal adenocarcinoma. Evidence from cohort studies will help determine whether randomised chemoprevention trials are warranted for the primary prevention of Barrett's oesophagus or its progression to cancer.

  15. Initial assessment and management of patients with nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Bethea, Emily D; Travis, Anne C; Saltzman, John R

    2014-01-01

    Upper gastrointestinal bleeding (UGIB) is a substantial clinical and economic burden, with an estimated mortality rate between 3% and 15%. The initial management starts with hemodynamic assessment and resuscitation. Blood transfusions may be needed in patients with low hemoglobin levels or massive bleeding, and patients who are anticoagulated may require administration of fresh frozen plasma. Patients with significant bleeding should be started on a proton-pump inhibitor infusion, and if there is concern for variceal bleeding, an octreotide infusion. Patients with UGIB should be stratified into low-risk and high-risk categories using validated risk scores. The use of these risk scores can aid in separating low-risk patients who are suitable for outpatient management or early discharge following endoscopy from patients who are at increased risk for needing endoscopic intervention, rebleeding, and death. Upper endoscopy after adequate resuscitation is required for most patients and should be performed within 24 hours of presentation. Key to improving outcomes is appropriate initial management of patients presenting with UGIB.

  16. Nonsteriodal Antiinflamatory Drugs As A Risk Factor Of Gastro-Oesophageal Reflux Oesophagitis, And Posterior Laryngitis In Arthritic Patients

    Directory of Open Access Journals (Sweden)

    Mahmoud A.Saleh M.D*, Khaled H.Abdel Mageed**, Kadry

    2001-06-01

    Full Text Available Non steroidal anti inflammatory drugs (NSAIDs are known to cause ulcers of the stomach and to a lesser degree, the duodenum. Consumption of NSAIDs has been associated with the infrequent occurrence of ulcers at other locations, such as the jejunum, ileum and colon. Several studies have suggested that consumption of NSAIDS also constitutes a risk factor for the development of erosive oesophagitis, including oesophageal strictures. It is now documented that NSAIDS are associated with gastro-oesophageal reflux disease (GERD. It was found recently that GERD is associated with a variety of laryngeal conditions and symptoms, of which "reflux laryngitis" is the most common. AIM OF THE WORK: is to study the effect of NSAIDs on the development of laryngitis in patients with GERD. PATIENTS AND METHODS: study included 60 patients, 42 males and 18 females aged between 26 ­ 52 years old (mean 37.9, a detailed history was taken from all patients. All the sixty patients were suspected to have GERD based on symptoms including acid reflux, Group I: - 40 patients were receiving daily-recommended doses of NSAIDs for at least one month for a diagnosed rheumatological disease, Group II: - 20 patients who were diagnosed as GERD, and were not receiving any NSAIDs for at least one month prior to the present study. The sixty patients were subjected to upper gastrointestinal endoscopy. Patients who were diagnosed as GERD with or without oesophagitis were subjected to ENT fibro-optic laryngoscopy. RESULTS: 42% of all patients with GERD have hoarseness of voice, 30% have recurrent chocking, 53% have excessive throat cleaning. Postglottic oedema, arytenoid oedema, vocal fold oedema, were all significantly higher in group I than in group II. CONCLUSION: The chronic use of NSAIDs can be considered as a risk factor for developing GERD, erosive oesophagitis with or without subsequent posterior laryngitis. Laryngoscopy may have a predictive value for the occurrence of GERD in

  17. Cardiovascular effects of oesophageal dilation under general anaesthesia

    DEFF Research Database (Denmark)

    Jakobsen, C H; Rasmussen, V; Rosenberg, J

    1999-01-01

    under general anaesthesia. Ten consecutive patients with benign oesophageal strictures were evaluated. Arterial oxygen saturation was measured by continuous pulse oximetry, ECG was recorded continuously with a Holter tape recorder, and blood pressure was measured non-invasively every five minutes during...... the procedure. Four patients developed significant hypotension at the time of balloon inflation with two patients requiring medical intervention to re-establish sufficient cardiovascular function. Tachycardia and ST-deviation occurred in four and three patients, respectively, during the general anaesthesia......, but was not associated with the actual time of oesophageal distension. Thus, all cases of myocardial ischaemia were related to the time of extubation. No lasting complications were seen, and all patients could be discharged a maximum of 24 hours after the procedure. Pneumatic dilation of the oesophagus under general...

  18. An oesophageal thermal tube for rewarming in hypothermia.

    Science.gov (United States)

    Kristensen, G; Gravesen, H; Benveniste, D; Jordening, H

    1985-11-01

    Five dogs were cooled externally with ice-bags to rectal temperatures of 21.8-24.8 degrees C. Rewarming was performed with a specially constructed double-lumen oesophageal tube with circulating water at 42 degrees C. With this device, rewarming of the dogs to 30 degrees C took place in 60-102 min (mean 82 min). Up to a temperature of 31 degrees C (the "cardiac safety temperature"), the rise in blood temperature was 4.5 degrees C/h +/- 0.79 (s.d.). Calculation of a "rewarming efficiency index" showed an inverse relationship between surface area and temperature rise per hour. The efficiency of this rewarming method is comparable to that of peritoneal dialysis. No after-drop in temperature was observed and there were no other complications during these experiments. Rewarming with an oesophageal thermal tube is very simple and safe to use.

  19. MiR-193b promotes autophagy and non-apoptotic cell death in oesophageal cancer cells

    NARCIS (Netherlands)

    J. Nyhan (Michelle); R. O'Donovan (Tracey); W.M.A. Boersma (Antonius); E.A.C. Wiemer (Erik); S.L. McKenna (Sharon)

    2016-01-01

    markdownabstract__Background:__ Successful treatment of oesophageal cancer is hampered by recurrent drug resistant disease. We have previously demonstrated the importance of apoptosis and autophagy for the recovery of oesophageal cancer cells following drug treatment. When apoptosis (with autophagy)

  20. Alcohol consumption, cigarette smoking and risk of subtypes of oesophageal and gastric cancer: A prospective cohort study

    NARCIS (Netherlands)

    Steevens, J.; Schouten, L.J.; Goldbohm, R.A.; Brandt, P.A. van den

    2010-01-01

    Objective: Alcohol consumption and cigarette smoking may be differentially associated with oesophageal squamous cell carcinoma (OSCC), oesophageal adenocarcinoma (OAC), gastric cardia adenocarcinoma (GCA) and gastric non-cardia adenocarcinoma (GNCA). However, because this was based on retrospective

  1. Impact of the inflammatory microenvironment on T-cell phenotype in the progression from reflux oesophagitis to Barrett oesophagus and oesophageal adenocarcinoma.

    Science.gov (United States)

    Kavanagh, Maria E; Conroy, Melissa J; Clarke, Niamh E; Gilmartin, Niamh T; O'Sullivan, Katie E; Feighery, Ronan; MacCarthy, Finbar; O'Toole, Dermot; Ravi, Narayanasamy; Reynolds, John V; O'Sullivan, Jacintha; Lysaght, Joanne

    2016-01-01

    The incidence of oesophageal adenocarcinoma (OAC), arising from reflux-induced Barrett oesophagus (BO), is increasing dramatically. T-cells have recently been implicated in the initiation of oesophagitis; however, their role in the progression from oesophagitis to BO and OAC has not been fully elucidated. Previous studies have examined the secreted cytokines from oesophageal tissue during disease progression but this study is the first to examine the activation phenotype and the inflammatory profile of CD4(+) and CD8(+) T-cells in human oesophagitis, BO and OAC tissue. Results demonstrated significantly higher levels of IL-4 producing CD4(+) T-cells and secreted levels of IL-6, confirming a Th2 phenotype in BO. In OAC tissue, both pro- and anti-inflammatory cytokines were secreted, with significantly higher levels of IL-6, IL-1β, TNF-α, IFN-γ, IL-2 and IL-10 compared with normal oesophageal tissue. In addition, CD4(+) T-cells infiltrating OAC tissue displayed a decreased activation profile, with significantly lower CD45RO and CD69 expression compared with normal tissue. Data from this study suggest that factors in the tissue microenvironment may alter T-cell phenotype and function early during oesophageal disease progression and may represent targets for immune intervention.

  2. Management of Gastric Varices in the Pediatric Population with Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Utilizing Sodium Tetradecyl Sulfate Foam Sclerosis with or without Partial Splenic Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Saad, Wael E. A., E-mail: wspikes@yahoo.com; Anderson, Curtis L., E-mail: dranderson@southfloridavascular.com [University of Virginia Health System, Department of Radiology, Division of Vascular Interventional Radiology (United States); Patel, Rahul S., E-mail: patelr516@gmail.com [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States); Schwaner, Sandra, E-mail: sls5c@virginia.edu [University of Virginia Health System, Department of Radiology, Division of Vascular Interventional Radiology (United States); Caldwell, Stephen, E-mail: shc5c@virginia.edu [University of Virginia Health System, Department of Medicine, Division of Gastroenterology (United States); Pelletier, Shawn, E-mail: sjp7t@virginia.edu; Angle, John, E-mail: jfa2h@virginia.edu; Matsumoto, Alan H., E-mail: ahm4d@virginia.edu [University of Virginia Health System, Department of Radiology, Division of Vascular Interventional Radiology (United States); Fischman, Aaron M., E-mail: aaron.fischman@mountsinai.org [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States)

    2015-02-15

    It is unknown whether spontaneous gastrorenal shunts actually develop in the pediatric population. The minimum age documented in studies from Asia is 32 (range 32–44) years. This study describes three pediatric patients undergoing balloon-occluded retrograde transvenous obliteration (BRTO) for bleeding gastric varices with two of the three patients undergoing combined partial splenic embolization. The first BRTO is a selective-BRTO via a surgical splenorenal shunt (15 years old) and the other two patients underwent conventional-BRTO via a spontaneous gastrorenal shunt (8 and 14 years old). The recurrent significant bleeding that they exhibited before the combined endovascular therapy did not recur for an average of 7.1 (range 1.4–14) months. In the second patient, quantitative digitally subtracted angiography was utilized to evaluate the inline portal venous flow before and after BRTO.

  3. Gastrointestinal bleeding under dabigatran

    Directory of Open Access Journals (Sweden)

    C Stöllberger

    2014-01-01

    Full Text Available Dabigatran-absorption is dependent on the intestinal P-glycoprotein (P-gp-system, and P-gp activity is modulated by several drugs. We report an 83-old female with atrial fibrillation who developed gastrointestinal bleeding. She was under a therapy with non-steroidal anti-inflammatory drugs (NSAID and P-gp-modulating drugs and renal function was impaired. We conclude that NSAID and P-gp-modulating drugs should be avoided in dabigatran-treated patients. If renal function deteriorates the dabigatran-dosage should be reduced or the therapy should be stopped. There is an urgent need to increase knowledge about drug interactions with dabigatran.

  4. The application of transabdominal 3D ultrasound for the diagnosis of gastric varices: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Hitoshi, E-mail: maru-cib@umin.ac.jp; Kamezaki, Hidehiro, E-mail: ugn29814@yahoo.co.jp; Kondo, Takayuki, E-mail: takakondonaika@yahoo.co.jp; Sekimoto, Tadashi, E-mail: tad_sekimoto@yahoo.co.jp; Shimada, Taro, E-mail: bobtaro51@yahoo.co.jp; Takahashi, Masanori, E-mail: machat1215@yahoo.co.jp; Yokosuka, Osamu, E-mail: yokosukao@faculty.chiba-u.jp

    2013-09-15

    Objective: The aim of this study was to determine the feasibility of using transabdominal three-dimensional (3D) colour Doppler ultrasound as a non-invasive tool to demonstrate and quantify gastric varices. Subjects and methods: A phantom study compared the 3D water flow volume data in a hose with the actual volume inside the hose at three different flow velocities. The prospective clinical study examined the reliability and reproducibility of 3D volume data for gastric varices (mild 28, moderate 26, large 8) in 62 patients. The 3D images were acquired using the colour Doppler with both convex and micro-convex probes. Results: The phantom study showed a 12.4–17.6% difference between the 3D data and the actual volume with no difference between the two types of probes or three velocities. The detectability of gastric varices was identical between the two probes (54/62, 87.1%). However, the scanning efficiency was significantly greater for the micro-convex probe (66.9 ± 14.1%) than the convex probe (57.3 ± 14%, p = 0.012). Body mass index was the only factor that had a significant relationship with the detectability of varices. The mean volume (mL) of the 3D signal was 0.82 ± 0.74 for mild varices, 5.48 ± 3.84 for moderate varices, and 10.63 ± 6.67 for large varices with significant differences between different grades. The intra-/inter-rater reliability was excellent. Conclusion: The method of 3D colour Doppler ultrasound is reliable and reproducible in the quantitative assessment of vascular volume and is applicable for grading gastric varices. This study may offer a practical usefulness for 3D ultrasonography as an alternative to endoscopy.

  5. Pelvic varices diagnosed with endorectal surface coil magnetic resonance imaging: case report

    Energy Technology Data Exchange (ETDEWEB)

    Gullo, G.; Russ, P.D. [Univ. of Colorado Health Sciences Center, Dept. of Radiology, Denver, Colorado (United States)

    2000-07-01

    Pelvic varices are a well-recognized cause of pain, especially in multiparous women, and are often associated with pelvic congestion syndrome. These dilated veins have been imaged using positive-contrast venography and ultrasonography (US). We present a case of painless pelvic varices that presented as an amorphous, non-specific-appearing parametrial and pericervical mass on computed tomography (CT), but which were diagnosed with magnetic resonance imaging (MRI) using an endorectal surface coil. (author)

  6. A retrospective analysis of ectopic varices in gastrointestinal tract diagnosed by endoscopy

    Institute of Scientific and Technical Information of China (English)

    李楠

    2013-01-01

    Objective To understand the incidence,causes,clinical manifestations and treatment of ectopic varices (EV) in gastrointestinal (GI) tract.Methods GI endoscopic examinations were carried out in 99 783 patients from January 2004 to October 2012 in General Hospital of PLA.Sixty-four cases of ectopic varices in GI tract were discovered.The clinical manifestations of EV patients and treatment were analyzed retrospectively.The

  7. Bleeding complications in immune thrombocytopenia.

    Science.gov (United States)

    Arnold, Donald M

    2015-01-01

    Bleeding manifestations in patients with immune thrombocytopenia (ITP) range from mild skin bruises to life-threatening intracranial hemorrhage (ICH). Severe bleeding is distinctly uncommon when the platelet count is >30 × 10(9)/L and usually only occurs when the platelet count falls administrative databases, the frequency of ICH in patients with ITP is ~0.5% in children and 1.5% in adults. Estimates of severe (non-ICH) bleeding are difficult to obtain because of the lack of standardized case definitions; the lack of a universally accepted, ITP-specific bleeding assessment tool; and the omission of reporting bleeding outcomes in many clinical studies. In practice, the presence of bleeding should dictate whether or not treatment is needed because many patients, especially children, can be safely managed with observation alone. Guiding principles for the management of ITP, based on the bleeding risk are: (1) Decide when treatment is needed and when it can safely be withheld; (2) for patients with chronic ITP, use the least toxic treatment at the lowest dose; (3) emergency treatment of severe thrombocytopenia-associated bleeding requires combination therapy; and (4) early aggressive therapy may result in durable platelet count responses.

  8. The Association of Gum Bleeding with Respiratory Health in a Population Based Study from Northern Europe

    DEFF Research Database (Denmark)

    Real, Francisco Gómez; Pérez Barrionuevo, Laura; Franklin, Karl

    2016-01-01

    symptoms and self-reported COPD. METHODS: A postal questionnaire including questions about respiratory and oral health was sent to general population samples in seven Northern European centres. In 13,409 responders, gum bleeding when brushing teeth was reported always/often by 4% and sometimes by 20......%. Logistic regressions accounted for age, smoking, educational level, centre and gender. Effects of BMI, cardio-metabolic diseases, early life factors, gastro-oesophageal reflux, dental hygiene, nasal congestion, and asthma medication were addressed. RESULTS: Gum bleeding always/often was significantly...... associated with ≥3 asthma symptoms (OR 2.58, 95% CI 2.10-3.18), asthma (1.62 [1.23-2.14]) and self-reported COPD (2.02 [1.28-3.18]). There was a dose-response relationship between respiratory outcomes and gum bleeding frequency (≥3 symptoms: gum bleeding sometimes 1.42 [1.25-1.60], often/always 2.58 [2...

  9. The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

    Institute of Scientific and Technical Information of China (English)

    Peter Schemmer; Frank Decker; Genevieve Dei-Anane; Volkmar Henschel; Klaus Buhl; Christian Herfarth; Stefan Riedl

    2006-01-01

    AIM: To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal (UGI)bleeding under today's therapeutic regimen.METHODS: From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital.Based on the patients' data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis:age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time (PT), gastric ulcer (small curvature), duodenal ulcer (bulbus back wall), Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding,conservative and surgical therapy.RESULTS: Seventy male (58%) and 51 female (42%)patients with a median age of 70 (range: 21-96) years were treated. Their in-hospital mortality was 14%. While 12% (11/91) of the patients died after conservative therapy, 20% (6/30) died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer (n = 36; 30%), gastric ulcer (n = 35; 29%), esophageal varicosis (n = 12; 10%), Mallory-Weiss syndrome (n = 8; 7%), erosive lesions of the mucosa (n = 20;17%), cancer (n = 5; 4%), coagulopathy (n = 4; 3%),lymphoma (n = 2; 2%), benign tumor (n = 2; 2%)and unknown reason (n = 1; 1%). A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer (bulbus back wall)were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis,the location of a bleeding ulcer (bulbus back wall) and patients' gender (male) were of prognostic importance for the clinical outcome (mortality) of patients with a bleeding ulcer.CONCLUSION: Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient's vital threat posed by

  10. Isolated varices over hepatic flexure colon indicating superior mesenteric venous thrombosis caused by uncinate pancreatic head cancer- a case report

    Institute of Scientific and Technical Information of China (English)

    Yu-Pin Ho; Chun-Jung Lin; Ming-Yao Su; Jeng-Hwei Tseng; Cheng-Tang Chiu; Pang-Chi Chen

    2005-01-01

    Very rare cases of varices involving right side colon were reported. Most of them were due to cirrhotic portal hypertension or other primary causes. No report case contributed to pancreatic cancer. Here, we reported a case of uncinate pancreatic cancer with the initial finding of isolated hepatic flexure colon varices. Following studies confirmed isolated varices involving hepatic flexure colon due to pancreatic cancer with occlusion of superior mesenteric vein. From this report, superior mesenteric vein occlusion caused by uncinate pancreatic head cancer should be considered as a differential diagnosis of colon varices.

  11. Reflux oesophagitis in the rat : the damaging action of pancreatic juice : the development of mural fibrosis

    NARCIS (Netherlands)

    H.J. Mud

    1981-01-01

    textabstractThe results obtained in a recent study of surgically induced reflux oesophagitis in rats (Kranendonk, 1980) prompted the study presented in this thesis. In the randomized study by Kranendonk (1980) the reflux of pancreatic juice invariably resulted in oesophagitis; admixture of bile and/

  12. A novel method to detect accidental oesophageal intubation based on ventilation pressure waveforms

    NARCIS (Netherlands)

    Kalmar, Alain F.; Absalom, Anthony; Monsieurs, Koenraad G.

    2012-01-01

    Background: Emergency endotracheal intubation results in accidental oesophageal intubation in up to 17% of patients. This is frequently undetected thereby adding to the morbidity and mortality. No current method to detect accidental oesophageal intubation in an emergency setting is both highly sensi

  13. Oesophageal pseudodiverticulum after foregut duplication cyst excision: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Iuliana D Bobanga

    2016-01-01

    Full Text Available Oesophageal pseudodiverticula rarely occur after excision of benign oesophageal neoplasms. While management and outcomes have been reported in the adult leiomyoma literature, sparse data exist on the occurrence and management of pseudodiverticula after foregut duplication cyst excision. We discuss our experience with a paediatric patient and review relevant literature regarding operative techniques and surgical outcomes.

  14. Inter- and intraobserver variation in the histopathological evaluation of early oesophageal adenocarcinoma

    NARCIS (Netherlands)

    Grotenhuis, Brechtje A.; van Heijl, Mark; ten Kate, Fiebo J. W.; Biermann, Katharina; Offerhaus, G. Johan A.; Wijnhoven, Bas P. L.; Henegouwen, Mark I. van Berge; Tilanus, Hugo W.; van Lanschot, J. Jan B.

    2010-01-01

    Aims According to the classification established by the Japanese Society for Oesophageal Disease, early oesophageal cancer can be subdivided into six successive layers of the mucosa or submucosa, which influences the treatment strategy and prognosis of the individual patient. However, the reproducib

  15. Oesophageal cancer in The Netherlands : Increasing incidence and mortality but improving survival

    NARCIS (Netherlands)

    Crane, Lucia M. A.; Schaapveld, Michael; Visser, Otto; Louwmand, Marieke W. J.; Plukker, John T. M.; van Dam, Gooitzen M.

    2007-01-01

    Aim: Oesophageal cancer is highly lethal with a 5-year relative survival of 10-15%. An increasing incidence has been reported for several parts bf the Western world. We studied time trends in incidence, mortality and survival for oesophageal cancer in the Netherlands during 1989-2003. Methods: Data

  16. Vitamin K deficiency bleeding of the newborn

    Science.gov (United States)

    Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often ...

  17. Dieulafoy Lesion in the Ascending Colon Presenting with Gastrointestinal Bleeding and Severe Anemia Complicated by a Coexisting Severe Resistant Chronic Idiopathic Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Sherif Ali Eltawansy

    2014-01-01

    Full Text Available Background. GI (gastrointestinal bleeding can be due to a variety of etiologies ranging from being common like bleeding peptic ulcer disease or esophageal varices. One of the rarely documented causes is the Dieulafoy lesion which is known as an abnormally large ectatic artery that penetrates the gut wall, occasionally eroding through the mucosa causing massive bleeding. In addition to that, we refer to the uncommon presentation of Dieulafoy lesion itself as it is well known to be found in the stomach, esophagus, duodenum, and jejunum but not the ascending colon as in our case. The patient had a coexisting ITP (idiopathic thrombocytopenic purpura that was resistant to different therapies. Case Report. We report a case of a 48-year-old Egyptian female known for chronic ITP resistant to treatment. The patient presented with bright red bleeding per rectum and severe life threatening anemia. Endoscopic study showed a Dieulafoy lesion. Endoscopic clipping was successful in controlling the bleeding. Conclusion. Dieulafoy lesion is a rare reason for GI bleeding and can present in common or unexpected places. Also extreme caution should be used in patients with bleeding tendency due to different reasons, like ITP in our case.

  18. Management of digestive bleeding related to portal hypertension in cirrhotic patients: A French multicenter cross-sectional practice survey

    Institute of Scientific and Technical Information of China (English)

    Pierre Ingrand; Jean-Claude Barbare; Isabelle Ingrand; Michel Beauchant; Jér(o)me Gournay; Pierre Bernard; Frédéric Oberti; Brigitte Bernard-Chabert; Arnault Pauwels; Philippe Renard; Eric Bartoli; Jean-Fran(c)ois Cadranel

    2006-01-01

    AIM: To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines.METHODS: A questionnaire on the management of digestive bleeding was completed for all consecutive cirrhotic patients admitted to 31 French hospitals.RESULTS: One hundred and twenty-six bleeding events were recorded. It was the first bleeding episode in 79 patients (63%), of whom 40 (51%) had a prior diagnosis of cirrhosis and 25 (32%) had previously undergone an endoscopy. The bleeding episode was a recurrence in 46 patients (37%). The median time between onset and admission was 4 h, but exceeded 12 h in 42% of cases. There was an agreement between centers for early vasoactive drug administration (87% of cases),association with ligation (42%) more often than sclerosis (21%) at initial endoscopy, and antibiotic prophylaxis (64%). By contrast, prescription of beta-blockade alone or in combination (0 to 100%, P = 0.003) for secondary prophylaxis and lactulose (26% to 86%, P = 0.04),differed among centers.CONCLUSION: In French hospitals, management of bleeding related to portal hypertension in cirrhotic patients is generally in keeping with the consensus.Broad variability still remains concerning beta-blockade use for secondary prophylaxis. Screening for esophageal varices, the use of antibiotic prophylaxis and patients information need to be improved.

  19. Transabdominal US evaluation of esophageal varices: as a prospective screening test

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Seung Yon; Lee, Sun Wha [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2001-03-15

    To evaluate the efficacy of transabdominal ultrasonography to diagnose esophageal varices and to predict the grade of varices as a screening test for cirrhotic patients. Transabdominal ultrasonography was performed in 41 cirrhotic patients to evaluate esophageal varices prospectively. We measured thickness of the anterior distal esophageal wall three times and calculated the main thickness. We evaluated the pattern of the wall (smooth or irregularly), the presence of Doppler signal flow, the pattern and direction and velocity of Doppler signal flow in the esophageal wall. We considered the mean thickness of the esophageal wall in 44 patients without liver diseases to normal control. The endoscopic grade (grade 1 to 4) of esophageal varices was considered as gold standard. We analyzed the statistical difference between groups of esophageal varices and the normal control group using ANOVA and multiple complication method and t-test. Mean thickness of the normal and variceal group was 2.7 {+-} 0.7 mm and 5.2 {+-} 1.8 mm with statistical deference (p<0.001). Mean thickness between the normal group and each of the three grades of variceal groups was statically different (p<0.001) respectively. Mean thickness of grade I (N=19), grade II (N=10) and grade III and above (N=12) was 4.2 {+-} 1.2 mm, 4.9 mm {+-} 1.1 mm, 7.0 {+-} 1.8 mm respectively and for higher grades, the esophageal wall became thicker. There was statistical difference of mean thickness between grade I and grade III and above, grade II and grade III and above (p<0.001) and no difference between grade I and grade II (P=0.40). The pattern of the esophageal wall was irregular in 17 (41%)patients and the presence of Doppler signal flow was found in 8 (20%) patients. If the diagnostic criteria of mean thickness to diagnose varices was 3.5 mm, accuracy, sensitivity, specificity, positive predictive value and negative predictive value was 85.9%, 82.9%, 88.6%, 87.2%, 84.8% respectively. Transabdominal

  20. Spontaneous intra-abdominal bleeding in twin pregnancy: Case report

    Directory of Open Access Journals (Sweden)

    Berisavac Milica

    2008-01-01

    Full Text Available INTRODUCTION Spontaneous rupture of utero-ovarian vessels is a rare cause of haemoperitoneum in pregnancy, leading to significant maternal and foetal morbidity and mortality. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important. Clinical symptoms are nonspecific, and the diagnosis is usually made at laparotomy. CASE OUTLINE We report a case of spontaneous haematoperitoneum in the third trimester of twin pregnancy. Differential diagnosis included uterine rupture and placental abruption. Due to the deteriorated condition of the patient, it was decided to perform laparotomy which established the diagnosis of ruptured venous varices on the posterior uterine wall. Delivery was performed by caesarean section. The postoperative period was uneventful. CONCLUSION The clinical presentation of spontaneous rupture of utero-ovarian blood vessels is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. Once the diagnosis of spontaneous haematoperitoneum in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to establish surgical haemostasis. There are some authors who suggest leaving the pregnancy intact in cases when the fetus is not viable, although one must have in mind the possibility of recurrent bleeding. The safety of this procedure requires further investigation. It is necessary to have in mind the possibility of blood vessel rupture in all cases of abdominal pain and hypotension of unknown origin during pregnancy.

  1. CT Findings after BRTO in Patients with Gastric Varix Bleeding: Can We Predict Varix Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Joo Hwan; Kim, Young Hwan; An, Eun Jung; Kim, See Hyung; Choi, Jin Soo [Dongsan Medical Center, Keimyung University, College of Medicine, Daegu (Korea, Republic of)

    2011-02-15

    We wanted to retrospectively evaluate the CT findings after balloon occluded retrograde transvenous obliteration (BRTO) to determine whether the CT findings can predict varix recurrence. Of the 48 patients with gastric varix that was bleeding successfully treated with BRTO between February 2004 and November 2008, 35 of them who underwent follow-up endoscopy and CT were enrolled in this study. The morphologic changes of the gastric varix, including gastrorenal shunt and an afferent vein, were evaluated with the use of CT. Gastric varix recurred in 4 patients and rebleeding occurred in 2. In 22 of 25 patients who underwent CT within 6 months, complete thrombosis of the gastric varix filled with lipiodol was noted, and the gastric varix disappeared without recurrence in all the patients during the long term follow up period. In the other 3 patients who only had thrombosis without lipiodol in the gastric varix, the gastric varices recurred (p=0.0001). The existence of lipiodol, as seen on CT within 6 months after BRTO, was useful to predict complete obliteration of gastric varices without recurrence during the long term follow up period

  2. Dietary magnesium, calcium:magnesium ratio and risk of reflux oesophagitis, Barrett's oesophagus and oesophageal adenocarcinoma: a population-based case-control study.

    Science.gov (United States)

    Dai, Qi; Cantwell, Marie M; Murray, Liam J; Zheng, Wei; Anderson, Lesley A; Coleman, Helen G

    2016-01-28

    Evidence suggests a role of Mg and the ratio of Ca:Mg intakes in the prevention of colonic carcinogenesis. The association between these nutrients and oesophageal adenocarcinoma - a tumour with increasing incidence in developed countries and poor survival rates - has yet to be explored. The aim of this investigation was to explore the association between Mg intake and related nutrients and risk of oesophageal adenocarcinoma and its precursor conditions, Barrett's oesophagus and reflux oesophagitis. This analysis included cases of oesophageal adenocarcinoma (n 218), Barrett's oesophagus (n 212), reflux oesophagitis (n 208) and population-based controls (n 252) recruited between 2002 and 2005 throughout the island of Ireland. All the subjects completed a 101-item FFQ. Unconditional logistic regression analysis was applied to determine odds of disease according to dietary intakes of Mg, Ca and Ca:Mg ratio. After adjustment for potential confounders, individuals consuming the highest amounts of Mg from foods had significant reductions in the odds of reflux oesophagitis (OR 0·31; 95 % CI 0·11, 0·87) and Barrett's oesophagus (OR 0·29; 95 % CI 0·12, 0·71) compared with individuals consuming the lowest amounts of Mg. The protective effect of Mg was more apparent in the context of a low Ca:Mg intake ratio. No significant associations were observed for Mg intake and oesophageal adenocarcinoma risk (OR 0·77; 95 % CI 0·30, 1·99 comparing the highest and the lowest tertiles of consumption). In conclusion, dietary Mg intakes were inversely associated with reflux oesophagitis and Barrett's oesophagus risk in this Irish population.

  3. Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

    Energy Technology Data Exchange (ETDEWEB)

    Koc, Zafer [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)]. E-mail: koczafer@gmail.com; Ulusan, Serife [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey); Oguzkurt, Levent [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)

    2006-09-15

    Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The {chi}{sup 2}-test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices.

  4. Percutaneous Transportal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices: Technique and Clinical Efficacy

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Hyo Sung; Han, Young Min [Chonbuk National University Medical School and Hospital, Jeonju (Korea, Republic of)

    2008-12-15

    This study was deigned to evaluate the technique and clinical efficacy of the use of percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) for patients with gastric varices. Seven patients were treated by transportal sclerotherapy with the use of NBCA. For transportal sclerotherapy, portal vein catheterization was performed with a 6-Fr sheath by the transhepatic approach. A 5-Fr catheter was introduced into the afferent gastric vein and a microcatheter was advanced through the 5-Fr catheter into the varices. NBCA was injected through the microcatheter in the varices by use of the continuous single-column injection technique. After the procedure, postcontrast computed tomography (CT) was performed on the next day and then every six months. Gastroendoscopy was performed at one week, three months, and then every six months after the procedure. The technical success rate of the procedure was 88%. In six patients, gastric varices were successfully obliterated with 1-8 mL (mean, 5.4 mL) of a NBCA-Lipiodol mixture injected via a microcatheter. No complications related to the procedure were encountered. As seen on the follow-up endoscopy and CT imaging performed after six months, the presence of gastric varcies was not seen in any of the patients after treatment with the NBCA-Lipiodol mixture and the use of microcoils. Recurrence of gastric varices was not observed during the followup period. Worsening of esophageal varices occurred in four patients after transportal sclerotherapy. The serum albumin level increased, the ammonia level decreased and the prothrombin time increased at six months after the procedure (p < 0.05). Percutaneous transportal sclerotherapy with NBCA is useful to obliterate gastric varices if it is not possible to perform balloon-occluded retrograde transvenous obliteration.

  5. Oesophageal elongation with traction sutures (FOKER procedure in a newborn baby with long-gap oesophageal atresia (LGEA: Maybe too early, maybe too dangerous?

    Directory of Open Access Journals (Sweden)

    Holger Till

    2013-01-01

    Full Text Available In children with long gap oesophageal atresia (LGEA, the FOKER technique (oesophageal elongation with traction sutures has been criticized for its high complication rate. We advocate analysing such problems to increase the safety in the future. The present case report will focus on timing. A female newborn (3000 g with LGEA (gap of 5 cm was delivered in an outward hospital. On day two of life, she received traction sutures on both pouches. By day five, all sutures had torn out, and a primary anastomosis was attempted. However, it leaked severely. Thus, on day ten, the oesophagus was approached from the neck converting the proximal end into a spit fistula and closing the distal end blindly. Furthermore, the gastro-oesophageal (GE- junction was wrapped with a Teflon sling. When the baby arrived in our institution, she suffered from cavernous oesophageal masses extending from the thoracic inlet down to the diaphragm and fistulas draining them into the neck as well as into the right lung. Moreover, the Teflon sling had dislodged allowing for GE-reflux. In several stages, the oesophageal remnants were resected without any complications. Finally, Prof. Alaa Hamza performed a colonic interposition, which is working well today. In conclusion, the present case aims to caution paediatric surgeons to apply traction sutures for oesophageal elongation in newborns with LGEA.

  6. 经颈静脉肝内门体静脉分流术联合胃冠状静脉栓塞治疗门静脉高压症上消化道出血%Treatment of variceal hemorrhage with transjugular intrahepatic portosystemic shunt combined with variceal embolization

    Institute of Scientific and Technical Information of China (English)

    刘仕睿; 丁鹏绪; 化召辉; 吴智慧; 黄必润; 徐鹏; 王志伟; 张文广; 李震

    2015-01-01

    目的 比较单独行经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS)与TIPS联合胃冠状静脉栓塞术治疗食管胃底曲张静脉破裂出血的再出血率.方法 回顾分析2009年1月至2013年4月间77例因肝硬化门静脉高压上消化道出血行TIPS手术治疗的患者,全部应用8 mm直径金属裸支架配合8 mm直径覆膜支架.24例患者单独行TIPS治疗,53例患者行TIPS联合胃冠状静脉栓塞治疗.结果 所有TIPS手术操作均成功完成.栓塞组与非栓塞组门静脉压力分别下降l0 mmHg和11 mmHg,两组门体压力梯度变化之间相比差异无统计学意义.非栓塞组24例患者中5例发生再出血(21%),栓塞组53例患者中3例发生再出血(7%),两组相比差异有统计学意义,x2=4.085,P=0.043;两组死亡率比较差异无统计学意义,x2=0.194,P=0.659.结论 TIPS联合胃冠状静脉栓塞较单独行TIPS可降低门静脉高压上消化道出血患者的术后再出血率.%Objective To compare rebleeding rates following treatment of variceal hemorrhage with TIPS alone versus TIPS with variceal embolization in patients of gastroesophageal variceal bleeding.Methods In this retrospective study,77 patients with hepatic cirrhosis and variceal hemorrhage underwent TIPS insertion between 2009 and 2013.Generally,8 mm diameter TIPS were created using bare metal stents and covered stent-grafts simultaneously.A total of 24 patients underwent TIPS alone,while 53 patients underwent TIPS with variceal embolization.Results All TIPS were technically successful.Median portosystemic pressure gradient reductions were 10 mmHg versus 11 mmHg in the embolization and nonembolization groups.There were no statistically significant differences in portosystemic pressure gradients between the two groups.5/24(21%)patients in the TIPS alone group rebled while 3/53 (7%) patients in the TIPS with embolization group rebled during follow-up periods.A trend toward increased

  7. Curcumin induces apoptosis-independent death in oesophageal cancer cells.

    LENUS (Irish Health Repository)

    O'Sullivan-Coyne, G

    2009-10-06

    Background:Oesophageal cancer incidence is increasing and survival rates remain extremely poor. Natural agents with potential for chemoprevention include the phytochemical curcumin (diferuloylmethane). We have examined the effects of curcumin on a panel of oesophageal cancer cell lines.Methods:MTT (3-(4,5-dimethyldiazol-2-yl)-2,5 diphenyl tetrazolium bromide) assays and propidium iodide staining were used to assess viability and DNA content, respectively. Mitotic catastrophe (MC), apoptosis and autophagy were defined by both morphological criteria and markers such as MPM-2, caspase 3 cleavage and monodansylcadaverine (MDC) staining. Cyclin B and poly-ubiquitinated proteins were assessed by western blotting.Results:Curcumin treatment reduces viability of all cell lines within 24 h of treatment in a 5-50 muM range. Cytotoxicity is associated with accumulation in G2\\/M cell-cycle phases and distinct chromatin morphology, consistent with MC. Caspase-3 activation was detected in two out of four cell lines, but was a minor event. The addition of a caspase inhibitor zVAD had a marginal or no effect on cell viability, indicating predominance of a non-apoptotic form of cell death. In two cell lines, features of both MC and autophagy were apparent. Curcumin-responsive cells were found to accumulate poly-ubiquitinated proteins and cyclin B, consistent with a disturbance of the ubiquitin-proteasome system. This effect on a key cell-cycle checkpoint regulator may be responsible for the mitotic disturbances and consequent cytotoxicity of this drug.Conclusion:Curcumin can induce cell death by a mechanism that is not reliant on apoptosis induction, and thus represents a promising anticancer agent for prevention and treatment of oesophageal cancer.British Journal of Cancer advance online publication, 6 October 2009; doi:10.1038\\/sj.bjc.6605308 www.bjcancer.com.

  8. Curcumin induces apoptosis-independent death in oesophageal cancer cells.

    LENUS (Irish Health Repository)

    O'Sullivan-Coyne, G

    2012-01-31

    BACKGROUND: Oesophageal cancer incidence is increasing and survival rates remain extremely poor. Natural agents with potential for chemoprevention include the phytochemical curcumin (diferuloylmethane). We have examined the effects of curcumin on a panel of oesophageal cancer cell lines. METHODS: MTT (3-(4,5-dimethyldiazol-2-yl)-2,5 diphenyl tetrazolium bromide) assays and propidium iodide staining were used to assess viability and DNA content, respectively. Mitotic catastrophe (MC), apoptosis and autophagy were defined by both morphological criteria and markers such as MPM-2, caspase 3 cleavage and monodansylcadaverine (MDC) staining. Cyclin B and poly-ubiquitinated proteins were assessed by western blotting. RESULTS: Curcumin treatment reduces viability of all cell lines within 24 h of treatment in a 5-50 muM range. Cytotoxicity is associated with accumulation in G2\\/M cell-cycle phases and distinct chromatin morphology, consistent with MC. Caspase-3 activation was detected in two out of four cell lines, but was a minor event. The addition of a caspase inhibitor zVAD had a marginal or no effect on cell viability, indicating predominance of a non-apoptotic form of cell death. In two cell lines, features of both MC and autophagy were apparent. Curcumin-responsive cells were found to accumulate poly-ubiquitinated proteins and cyclin B, consistent with a disturbance of the ubiquitin-proteasome system. This effect on a key cell-cycle checkpoint regulator may be responsible for the mitotic disturbances and consequent cytotoxicity of this drug. CONCLUSION: Curcumin can induce cell death by a mechanism that is not reliant on apoptosis induction, and thus represents a promising anticancer agent for prevention and treatment of oesophageal cancer.

  9. Fibrinogen concentrate in bleeding patients

    DEFF Research Database (Denmark)

    Wikkelsø, Anne; Lunde, Jens; Johansen, Mathias;

    2013-01-01

    Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic...

  10. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre

    2013-01-01

    with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees......The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia...... and stabilisation of the macro- and microcirculations in order to optimise the patient's tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject...

  11. Cyanoacrylate spray as treatment in difficult-to-manage gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Liz; Toapanta-Yanchapaxi; Norberto; Chavez-Tapia; Félix; Téllez-ávila

    2014-01-01

    Gastrointestinal bleeding can be a life-treating event that is managed with standard endoscopic therapy in the majority of cases. However, up to 5%-10% of patients may have persistent bleeding that does not respond to conventional measures. Several endoscopic treatment techniques have been proposed as strategies to control such cases, such as epinephrine injection, hemoclips or argon plasma coagulation, but there are certain clinical scenarios where it is difficult to achieve hemostasis even though adequate use of the available resources is made. Reasons for these failures can be associated with the lesion features, such as extent or location. The use of long-standing techniques in nontraditional scenarios, such as with cyanoacrylate for gastric varices sclerosis, has been reported with favorable results. Although new products such as TC-325 or Ankaferd Blood Stopper hemosprays may be useful, their formulations are not available worldwide. Here we present two clinical cases with very different scenarios of gastrointestinal bleeding, where the use of cyanoac-rylate in spray had favorable results in uncommon indications. Cyanoacrylate used as a spray is a technique that can be used as an alternative method in emergent settings.

  12. Digital radiography in the evaluation of oesophageal motility disorders

    Energy Technology Data Exchange (ETDEWEB)

    Aly, Yehia A

    2000-07-01

    AIMS: To develop a simple technique for examination of the oesophagus by digital radiography and to assess its role in the evaluation of motility disorders of the oesophagus. MATERIALS AND METHODS: Forty-nine patients and 44 control subjects underwent manometry and digital examination of the oesophagus. The digital study consisted of two parts: firstly examination of the pharynx and cervical oesophagus using 15 ml of fluid barium in anterio-posterior (AP) and lateral views, with image acquisition of four frames/s for 2 s. Secondly, examination of the thoracic oesophagus and oesophagogastric junction using 25 ml of barium in two prone oblique and one supine AP series, with image acquisition of one frame/s for 20 s. Oesophageal transit time (OTT) was measured in each case. Abnormal or non-peristaltic contractions were described regarding their morphology, time of visualization and length. The presence or absence of hiatal hernia, reflux or any associated organic lesions was noted. RESULTS: Digital radiography diagnosed 14 cases of achalasia and 28 cases of non-specific oesophageal motility disorder (NOMD). Normal OTT was 11.95 {+-} 1.304 s. The OTT was prolonged (16 s or more) in all patients except five; four of these were cases of NOMD. Abnormal contractions were classified into circular and longitudinal types. The circular non-obliterating type was commoner. Achalasia was diagnosed in all cases, as failure of relaxation of the inferior oesophageal sphincter was always present and easily depicted by digital radiography. Abnormal contractions in the body of the oesophagus were elicited in 57% of cases of achalasia. The sensitivity of digital radiography in detecting oesophageal motility disorders was 85.7% based on the presence of abnormal contractions and 91.6% by eliciting a prolonged OTT. CONCLUSIONS: Examination of the oesophagus by digital radiography is simple, non-invasive, reproducible, rapid and without discomfort to patients. It allows the diagnosis of

  13. Investigating the Pathogenic Role of PADI4 in Oesophageal Cancer

    Directory of Open Access Journals (Sweden)

    Xiaotian Chang, Xiuli Hou, Jihong Pan, Kehua Fang, Lin Wang, Jinxiang Han

    2011-01-01

    Full Text Available PADI4 post-translationally converts peptidylarginine to citrulline. PADI4 can disrupt the apoptotic process via the citrullination of histone H3 in the promoter of p53-target genes. The current study focused on PADI4 expression in various subtypes of oesophageal carcinoma (EC by immunohistochemistry, western blotting and real time PCR. The study also investigated the effect of bile acid deoxycholate (DCA on PADI4 expression in Eca-109 cells that originated from EC. Apoptosis and DCA-induced toxicity were analyzed by TUNEL, MTT assay and flow cytometry. Additionally, the present study investigated the correlation between single nucleotide polymorphism (SNP in PADI4 gene and EC risk in Chinese population using Illumina GoldenGate assay. Compared with paraneoplastic tissues, the transcriptional and translational levels of PADI4 were significantly elevated in oesophageal squamous cell carcinoma (ESCC, n=9 and oesophageal adenocarcinoma (EAC, n=5 tissues. Immunolabeling detected expression of PADI4 in ESCC tissues (98.56%, n=139, EAC samples (87.5%, n=16 and oesophageal small cell undifferentiated carcinoma (91.7%, n=12 but not in normal tissues (0%, n=16. Furthermore, PADI4 levels is positively correlated with the pathological classification of ESCC (p=0.009. PADI4 expression levels were consistent with the number of apoptotic cells in the induced Eca-109 cells. rs10437048 [OR= 0.012831; 95% CI, 0.001746~0.094278; p=1.556×10-12] were significantly associated with decreased risk of EC, whereas rs41265997 [OR=12.7; 95% CI, 0.857077~33.207214; p=3.896×10-8] were significantly associated with increased risk of EC. rs41265997 in exon 3 of PADI4 gene is non-synonymous and converts ACG to ATG resulting in a threonine /methionine conversion at position 274 of the protein. Haplotypes GC that carries the variant alleles for rs2501796 and rs2477134 was significantly associated with increased risk of EC (frequency=0.085, p=0.0256, OR=2.7. The results suggest

  14. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  15. Oesophageal motility disorders in type 1 diabetes mellitus and their relation to cardiovascular autonomic neuropathy.

    Science.gov (United States)

    Ascaso, J F; Herreros, B; Sanchiz, V; Lluch, I; Real, J T; Minguez, M; Mora, F; Benages, A

    2006-09-01

    The relationship between cardiovascular autonomic neuropathy (CVAN) and oesophageal dysfunction in diabetes mellitus has not been well established because reports are contradictory. The aim of this study was to assess oesophageal function and its correlation with CVAN in type 1 diabetic patients without oesophageal symptoms. Forty-six type 1 diabetic patients without oesophageal symptoms (DG) and 34 healthy volunteers (CG) were studied. Both groups underwent CVAN tests and oesophageal manometry and pH-metry. Differences between groups regarding results of cardiovascular autonomic tests and oesophageal studies were statistically analysed. Compared with the CG, the DG group showed insufficient lower oesophageal sphincter (LOS) relaxation and a higher percentage of simultaneous waves (P 10%), and the prevalence of simultaneous waves related to the degree of autonomic neuropathy was: 9% of patients without CVAN, 7% of those suspected to have it and 50% of patients with CVAN (P 10%) were the presence of CVAN and duration of diabetes (P < 0.05, logistic regression analysis). Increase in simultaneous waves and impaired relaxation of LOS are more frequent in diabetic patients with CVAN.

  16. A dietary pattern rich in lignans, quercetin and resveratrol decreases the risk of oesophageal cancer.

    Science.gov (United States)

    Lin, Yulan; Yngve, Agneta; Lagergren, Jesper; Lu, Yunxia

    2014-12-28

    Dietary lignans, quercetin and resveratrol have oestrogenic properties, and animal studies suggest that they synergistically decrease cancer risk. A protective effect of lignans on the development of oesophageal cancer in humans has recently been demonstrated, and the present study aimed to test whether these three phytochemicals synergistically decrease the risk of oesophageal cancer. Data from a Swedish nationwide population-based case-control study that recruited 181 cases of oesophageal adenocarcinoma (OAC), 158 cases of oesophageal squamous-cell carcinoma (OSCC), 255 cases of gastro-oesophageal junctional adenocarcinoma (JAC) and 806 controls were analysed. Exposure data were collected through face-to-face interviews and questionnaires. The intake of lignans, quercetin and resveratrol was assessed using a sixty-three-item FFQ. Reduced-rank regression was used to assess a dietary pattern, and a simplified dietary pattern score was categorised into quintiles on the basis of the distribution among the control subjects. Unconditional multivariable logistic regression provided OR with 95% CI, adjusted for all the potential risk factors. A dietary pattern rich in lignans, quercetin and resveratrol was mainly characterised by a high intake of tea, wine, lettuce, mixed vegetables, tomatoes, and whole-grain bread and a low intake of milk. There were dose-dependent associations between simplified dietary pattern scores and all types of oesophageal cancer (all P for trend dietary pattern characterised by the intake of lignans, quercetin and resveratrol may play a protective role in the development of oesophageal cancer in the Swedish population.

  17. Risk factors for Barrett's oesophagus and oesophageal adenocarcinoma: Results from the FINBAR study

    Institute of Scientific and Technical Information of China (English)

    Lesley A Anderson; RG Peter Watson; Seamus J Murphy; Brian T Johnston; Harry Comber; Jim Mc Guigan; John V Reynolds; Liam J Murray

    2007-01-01

    AIM: To investigate risk factors associated with Barrett's oesophagus and oesophageal adenocarcinoma.METHODS: This all-Ireland population-based case-control study recruited 224 Barrett's oesophagus patients, 227 oesophageal adenocarcinoma patients and 260 controls. All participants underwent a structured interview with information obtained about potential lifestyle and environmental risk factors.RESULTS: Gastro-oesophageal reflux was associated with Barrett's [OR 12.0 (95% CI 7.64-18.7)] and oesophageal adenocarcinoma [OR 3.48 (95% CI 2.25-5.41)]. Oesophageal adenocarcinoma patients were more likely than controls to be ex- or current smokers [OR 1.72 (95% CI 1.06-2.81) and OR 4.84 (95% CI 2.72-8.61) respectively] and to have a high body mass index [OR 2.69 (95% CI 1.62-4.46)]. No significant associations were observed between these risk factors and Barrett's oesophagus. Fruit but not vegetables were negatively associated with oesophageal adenocarcinoma [OR 0.50 (95% CI 0.30-0.86)].CONCLUSION: A high body mass index, a diet low in fruit and cigarette smoking may be involved in the progression from Barrett's oesophagus to oesophageal adenocarcinoma.

  18. Oesophageal cancer in never-smokers and never-drinkers.

    Science.gov (United States)

    Cheng, K K; Duffy, S W; Day, N E; Lam, T H

    1995-03-16

    Alcohol, tobacco and diet are the most important determinants of oesophageal cancer. Previous studies which examined smoking in non-drinkers and drinking in non-smokers did not report the main effects of dietary factors or the smoking and drinking effects adjusted for dietary factors. Data from a hospital-based case-control study in Hong Kong Chinese were used to examine the effects of dietary variables as well as tobacco and alcohol in never-drinkers and never-smokers. Among the 400 cases, there were 68 never-smokers and 53 never-drinkers; 540 were never-smokers and 407 were never-drinkers among 1598 controls. In never-smokers, alcohol drinking was strongly associated with risk. Use of green leafy vegetables and citrus fruits was protective. Among never-drinkers, smokers had increased risk, but the protective effect of vegetables and fruits did not reach statistical significance. In never-smokers and in never-drinkers alike, frequent consumption of pickled vegetables and being born in Teochew or Hokkien were associated with increased risks. This study provides further support for the independent effects of alcohol, tobacco and diet in oesophageal cancer.

  19. Curative treatment of oesophageal carcinoma: current options and future developments

    Directory of Open Access Journals (Sweden)

    Bruns Christiane

    2011-05-01

    Full Text Available Abstract Since the 1980s major advances in surgery, radiotherapy and chemotherapy have established multimodal approaches as curative treatment options for oesophageal cancer. In addition the introduction of functional imaging modalities such as PET-CT created new opportunities for a more adequate patient selection and therapy response assessment. The majority of oesophageal carcinomas are represented by two histologies: squamous cell carcinoma and adenocarcinoma. In recent years an epidemiological shift towards the latter was observed. From a surgical point of view, adenocarcinomas, which are usually located in the distal third of the oesophagus, may be treated with a transhiatal resection, whereas squamous cell carcinomas, which are typically found in the middle and the upper third, require a transthoracic approach. Since overall survival after surgery alone is poor, multimodality approaches have been developed. At least for patients with locally advanced tumors, surgery alone can no longer be advocated as routine treatment. Nowadays, scientific interest is focused on tumor response to induction radiochemotherapy. A neoadjuvant approach includes the early and accurate assessment of clinical response, optimally performed by repeated PET-CT imaging and endoscopic ultrasound, which may permit early adaption of the therapeutic concept. Patients with SCC that show clinical response by PET CT are considered to have a better prognosis, regardless of whether surgery will be performed or not. In non-responding patients salvage surgery improves survival, especially if complete resection is achieved.

  20. Cytomegalovirus oesophagitis in a patient with non-hodgkin′s lymphoma

    Directory of Open Access Journals (Sweden)

    Hingmire S

    2008-01-01

    Full Text Available Cytomegalovirus (CMV infection is frequent in immunocompromised patients, especially in AIDS, organ transplantation and rarely in Hodgkin′s disease and Non-Hodgkin′s lymphoma (NHL. We present a case of NHL with CMV oesophagitis, which has rarely been documented in literature. Apart from fungal and herpes simplex infections, as the common differential diagnosis for oesophagitis in patients of lymphoma, CMV should be considered an important etiologic agent. Early diagnosis and prompt treatment of CMV oesophagitis with gancyclovir can avert significant morbidity and avoid unacceptable treatment delays.

  1. Bleed Hole Flow Phenomena Studied

    Science.gov (United States)

    1997-01-01

    Boundary-layer bleed is an invaluable tool for controlling the airflow in supersonic aircraft engine inlets. Incoming air is decelerated to subsonic speeds prior to entering the compressor via a series of oblique shocks. The low momentum flow in the boundary layer interacts with these shocks, growing in thickness and, under some conditions, leading to flow separation. To remedy this, bleed holes are strategically located to remove mass from the boundary layer, reducing its thickness and helping to maintain uniform flow to the compressor. The bleed requirements for any inlet design are unique and must be validated by extensive wind tunnel testing to optimize performance and efficiency. To accelerate this process and reduce cost, researchers at the NASA Lewis Research Center initiated an experimental program to study the flow phenomena associated with bleed holes. Knowledge of these flow properties will be incorporated into computational fluid dynamics (CFD) models that will aid engine inlet designers in optimizing bleed configurations before any hardware is fabricated. This ongoing investigation is currently examining two hole geometries, 90 and 20 (both with 5-mm diameters), and various flow features.

  2. Hepatocellular carcinoma masquerading as a bleeding gastric ulcer: A case report and a review of the surgical management

    Institute of Scientific and Technical Information of China (English)

    Johnny CA Ong; Pierce KH Chow; Weng-Hoong Chan; Alex YF Chung; Choon Hua Thng; Wai-Keong Wong

    2007-01-01

    Hepatocellular Carcinoma (HCC) is a common malignancy worldwide. While bleeding from the gastrointestinal tract (BGIT) has a well known association with HCC, such cases are mainly due to gastric and esophageal varices.BGIT as a result of invasion of the gastrointestinal tract by HCC is extremely rare and is reportedly associated with very poor prognosis. We describe a 67-year-old male who presented with BGIT. Endoscopy showed the site of bleeding to be from a gastric ulcer, but endoscopic therapy failed to control the bleeding and emergency surgery was required. At surgery, the ulcer was found to have arisen from direct invasion of the gastrointestinal tract by HCC of the left lobe. Control of the bleeding was achieved by surgical resection of the HCC enbloc with the lesser curve of the stomach. The patient remains alive 33 mo after surgery. Direct invasion of the gastrointestinal tract by HCC giving rise to BGIT is very uncommon. Surgical resection may offer significantly better survival over non-surgical therapy, especially if the patient is a good surgical candidate and has adequate functional liver reserves. Prognosis is not uniformly grave.

  3. Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review

    Directory of Open Access Journals (Sweden)

    Christine N. Manser

    2012-04-01

    Full Text Available Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.

  4. Diagnostic non-invasive model of large risky esophageal varices in cirrhotic hepatitis C virus patients

    Science.gov (United States)

    Elalfy, Hatem; Elsherbiny, Walid; Abdel Rahman, Ashraf; Elhammady, Dina; Shaltout, Shaker Wagih; Elsamanoudy, Ayman Z; El Deek, Bassem

    2016-01-01

    AIM To build a diagnostic non-invasive model for screening of large varices in cirrhotic hepatitis C virus (HCV) patients. METHODS This study was conducted on 124 post-HCV cirrhotic patients presenting to the clinics of the Endemic Medicine Department at Mansoura University Hospital for evaluation before HCV antiviral therapy: 78 were Child A and 46 were Child B (score ≤ 8). Inclusion criteria for patients enrolled in this study was presence of cirrhotic HCV (diagnosed by either biopsy or fulfillment of clinical basis). Exclusion criteria consisted of patients with other etiologies of liver cirrhosis, e.g., hepatitis B virus and patients with high MELD score on transplant list. All patients were subjected to full medical record, full basic investigations, endoscopy, and computed tomography (CT), and then divided into groups with no varices, small varices, or large risky varices. In addition, values of Fibrosis-4 score (FIB-4), aminotransferase-to-platelet ratio index (APRI), and platelet count/splenic diameter ratio (PC/SD) were also calculated. RESULTS Detection of large varies is a multi-factorial process, affected by many variables. Choosing binary logistic regression, dependent factors were either large or small varices while independent factors included CT variables such coronary vein diameter, portal vein (PV) diameter, lieno-renal shunt and other laboratory non-invasive variables namely FIB-4, APRI, and platelet count/splenic diameter. Receiver operating characteristic (ROC) curve was plotted to determine the accuracy of non-invasive parameters for predicting the presence of large esophageal varices and the area under the ROC curve for each one of these parameters was obtained. A model was established and the best model for prediction of large risky esophageal varices used both PC/SD and PV diameter (75% accuracy), while the logistic model equation was shown to be (PV diameter × -0.256) plus (PC/SD × -0.006) plus (8.155). Values nearing 2 or more denote

  5. Complete Esophageal Obstruction after Endoscopic Variceal Band Ligation in a Patient with a Sliding Hiatal Hernia

    Science.gov (United States)

    Mansour, Munthir; Abdel-Aziz, Yousef; Awadh, Hesham; Shah, Nihar

    2017-01-01

    Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.

  6. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  7. Endoscopic management of diverticular bleeding.

    Science.gov (United States)

    Rustagi, Tarun; McCarty, Thomas R

    2014-01-01

    Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB) with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70-80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  8. Endoscopic Management of Diverticular Bleeding

    Directory of Open Access Journals (Sweden)

    Tarun Rustagi

    2014-01-01

    Full Text Available Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.

  9. [Gastrointestinal bleeding: the role of radiology].

    Science.gov (United States)

    Quiroga Gómez, S; Pérez Lafuente, M; Abu-Suboh Abadia, M; Castell Conesa, J

    2011-01-01

    Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding.

  10. Application of CT Portography in Esophagogastric Varices in Cirrhotic Patients%CT 门静脉成像在肝硬化食管胃静脉曲张中的应用价值

    Institute of Scientific and Technical Information of China (English)

    赵尚飞; 冯琨; 曲巧燕; 崔铭娟; 王艳婷; 谭军英; 宋明全

    2016-01-01

    Background:CT portography(CTP)permits comprehensive evaluation of portal vein and its collateral pathways. It is widely used for assessment of portal hypertension in clinical practice. Aims:To assess the value of CTP in esophagogastric varices in cirrhotic patients. Methods:A retrospective cohort study was performed in 143 cirrhotic patients admitted from Jan. 2013 to Sep. 2015 at the Affiliated Hospital of Qingdao University. All patients fulfilled the inclusion criteria and underwent CTP and gastroscopy within 7 days after admission. According to the occurrence of gastrointestinal bleeding at admission,patients were allocated into two groups:bleeding group( n = 70 ) and non-bleeding group( n = 73 ). Consistency of the results of CTP and gastroscopy was analyzed by kappa coefficient;the accuracy of CTP parameters, including diameters of main portal vein(MPV),splenic vein(SPV)and left gastric vein(LGV)for prediction of variceal bleeding was evaluated by ROC curve. Results:CTP and gastroscopy had a good consistency in typing and grading of esophagogastric varices,with the kappa value of 0. 793 and 0. 775,respectively. The diameters of MPV,SPV and LGV were significantly higher in bleeding group than in non-bleeding group(P < 0. 01),and their area under the ROC curve (AUC)in predicting variceal bleeding was 0. 741,0. 627 and 0. 816,respectively. The accuracy of diameter of LGV was superior to that of MPV and SPV. With the cutoff value of 6. 1 mm,the sensitivity and specificity of diameter of LGV were 65. 71% and 84. 93% ,respectively. With the cutoff value of 16. 3 mm,the sensitivity of diameter of MPV was 75. 71% , which was higher than that of LGV and SPV. Conclusions:CTP can be used in clinical diagnosis of esophagogastric varices in cirrhotic patients,and two CTP parameters,the diameters of LGV and MPV,might be helpful for prediction of variceal bleeding.%背景:CT 门静脉成像(CTP)可直观地显示门静脉及其侧支循环,为临床常用的门静

  11. Targeting key signalling pathways in oesophageal adenocarcinoma: A reality for personalised medicine?

    Institute of Scientific and Technical Information of China (English)

    Richard R Keld; Yeng S Ang

    2011-01-01

    Cancer treatments are rapidly changing. Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a result of tumor recurrence. We have reviewed the key signalling pathways associated with oesophageal adenocarcinomas and discussed the recent trials of novel agents that attempt to target these pathways. There are many trials underway with the aim of improving survival in oesophageal cancer. Currently,phase 2 and 3 trials are focused on MAP kinase inhibition, either through inhibition of growth factor receptors or signal transducer proteins. In order to avoid tumor resistance, it appears to be clear that targeted therapy will be needed to combat the multiple signalling pathways that are in operation in oesophageal adenocarcinomas. This may be achievable in the future with the advent of gene signatures and a combinatorial approach.

  12. Targeting key signalling pathways in oesophageal adenocarcinoma: a reality for personalised medicine?

    Science.gov (United States)

    Keld, Richard R; Ang, Yeng S

    2011-06-21

    Cancer treatments are rapidly changing. Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy. Outcomes for both regimes are generally poor as a result of tumor recurrence. We have reviewed the key signalling pathways associated with oesophageal adenocarcinomas and discussed the recent trials of novel agents that attempt to target these pathways. There are many trials underway with the aim of improving survival in oesophageal cancer. Currently, phase 2 and 3 trials are focused on MAP kinase inhibition, either through inhibition of growth factor receptors or signal transducer proteins. In order to avoid tumor resistance, it appears to be clear that targeted therapy will be needed to combat the multiple signalling pathways that are in operation in oesophageal adenocarcinomas. This may be achievable in the future with the advent of gene signatures and a combinatorial approach.

  13. Met expression is an independent prognostic risk factor in patients with oesophageal adenocarcinoma

    NARCIS (Netherlands)

    J.B. Tuynman; S.M. Lagarde (Sjoerd); F.J.W. ten Kate (Fiebo); D.J. Richel (Dirk); J.J.B. van Lanschot (Jan)

    2008-01-01

    textabstractOesophageal adenocarcinoma is an aggressive malignancy with propensity for early lymphatic and haematogenous dissemination. Since conventional TNM staging does not provide accurate prognostic information, novel molecular prognostic markers and potential therapeutic targets are subject of

  14. A review of the epidemiology of Barrett's oesophagus and oesophageal adenocarcinoma.

    Science.gov (United States)

    Schneider, Jennifer L; Corley, Douglas A

    2015-02-01

    While the incidence rates of many cancers have decreased in past decades, the incidence of oesophageal adenocarcinoma continues to increase. The only known precursor for oesophageal adenocarcinoma is Barrett's oesophagus. Studies conducted have identified white race, male sex, GORD, cigarette smoking, obesity, and the absence of Helicobacter pylori status as risk factors for oesophageal adenocarcinoma. Other potential associations include dietary factors and the absence of non-steroidal anti-inflammatory drug use. Many individual studies have been limited by sample size and several meta-analyses have pooled data from studies to address this limitation. In this review we present a synthesis of these studies and summarize current knowledge of risk factors for both oesophageal adenocarcinoma and Barrett's oesophagus.

  15. Splenic artery embolisation for portal hypertention in children

    Directory of Open Access Journals (Sweden)

    Meisheri Ila

    2010-01-01

    Full Text Available Background: Bleeding from esophageal varices is one of the most common causes of serious gastrointestinal haemorrhage in children. We analysed our experience with the use of splenic artery embolisation and variceal sclerotherapy for bleeding oesophageal varices. Patients and Methods: Records of all patients treated for bleeding oesophageal varices caused by portal hypertension from 1998 to 2004 were retrospectively analysed. Patients were followed up for five years. Results: Out of 25 patients treated, ten belonged to sclerotherapy (group A, eight to combined sclerotherapy and embolisation (group B, and seven to only embolisation (group C. The patients were selected randomly, only two patients who had active bleed recently were directly sclerosed. The splenic artery was embolised at the hilum using steel coils in 15 patients with portal hypertension and hypersplenism. Follow-up findings showed decrease in splenic mass, varices, and hyperdynamic flow. Conclusion: In spite of few patients and a short period of follow-up, our results pointed out that a serious consideration should be given to this procedure, as it slowed the sequel of portal hypertension and the complications associated with it. Patients who were embolised and followed up for five years had lesser rebleeds and complications than sclerotherapy patients.

  16. Oesophageal cancer mortality in Spain: a spatial analysis

    Directory of Open Access Journals (Sweden)

    García-Pérez Javier

    2007-01-01

    Full Text Available Abstract Background Oesophageal carcinoma is one of the most common cancers worldwide. Its incidence and mortality rates show a wide geographical variation at a world and regional level. Geographic mapping of age-standardized, cause-specific death rates at a municipal level could be a helpful and powerful tool for providing clues leading to a better understanding of its aetiology. Methods This study sought to describe the geographic distribution of oesophageal cancer mortality for Spain's 8077 towns, using the autoregressive spatial model proposed by Besag, York and Mollié. Maps were plotted, depicting standardised mortality ratios, smoothed relative risk (RR estimates, and the spatial pattern of the posterior probability of RR being greater than 1. Results Important differences associated with area of residence were observed in risk of dying from oesophageal cancer in Spain during the study period (1989–1998. Among men, excess risk appeared across the north of the country, along a band spanning the length of the Cantabrian coastline, Navarre, the north of Castile & León and the north-west of La Rioja. Excess risk was likewise observed in the provinces of Cadiz and part of Seville in Andalusia, the islands of Tenerife and Gran Canaria, and some towns in the Barcelona and Gerona areas. Among women, there was a noteworthy absence of risk along the mid-section of the Cantabrian seaboard, and increases in mortality, not observed for men, in the west of Extremadura and south-east of Andalusia. Conclusion These major gender- and area-related geographical differences in risk would seem to reflect differences in the prevalence of some well-established and modifiable risk factors, including smoking, alcohol consumption, obesity and diet. In addition, excess risks were in evidence for both sexes in some areas, possibly suggesting the implication of certain local environmental or socio-cultural factors. From a public health standpoint, small

  17. Embolisation of the splenic artery

    Energy Technology Data Exchange (ETDEWEB)

    Essler, G.; Duex, A.

    1982-09-01

    In bleeding of oesophageal varices with resistance to common treatment embolisation of the splenic artery causes depression of the portal hypertension by forty per cent. Thrombosis of the splenic or portal vein as in splenectomies are not to be expected. The splenic vein remains open for later spleno-renal anastomosis. By occlusion of the splenic artery we were successful in stopping oesophageal bleeding. In a patient with dominant hypersplenism in portal hypertension the severity of the syndrome decreased after embolisation of the splenic artery. Thrombocytes, leukocytes and gammaglobulin increased.

  18. Role of CD1A and HSP60 in the antitumoral response of oesophageal cancer

    OpenAIRE

    Giovanni Zummo; Francesco Cappello; Felicia Farina; Lorenzo Marasà; Rita Anzalone; Giampiero La Rocca; Simona Corrao

    2011-01-01

    Oesophageal cancer (OC) is one of the most common and severe forms of tumor. A wider knowledge of molecular mechanisms which lead to a normal epithelium becoming a neoplasm may reveal new strategies to improve treatment and outcome of this disease. In this review, we report recent findings concerning molecular events which take place during carcinogenesis of the oesophagus. In particular, we focus on the role of two molecules, CD1a and Hsp60, which are overexpressed in oesophageal and many ot...

  19. Low morbidity after palliation of obstructing gastro-oesophageal adenocarcinoma to restore swallowing function

    DEFF Research Database (Denmark)

    Kofoed, Steen Christian; Lundsgaard, Martin; Ellemann, Ann-Camilla;

    2012-01-01

    This study describes the procedure-related complications and survival after deployment of self-expanding metal stents (SEMS) or use of argon plasma coagulation (APC) in patients with obstructing gastro-oesophageal junction (GEJ) adenocarcinoma.......This study describes the procedure-related complications and survival after deployment of self-expanding metal stents (SEMS) or use of argon plasma coagulation (APC) in patients with obstructing gastro-oesophageal junction (GEJ) adenocarcinoma....

  20. Cost saving by reloading the multiband ligator in endoscopic esophageal variceal ligation: A proposal for developing countries

    Institute of Scientific and Technical Information of China (English)

    Zaigham Abbas; Lubna Rizvi; Umair Syed Ahmed; Khalid Mumtaz; Wasim Jafri

    2008-01-01

    AIM: To assess the cost savings of reloading the multiband ligator in endoscopic esophageal variceal ligation (EVL) used on the same patient for subsequent sessions,METHODS: This single centre retrospective descriptive study analysed patients undergoing variceal ligation at a tertiary care centre between 1st January, 2003 and 30th June, 2006. The multiband ligator was reloaded with six hemorrhoidal bands using hemorrhoidal ligator for the second and subsequent sessions. Analysis of cost saving was done for the number of follow-up sessions for the variceal eradication.RESULTS: A total of 261 patients underwent at least one session of endoscopic esophageal variceal ligation between January 2003 and June 2006. Out of 261, 108 patients (males 67) agreed to follow the eradication program and underwent repeated sessions. A total of 304 sessions was performed with 2.81 sessions per patient on average. Thirty-two patients could not complete the programm. In 76 patients (70%), variceal obliteration was achieved. The ratio of the costs for the session with reloaded ligator versus a session with a new ligator was 1:2.37. Among the patients who completed esophageal varices eradication, cost saving with reloaded ligator was 58%.CONCLUSION: EVL using reloaded multiband ligators for the follow-up sessions on patients undergoing variceal eradication is a cost saving procedure. Reloading the ligator thus is recommended especially for developing countries where most of the patients are not health insured.

  1. Ultrastructural aspects of the oesophageal and reproductive systems of the equine parasite Strongylus vulgaris.

    Science.gov (United States)

    Mobarak, M S; Ryan, M F

    2002-06-01

    The ultrastructure of the dorsal oesophageal gland ampulla and its relationship with the oesophagus, oesophageal ultrastructure, and control mechanisms in oesophageal activity were studied. Terminal ducts of the sub-ventral glands open through the oesophageal crown at the base of the buccal cavity. The terminal duct of the dorsal oesophageal gland running through the dorsal gutter opens to the exterior at the rim 'groove' of the buccal capsule. The posterior oesophageal region is clavate and the cuticle of the lumen folds to form outlet valves, 'valvulae'. An inconspicuous oesophago-intestinal valve (three lobes) connects oesophagus and intestine and is visualized in the open and shut position. In the female reproductive tract, with the exception of the uterus, the cells lie on a thick, irregular (convoluted) basal lamina. The apical plasma membrane of the uterus, and seminal receptacle, extend into the lumen by microvilli-like projections with which spermatozoa make intimate contact. The lumen of the uterus is filled with oocytes, fertilized and unfertilized. Testicular cells have two parts linked by a rachis. Spermatocytes are elongated with a large nucleus, distinct nuclear membrane, and many granules. The apical membrane of the rachis forms long microvilli-like projections with balloon-like tips. The amoeboid spermatozoa contain membrane specializations, a nucleus devoid of a membrane, and are enclosed by a pseudopodial-like extension.

  2. Immediate primary anastomosis for isolated oesophageal atresia: A single-centre experience

    Directory of Open Access Journals (Sweden)

    Ibrahim Uygun

    2015-01-01

    Full Text Available Background: Isolated oesophageal atresia without tracheo-oesophageal fistula represents a major challenge for most paediatric surgeons. Here, we present our experience with six neonates with isolated oesophageal atresia who successfully underwent immediate primary anastomosis using multiple Livaditis circular myotomy. Materials and Methods: All six neonates were gross type A isolated oesophageal atresia (6%, from among 102 neonates with oesophageal atresia, treated between January 2009 and December 2013. Five neonates were female; one was male. The mean birth weight was 2300 (range 1700-3100 g. Results: All six neonates successfully underwent immediate primary anastomosis using multiple myotomies (mean 3; range 2-4 within 10 (median 3 days after birth. The gap under traction ranged from 6 to 7 cm. One neonate died of a major cardiac anomaly. Another neonate was lost to follow-up after being well for 3 months. Three anastomotic strictures were treated with balloon dilatation, and four anastomotic leaks were treated conservatively. The mean duration of follow-up was 33 months. Conclusions: To treat isolated oesophageal atresia, an immediate primary anastomosis can be achieved using multiple myotomies. Although, this approach is associated with high complication rates, as are other similar approaches, these complications can be overcome.

  3. Endoscopic removal or ablation of oesophageal and gastric superficial tumours.

    Science.gov (United States)

    Deprez, P H; Aouattah, T; Piessevaux, H

    2006-01-01

    Endoscopic mucosal resection was developed in Eastern countries as a curative treatment for superficial carcinomas in the stomach and oesophagus. Experience in Western countries is more recent and limited due to less frequent diagnosis of early gastric cancers compared to the Japanese and Korean populations and to more frequent use of ablation techniques such as argon plasma coagulation and photodynamic therapy in pre-neoplastic lesions and superficial tumours. This review summarizes the respective indications, advantages, disadvantages, limitations and complications of the different ablative and resection techniques in the upper gastrointestinal tract. Several methods are described such as electrocoagulation, argon plasma coagulation, photodynamic therapy, lift and cut resection, cap assisted aspiration and band ligation mucosectomy, and endoscopic submucosal dissection. Local results in more than 170 patients managed with endoscopic resection of oesophageal high grade dysplasia or squamous cell carcinoma and gastric or Barrett's epithelium high grade dysplasia or adenocarcinoma furthermore demonstrate the safety and effectiveness of endoscopic resection practiced in experienced centres.

  4. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B.

    2012-01-01

    -risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  5. Gastrointestinal Bleeding Secondary to Calciphylaxis.

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-11-17

    BACKGROUND Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. CASE REPORT A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. CONCLUSIONS Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding.

  6. Noninvasive assessment of esophageal-gastric varices by spleen stiffness in liver cirrhosis patients

    Institute of Scientific and Technical Information of China (English)

    李庭红

    2012-01-01

    Objective To investigate the value of spleen stiffness measured by transient elastography(FibroScan,FS) for diagnosing esophageal-gastric varices in liver cirrhosis patients. Methods A total of 259 cirrhotic patients in Tianjin Third Central Hospital rom Apr 2011 to Apr 2012,and 30 healthy controls were enrolled

  7. Prophylactic antibiotics for variceal hemorrhage: Clostridium difficile infection still can be a risk

    Institute of Scientific and Technical Information of China (English)

    Naohiro Okano; Kentaro Iwata

    2011-01-01

    Bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. Antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile infection (CDI). We argue against the conclusion of the authors and consider that this result may be simply due to concurrent use of metronidazole, a therapeutic agent against CDI.

  8. CT-maximum intensity projection is a clinically useful modality for the detection of gastric varices

    Institute of Scientific and Technical Information of China (English)

    Toru Ishikawa; Tomoteru Kamimura; Takashi Ushiki; Ken-ichi Mizuno; Tadayuki Togashi; Kouji Watanabe; Kei-ichi Seki; Hironobu Ohta; Toshiaki Yoshida; Keiko Takeda

    2005-01-01

    AIM: To evaluate the efficacy of CT-maximum intensity projection (CT-MIP) in the detection of gastric varicesand their inflowing and outflowing vessels in patientswith gastric varices scheduled to undergo balloonoccluded retrograde transvenous obliteration (B-RTO). METHODS: Sixteen patients with endoscopicallyconfirmed gastric varices were included in this study. All patients were evaluated with CT-MIP using threedimensional reconstructions, before and after B-RTO. RESULTS: CT-MIP clearly depicted gastric varices in 16 patients (100%), the left gastric vein in 6 (32.5%),the posterior gastric vein in 12 (75.0%), the short gastric veins in 13 (81.3%), gastrorenal shunts in 16 (100%), the hemiazygos vein (HAZV) in 4 (25.0%), the pericardiophrenic vein (PCPV) in 9 (56.3%), and the left inferior phrenic vein in 9 patients (56.3%). Although flow direction itself cannot be determined from CT-MIP,this modality provided clear images of the inflowing and the outflowing vessels. Moreover, in one patient, short gastric veins were not seen on conventional angiographic portography images of the spleen, but were clearly revealed on CT-MIP,CONCLUSION: We suggest that CT-MIP should be considered as a routine method for detecting and diagnosing collateral veins in patients with gastric varices scheduled for B-RTO. Furthermore, CT-MIP is more useful than endoscopy in verifying the early therapeutic effects of B-RTO.

  9. Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices

    Institute of Scientific and Technical Information of China (English)

    Yi Lu; Rui Gao; Zhuan Liao; Liang-Hao Hu; Zhao-Shen Li

    2009-01-01

    AIM: To review the literature on capsule endoscopy (CE) for detecting esophageal varices using conventional esophagogastroduodenoscopy (EGD) as the standard.METHODS: A strict literature search of studies comparing the yield of CE and EGD in patients diagnosed or suspected as having esophageal varices was conducted by both computer search and manual search. Data were extracted to estimate the pooled diagnostic sensitivity and specificity.RESULTS: There were seven studies appropriate for meta-analysis in our study, involving 446 patients.The pooled sensitivity and specificity of CE for detecting esophageal varices were 85.8% and 80.5%,respectively. In subgroup analysis, the pooled sensitivity and specificity were 82.7% and 54.8% in screened patients, and 87.3% and 84.7% in the screened/patients under surveillance, respectively.CONCLUSION: CE appears to have acceptable sensitivity and specificity in detecting esophageal varices. However, data are insufficient to determine the accurate diagnostic value of CE in the screen/surveillance of patients alone.

  10. The Ultrasound Diagnosis of Round Ligament Varices That Mimicked Inguinal Hernias During Pregnancy:A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hyung Jo; Shin, Hyun Woong; Kim, Seong Hun [Daegu Fatima Hospital, Daegu (Korea, Republic of); Cho, Sang Hee; Byun, Kyung Hwan [CHA Gumi Medical Center, CHA University, Gumi (Korea, Republic of)

    2010-03-15

    Round ligament varices during pregnancy are an important part of the differential diagnosis of inguinal hernia as they may cause symptoms and clinical features that are similar to those of inguinal hernia. When this condition is correctly diagnosed, an unnecessary operation may be prevented. The diagnosis of round ligament varices should be considered for pregnant women who present with a palpable mass in the groin. We describe here a case of round ligament varices that presented during pregnancy and this was readily diagnosed with Doppler sonography

  11. Balloon occlusion retrograde transvenous obliteration of gastric varices in two-cirrhotic patients with portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Borhei, Peyman; Kim, Seung Kwon; Zukerman, Darryl A [Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2014-02-15

    This report describes two non-cirrhotic patients with portal vein thrombosis who underwent successful balloon occlusion retrograde transvenous obliteration (BRTO) of gastric varices with a satisfactory response and no complications. One patient was a 35-year-old female with a history of Crohn's disease, status post-total abdominal colectomy, and portal vein and mesenteric vein thrombosis. The other patient was a 51-year-old female with necrotizing pancreatitis, portal vein thrombosis, and gastric varices. The BRTO procedure was a useful treatment for gastric varices in non-cirrhotic patients with portal vein thrombosis in the presence of a gastrorenal shunt.

  12. Elevated expression of the nuclear export protein, Crm1 (exportin 1), associates with human oesophageal squamous cell carcinoma.

    Science.gov (United States)

    van der Watt, Pauline J; Zemanay, Widaad; Govender, Dhirendra; Hendricks, Denver T; Parker, M I; Leaner, Virna D

    2014-08-01

    The nuclear export receptor, Crm1 (exportin 1), is involved in the nuclear translocation of proteins and certain RNAs from the nucleus to the cytoplasm and is thus crucial for the correct localisation of cellular components. Crm1 has recently been reported to be highly expressed in certain types of cancers, yet its expression in oesophageal cancer has not been investigated to date. We investigated the expression of Crm1 in normal and tumour tissues derived from 56 patients with human oesophageal squamous cell carcinoma and its functional significance in oesophageal cancer cell line models. Immunohistochemistry revealed that Crm1 expression was significantly elevated in oesophageal tumour tissues compared to normal tissues and its localisation shifted from predominantly nuclear to nuclear and cytoplasmic. Real‑time RT‑PCR revealed that Crm1 expression was elevated at the mRNA level. To determine the functional significance of elevated Crm1 expression in oesophageal cancer, its expression was inhibited using siRNA, and a significant decrease in cell proliferation was observed associated with G1 cell cycle arrest and the induction of apoptosis. Similarly, leptomycin B (LMB) treatment resulted in the effective killing of oesophageal cancer cells at nanomolar concentrations. Normal oesophageal epithelial cells, however, were much less sensitive to Crm1 inhibition with siRNA and LMB. Together, this study reveals that Crm1 expression is increased in oesophageal cancer and is required for the proliferation and survival of oesophageal cancer cells.

  13. Oesophageal-cancer-derived death in the population of Belgrade in a period 1989-2006

    Directory of Open Access Journals (Sweden)

    Janković Janko

    2009-01-01

    Full Text Available Background/Aim. Oesophageal cancer is the sixth most common cause of death from all malignant tumors in the world (fifth in men, eighth in women. This cancer was estimated to account for about 529 000 new cases and about 442 000 deaths in the year 2007. In the year 2002 the highest standardized mortality rates (per 100 000 habitants of oesophageal carcinoma were noticed in the East Asia (men/women: 18.8/7.7 and East Africa (18.6/7.8, while the lowest were noticed in the Middle Africa (1.4/0.2 and West Africa (1.3/0.5. The aim of this descriptive epidemiologic study was to analyze epidemiologic situation of oesophageal cancer in Belgrade population during the period 1989-2006, using mortality data. Methods. Mortality data were collected from the City Organization for Statistics. In data analysis we used mortality rates which were standardized directly using those of the world population as the standard, and proportions. A denominator for mortality rates was calculated using the Belgrade population which was an average of the two latest register years (1991 and 2002. In order to analyze trend mortality from oesophageal cancer we used linear trend. Results. In Belgrade deaths from oesophageal cancer accounted for about 5.2% of all malignant tumors of intestinal system in male population, and 2.4% in female population. This cancer is, according to standardized mortality rates (per 100 000 habitants, on the fifth place in Belgrade population behind colorectal, stomach, pancreatic, liver and cholecystic cancer. During the period 1989-2006 in Belgrade 44 persons died from oesophageal carcinoma on the average each year, mainly men (75%, and the rest were women (25%. In male population during the same period we noticed a significant increase in trend mortality (y = 1.61 + 0.06x, p = 0.001, while in female population the increase of mortality was not significant. The male/female oesophageal cancer mortality ratio was 3:1. Mortality rates for oesophageal

  14. Abdominal compartment syndrome from bleeding duodenal diverticulum

    Directory of Open Access Journals (Sweden)

    Vakhtang Tchantchaleishvili

    2012-01-01

    Full Text Available Duodenal diverticuli are acquired false diverticuli of unknown etiology. Although mostly asymptomatic, they can occasionally cause upper gastrointestinal hemorrhage, rarely with massive bleeding. In this report, we present (to the best of our knowledge the first reported case of duodenal diverticular bleeding, causing abdominal compartment syndrome. Albeit a rare event, duodenal diverticular bleeding should be included in the differential diagnosis of upper gastrointestinal bleeding. As with our case, a multidisciplinary approach to managing such patients is crucial.

  15. Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment.

    Science.gov (United States)

    Heiss, Peter; Feuerbach, Stefan; Iesalnieks, Igors; Rockmann, Felix; Wrede, Christian E; Zorger, Niels; Schlitt, Hans J; Schölmerich, Jürgen; Hamer, Okka W

    2009-04-01

    A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically.

  16. 上消化道出血182例患者的临床分析%Clinical Analysis of Upper Gastrointestinal Bleeding in 182 Patients

    Institute of Scientific and Technical Information of China (English)

    顾莹

    2011-01-01

    目的 探讨上消化道出血的常见病因,观察肿瘤标志物在胃癌出血患者中的异常率,分析患者未能行胃镜检查明确出血病因的原因.方法 对我院出院诊断考虑为"上消化道出血"的182例患者临床资料进行回顾性分析.结果 182例上消化道出血患者中,消化道溃疡出血61例(占33%),胃癌出血12例(占7%),食管、胃底静脉曲张破裂出血8例占4%;其中男性分别占85%(52/61)、67%(8/12)、8/8.胃癌患者癌胚抗原异常率为33%(4/12).89例上消化道出血患者病因未明的原因:患者或家属拒绝胃镜检查48例(占54%),因心肌梗死、不稳定型心绞痛、心功能不全不宜行胃镜检查7例占8%.结论 (1)上消化道出血最常见原因为消化性溃疡合并出血,其次为胃癌出血及食管、胃底静脉曲张破裂出血;(2)此3类出血患者均男多于女;(3)肿瘤标志物用于协助诊断胃癌的意义有限;(4)患者或家属拒绝行胃镜检查或必要时胃镜复查是不能明确上消化道出血病因的最常见原因.%Objective To explore the common causes of upper gastrointestinal bleeding, observe the incidence of abnormal tumor markers in gastric cancer patients with bleeding, and to analyze why patients unable to get the specific reasons for bleeding by gastroscopy. Methods Clinical data of 182 cases with discharge diagnosis of upper gastrointestinal bleeding were Retrospectively analyzed. Results Of the 182 cases with upper gastrointestinal bleeding, 61 cases ( 33% ) had peptic ulcer bleeding, 12 cases had gastric cancer bleeding ( 7% ), 8 cases had esophageal and gastric variceal bleeding ( 4% ), among which males accounted for 85% ( 52/61 ), 67% ( 8/12 ) and 8/8 respectively. Incidence of ahnormal carcinoemhryonic antigen was 33% ( 4/12 ) in patients with gastric cancer. Etiology of 89 cases with upper gastrointestinal bleeding were unknown :48 cases ( 54% ) or their families refused endoscopy, 7 cases ( 8% ) should

  17. Deferasirox (ICL670A) effectively inhibits oesophageal cancer growth in vitro and in vivo

    Science.gov (United States)

    Ford, SJ; Obeidy, P; Lovejoy, DB; Bedford, M; Nichols, L; Chadwick, C; Tucker, O; Lui, GYL; Kalinowski, DS; Jansson, PJ; Iqbal, TH; Alderson, D; Richardson, DR; Tselepis, C

    2013-01-01

    Background and Purpose Growing evidence implicates iron in the aetiology of gastrointestinal cancer. Furthermore, studies demonstrate that iron chelators possess potent anti-tumour activity, although whether iron chelators show activity against oesophageal cancer is not known. Experimental Approach The effect of the iron chelators, deferoxamine (DFO) and deferasirox, on cellular iron metabolism, viability and proliferation was assessed in two oesophageal adenocarcinoma cell lines, OE33 and OE19, and the squamous oesophageal cell line, OE21. A murine xenograft model was employed to assess the effect of deferasirox on oesophageal tumour burden. The ability of chelators to overcome chemoresistance and to enhance the efficacy of standard chemotherapeutic agents (cisplatin, fluorouracil and epirubicin) was also assessed. Key Results Deferasirox and DFO effectively inhibited cellular iron acquisition and promoted intracellular iron mobilization. The resulting reduction in cellular iron levels was reflected by increased transferrin receptor 1 expression and reduced cellular viability and proliferation. Treating oesophageal tumour cell lines with an iron chelator in addition to a standard chemotherapeutic agent resulted in a reduction in cellular viability and proliferation compared with the chemotherapeutic agent alone. Both DFO and deferasirox were able to overcome cisplatin resistance. Furthermore, in human xenograft models, deferasirox was able to significantly suppress tumour growth, which was associated with decreased tumour iron levels. Conclusions and Implications The clinically established iron chelators, DFO and deferasirox, effectively deplete iron from oesophageal tumour cells, resulting in growth suppression. These data provide a platform for assessing the utility of these chelators in the treatment of oesophageal cancer patients. Linked Article This article is commented on by Keeler and Brookes, pp. 1313–1315 of this issue. To view this commentary visit

  18. Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

    Institute of Scientific and Technical Information of China (English)

    Naoki; Hashimoto

    2015-01-01

    AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.

  19. Diverging trends in recent population-based survival rates in oesophageal and gastric cancer.

    Directory of Open Access Journals (Sweden)

    Jesper Lagergren

    Full Text Available BACKGROUND: Survival trends in oesophageal and gastric cancer need to be updated. A nationwide Swedish population-based study in 1961-2009 was based on registry data. METHODOLOGY/PRINCIPAL FINDINGS: Relative survival rate, i.e. the ratio of the observed to the expected survival, adjusted for age, sex, and calendar period, and presented with 95% confidence intervals (CI, was the main outcome measure. The expected survival was calculated using the corresponding Swedish general population with no exclusions. The relative survival rates in oesophageal and gastric cardia adenocarcinoma have improved since the 1990s (p for trend <0.001, but not in oesophageal squamous cell carcinoma or gastric non-cardia adenocarcinoma. The relative 5-year survival rates during the two recent periods 1990-1999 and 2000-2008 were 12.5% (95%CI 10.1%-14.9% and 10.3% (95%CI 8.5-12.0% for oesophageal squamous cell carcinoma, 12.5% (95%CI 10.1%-14.9% and 14.6% (95%CI 12.6-16.6% for oesophageal adenocarcinoma, 11.1% (95%CI 9.6%-12.6% and 14.3% (95%CI 12.3-16.3% for gastric cardia adenocarcinoma, and 20.2% (95%CI 19.2%-21.1% and 19.0% (95%CI 17.7-20.2% for gastric non-cardia adenocarcinoma. The 3-year survival in tumour stage III in 2004-2008 was about 25% for all four tumour types. CONCLUSIONS/SIGNIFICANCE: The survival in oesophageal and cardia adenocarcinoma is increasing, but the lack of such increase in oesophageal squamous cell carcinoma and gastric non-cardia adenocarcinoma is a concern.

  20. Epidemiological changes in oesophageal cancer at National Hospital, Bloemfontein: 1995, 2000 and 2005

    Directory of Open Access Journals (Sweden)

    Tian van der Merwe

    2010-03-01

    Full Text Available Background: Oesophageal cancer is a common malignancy with a high mortality rate. The two main histological types are squamous cell and adenocarcinoma. An increase in oesophageal adenocarcinoma has been noted, especially in developed countries.Objectives: The aim of this retrospective study was to investigate the profile of oesophageal cancer by reviewing medical records of patients diagnosed with oesophageal cancer in 1995, 2000 and 2005.Method: The study sample consisted of 474 files of patients diagnosed, for the first time, with oesophageal cancer in 1995, 2000 and 2005, at the National Hospital in Bloemfontein and the outreach clinics in surrounding areas. Information reviewed from patient files included: age, race and gender of the patient, as well as topography, size, histological grade and type of the tumour.Results: The number of newly diagnosed cases of oesophageal carcinoma decreased over the 10-year period. The mean age of patients was > 57 years. The majority of cases were Black patients: 90.5% in 1995, 93.2% in 2000 and 87.7% in 2005. More male patients were seen (71.5% in 1995, 70.1% in 2000 and 64.2% in 2005, although the number of female patients diagnosed with this malignancy increased by 7.3% from 1995 to 2005. The mid- and lower third of the oesophagus were affected most commonly, most lesions were 6 cm – 10 cm in length and classified as Grade II, moderately differentiated tumours. Squamous cell carcinoma was diagnosed in 76.9% of patients in 1995, 90.5% in 2000 and 94.3% in 2005.Conclusion: The number of newly diagnosed cases of oesophageal carcinoma decreased over the 10-year period, but demographic and disease characteristics remained constant.

  1. Evaluation of some pulmonary functions and pleuropulmonary complications after endoscopic sclerotherapy of gastric fundal varices at Zagazig university hospitals

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    Jihan A. Shawky

    2016-10-01

    Conclusions: NBCA injection of gastric fundal varices was associated with significant, reversible deterioration in some pulmonary functions, atelectasis and minimal pleural effusion with significant rapid improvement if incentive spirometry is used.

  2. Role of videocapsule endoscopy for gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Cristina Carretero; Ignacio Fernandez-Urien; Maite Betes; Miguel Mu(n)oz-Navas

    2008-01-01

    Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of an unknown origin that persists or recurs after negative initial upper and lower endoscopies.Several techniques,such as endoscopy,arteriography,scintigraphy and barium radiology are helpful for recognizing the bleeding source;nevertheless,in about 5%-10% of cases the bleeding lesion cannot be determined.The development of videocapsule endoscopy (VCE) has permitted a direct visualization of the small intestine mucosa.We will analyze those techniques in more detail.The diagnostic yield of CE for OGIB varies from 38% to 93%,being in the higher range in those cases with obscure-overt bleeding.

  3. Ambulatory oesophageal pH-metry. Position paper of the Working Team on Oesophageal pH-metry by the GISMAD (Gruppo Italiano di Studio sulla Motilità dell'Apparato Digerente).

    Science.gov (United States)

    Pace, F; Annese, V; Ceccatelli, P; Fei, L

    2000-05-01

    In the last three decades, oesophageal pH monitoring has progressed from a physiological research tool to a routine outpatient clinical investigation in patients with suspected gastro-oesophageal reflux disease, one of the most common gastrointestinal disorders. Technological progress has considerably simplified both the procedure and the interpretation of data obtained, and there is currently reasonable consensus as to the parameters that best discriminate between physiological and pathological reflux. There remains a need for internationally agreed definitions and standards with regard to indexes to quantitate the extent and the significance of the relationship between occurrence of symptoms and reflux episodes during the examination. It is felt that national or local normal values are to be used to circumvent different eating habits and other socio-cultural differences which may influence gastro-oesophageal reflux. The reproducibility of the test appears, at present, to be at least good enough to allow classification of the patient as a pathological or physiological refluxer, albeit wide day-to-day variations seem to exist as far as concerns the extent of gastro-oesophageal reflux. Clinical applications of the technique have increased with better knowledge of the protean clinical manifestations of gastro-oesophageal reflux disease, and include the evaluation of "typical" gastro-oesophageal reflux disease patients with negative endoscopy or refractory oesophagitis, the "atypical" manifestations of gastro-oesophageal reflux disease and the pre- and post-operative evaluation of patients undergoing antireflux surgery.

  4. Bleeding

    Science.gov (United States)

    ... Emergency medical services: overview and ground transport. In: Marx JA, Hockberger RS, Walls RM, et al, eds. ... Simon BC, Hern HG. Wound management principles. In: Marx JA, Hockberger RS, Walls RM, et al, eds. ...

  5. Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia

    Institute of Scientific and Technical Information of China (English)

    Natale Di Martino; Antonio Brillantino; Luigi Monaco; Luigi Marano; Michele Schettino; Raffaele Porfidia; Giuseppe Izzo; Angelo Cosenza

    2011-01-01

    AIM: To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.METHODS: Fifty-six patients (26 men, 30 women; mean age 42.8 ± 14.7 years) presenting for minimally invasive surgery for oesophageal achalasia, were enrolled. All patients underwent laparoscopic Heller myotomy followed by a 180° anterior partial fundoplication in 30 cases (group 1) and calibrated Nissen-Rossetti fundoplication in 26 (group 2). Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication. A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken. One and two years after surgery, the patients underwent symptom questionnaires, endoscopy,oesophageal manometry and 24 h oesophago-gastric pH monitoring.RESULTS: At the 2-year follow-up, no significant difference in the median symptom score was observed between the 2 groups (P = 0.66; Mann-Whitney U-test). The median percentage time with oesophageal pH < 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group (2; range 0.8-10 vs 0.35; range 0-2) (P < 0.0001; Mann-WhitneyMann-Whitney U-test).CONCLUSION: Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia. Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure.

  6. Incidence of gastro-oesophageal reflux in geriatric clinical patients - a radiological study

    Energy Technology Data Exchange (ETDEWEB)

    Brackins-Romero, J.; Bruening, B.; Beyer, H.K.

    1984-05-01

    Gastro-oesophageal reflux is obviously caused by an insufficiency of the dilatable lower end of the oesophagus. The physiological pressure acting on it corresponds to 15-30 mm Hg so that the gastric juice is prevented from entering the oesophagus. Reflux is associated with a reduction of that pressure. Many causes may be responsible, although hiatal hernia, where confirmed, will only play a secondary part. In half of the 74 examined elderly patients, gastro-oesophageal reflux was confirmed by radiology. About half of these suffered also from hiatal hernia which was a sliding hernia in 75 per cent of the cases. In about 25 per cent of the patients suffering from gastro-oesophageal reflux, signs of oesophagitis were discovered by radiology. There was no correlation between overweight and the incidence of reflux, but hiatus hernia and a positive Broca test were distinctly related to one another. In patients with gastro-oesophageal reflux, vomiting as a key symptom was more frequently confirmed than in patients without reflux.

  7. Dietary proportions of carbohydrates, fat, and protein and risk of oesophageal cancer by histological type.

    Directory of Open Access Journals (Sweden)

    Katarina Lagergren

    Full Text Available BACKGROUND: Dietary habits influence the risk of cancer of the oesophagus and oesophago-gastric junction, but the role of proportions of the main dietary macronutrients carbohydrates, fats and proteins is uncertain. METHODS: Data was derived from a nationwide Swedish population-based case-control study conducted in 1995-1997, in which case ascertainment was rapid, and all cases were uniformly classified. Information on the subjects' history of dietary intake was collected in personal interviews. Odds ratios (ORs and 95% confidence intervals (CIs were calculated using logistic regression, with adjustment for potentially confounding factors. RESULTS: Included were 189 oesophageal adenocarcinomas, 262 oesophago-gastric adenocarcinomas, 167 oesophageal squamous cell carcinomas, and 820 control subjects. Regarding oesophageal or oesophago-gastric junctional adenocarcinoma, a high dietary proportion of carbohydrates decreased the risk (OR 0.50, CI 0.34-0.73, and a high portion of fat increased the risk (OR 1.96, CI 1.34-2.87, while a high proportion of protein did not influence the risk (OR 1. 08, 95% CI 0.75-1.56. Regarding oesophageal squamous cell carcinoma, the single macronutrients did not influence the risk statistically significantly. CONCLUSIONS: A diet with a low proportion of carbohydrates and a high proportion of fat might increase the risk of oesophageal adenocarcinoma.

  8. A corrosive oesophageal burn model in rats: Double-lumen central venous catheter usage

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    Vedat Bakan

    2015-01-01

    Full Text Available Background: We aimed to create a new and less invasive experimental corrosive oesophageal burn model using a catheter without a gastric puncture (gastrotomy. Materials and Methods: We conducted the study with two groups composed of 8 male rats. The experimental oesophageal burn was established by the application of 10% sodium hydroxide to the distal oesophagus under a pressure of 20 cmH 2 O, via 5-F double-lumen central venous catheter without a gastrotomy. The control group was given 0.9% sodium chloride. All rats were killed 24 h after administration of NaOH or 0.9% NaCl. Histologic damage to oesophageal tissue was scored by a single pathologist blind to groups. Results: The rats in the control group were observed to have no pathological changes. Corrosive oesophagitis (tissue congestion, oedema, inflammation, ulcer and necrosis was observed in rats exposed to NaOH. Conclusion: We believe that an experimental corrosive oesophageal burn can safely be created under same hydrostatic pressure without a gastric puncture using this model.

  9. Nasogastric tube as protection for recurrent oesophageal stricture: a case report.

    Science.gov (United States)

    Woynarowski, Marek; Dądalski, Maciej; Wojno, Violetta; Teisseyre, Mikołaj; Szymczak, Marek; Chyżyńska, Anna; Hurkała, Leszek; Płowiecki, Emil; Kmiotek, Jakub

    2014-04-28

    This report presents the case of an 8.5-year-old boy with Down syndrome after experiencing extensive caustic injury to the oesophagus and stomach resulting from the accidental ingestion of concentrated sulphuric acid. The patient had undergone 32 unsuccessful endoscopic oesophageal stricture dilatations and stenting procedures performed over a period of 15 mo following the accident. Surgical reconstruction of the oesophagus was not possible due to previous gastric and cardiac surgeries for congenital conditions. Before referring the patient for salivary fistula surgery, the patient received a nasogastric tube with perforations located above the upper margin of the oesophageal stenosis for the passage of saliva and fluid. The tube was well tolerated and improved swallowing; however the backflow of gastric contents caused recurrent infections of the respiratory tract. To overcome these problems, we developed a double lumen, varying diameter, perforated tube for protection of the oesophageal closure. This nasogastric tube was found to be safe and decreased the need for hospitalization and further endoscopic procedures. This newly developed tube can thus be considered as a treatment option for patients with recurrent oesophageal stenosis and contraindications for surgical oesophageal reconstruction.

  10. New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair

    DEFF Research Database (Denmark)

    Czerny, Martin; Eggebrecht, Holger; Sodeck, Gottfried;

    2014-01-01

    To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR).......To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR)....

  11. SU-E-T-69: A Radiobiological Investigation of Dose Escalation in Lower Oesophageal Tumours with a Focus On Gastric Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Carrington, R [Cardiff University, Cardiff, Wales (United Kingdom); Staffurth, J; Spezi, E; Crosby, T [Velindre Cancer Centre, Cardiff, Wales (United Kingdom); Warren, S; Partridge, M; Hawkins, M [CRUK/MRC Oxford Institute for Radiation Oncology, Oxford (United Kingdom); Gwynne, S [Singleton Hospital, Swansea, Wales (United Kingdom)

    2015-06-15

    The incidence of lower third oesophageal tumours is increasing in most Western populations. With the role of radiotherapy dose escalation being identified as a research priority in improving outcomes, it is important to quantify the increased toxicity that this may pose to sites such as the lower oesophagus. This study therefore aims to investigate the feasibility of lower oesophageal dose escalation with a focus on stomach tissue toxicity.The original 3D-conformal plans (50Gy3D) from 10 patients in the SCOPE1 trial were reviewed and compared to two RapidArc plans created retrospectively to represent the treatment arms of the forthcoming SCOPE2 trial: 50GyRA and 60GyRA (50Gy to PTV1 with a simultaneously integrated boost of 60Gy to PTV2). The stomach was contoured as stomach wall and dose constraints set according to QUANTEC. Normal tissue complication probability (NTCP) was estimated for the stomach wall for an endpoint of gastric bleeding. There was a mean increase of 5.93% in NTCP from 50Gy3D to 60GyRA and a mean increase of 8.15% in NTCP from the 50GyRA to 60GyRA. With NTCP modelling restricted to volumes outside PTV2, there was a mean decrease of 0.92% in NTCP from the 50Gy3D to 60GyRA, and a mean increase of 2.25% from 50GyRA to 60GyRA. There was a strong correlation between the NTCP and Stomach Wall/PTV1 overlap volume for all plans (R=0.80, 0.77 and 0.77 for 60GyRA, 50GyRA and 50Gy3D respectively). There was also a strong correlation between NTCP and the Stomach Wall/PTV2 overlap volume for 60GyRA (R= 0.82).Radiobiological modelling suggests that increasing the prescribed dose to 60Gy may be associated with a significantly increased risk of toxicity to the stomach within the boost volume. It is recommended that stomach toxicity be closely monitored prospectively when treating patients with lower oesophageal tumours in the forthcoming SCOPE 2 trial. Rhys Carrington received a PhD studentship grant from Cancer Research Wales. Grant number: 2445; Dr Warren and

  12. Atrio-oesophageal fistula after transcatheter radiofrequency ablation.

    Science.gov (United States)

    Moss, Caroline E; Fernandez-Caballero, Sandra; Walker, David

    2015-01-05

    A 68-year-old woman presented 3 weeks following unsuccessful transcatheter radiofrequency ablation (TcRFA) for treatment of her chronic atrial fibrillation. Neurological signs manifested on day 2 of admission with generalised tonic-clonic seizures and reduced Glasgow Coma Score. She was treated for presumed central nervous system (CNS) infection, intubated and transferred to the intensive care unit. CT of the head showed bilateral oedema secondary to acute embolic stroke. Blood cultures grew Streptococcus viridans, and lumbar puncture findings were consistent with CNS infection. Echocardiography showed only a septostomy puncture from the atrial fibrillation ablation procedure. Thoracic CT demonstrated air in the left atrium, consistent with the diagnosis of atrio-oesophageal fistula, a rarely reported iatrogenic complication of TcRFA. MRI of the head showed significant neurological injury with innumerable embolic infarcts. After discussion with her family regarding the significant neurological insult, and with no signs of any clinical improvement, the patient died on day 8 of admission.

  13. Measurement of Gastric Circumference in Foetuses with Oesophageal Atresia.

    Science.gov (United States)

    Hoopmann, M; Kagan, K O; Borgmeier, F; Seitz, G; Arand, J; Wagner, P

    2015-11-01

    Background: The specific recognition of oesophageal atresia (OA) with or without a tracheal fistula in a foetus is a diagnostic challenge for prenatal medicine. The aim of the present work is to analyse the value of the measurement of gastric size in the diagnosis of this significant malformation. Materials and Methods: Altogether, the examinations of 433 pregnancies between the 18.4 and 39.1 weeks of gestation were retrospectively analysed. 59 of these foetuses exhibited an OA. By means of a linear regression analysis with normal foetuses, significant parameters influencing gastric size were examined. Subsequently the gastric sizes were transformed into z values and a comparison was made between OA with and without fistulae with the help of t tests. Results: In the normal foetuses there was a significant association between the gastric circumference and the abdominal circumference (circumference = 6.809 + 0.179 × abdominal circumference, r = 0.686, p values in the normal group and in the groups of OA with fistula and without fistula amounted to 0.0 (SD 1.0), -1.3 (SD 2.2) and -4.5 (SD 1.0). Conclusion: Measurements of the gastric circumference below the 5th percentile should lead to further diagnostic measures, especially when associated with polyhydramnios. Although OA without a fistula is always conspicuous, only about one in three OAs with fistula are associated with a significantly smaller stomach.

  14. The management of lower gastrointestinal bleeding.

    Science.gov (United States)

    Marion, Y; Lebreton, G; Le Pennec, V; Hourna, E; Viennot, S; Alves, A

    2014-06-01

    Lower gastrointestinal (LGI) bleeding is generally less severe than upper gastrointestinal (UGI) bleeding with spontaneous cessation of bleeding in 80% of cases and a mortality of 2-4%. However, unlike UGI bleeding, there is no consensual agreement about management. Once the patient has been stabilized, the main objective and greatest difficulty is to identify the location of bleeding in order to provide specific appropriate treatment. While upper endoscopy and colonoscopy remain the essential first-line examinations, the development and availability of angiography have made this an important imaging modality for cases of active bleeding; they allow diagnostic localization of bleeding and guide subsequent therapy, whether therapeutic embolization, interventional colonoscopy or, if other techniques fail or are unavailable, surgery directed at the precise site of bleeding. Furthermore, newly developed endoscopic techniques, particularly video capsule enteroscopy, now allow minimally invasive exploration of the small intestine; if this is positive, it will guide subsequent assisted enteroscopy or surgery. Other small bowel imaging techniques include enteroclysis by CT or magnetic resonance imaging. At the present time, exploratory surgery is no longer a first-line approach. In view of the lesser gravity of LGI bleeding, it is most reasonable to simply stabilize the patient initially for subsequent transfer to a specialized center, if minimally invasive techniques are not available at the local hospital. In all cases, the complexity and diversity of LGI bleeding require a multidisciplinary collaboration involving the gastroenterologist, radiologist, intensivist and surgeon to optimize diagnosis and treatment of the patient.

  15. Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices Eficácia da injeção de álcool absoluto comparada com ligadura elástica na erradicação de varizes de esôfago

    Directory of Open Access Journals (Sweden)

    Angelo Paulo Ferrari

    2005-06-01

    Full Text Available BACKGROUND: Endoscopic sclerotherapy is an absolute indication for treating esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated. AIM: To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation. PATIENTS AND METHOD: Forty-six patients with liver cirrhosis and esophageal varices were prospectively randomized into two treatment groups: endoscopic sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. Informed writing consent was obtained from every patient and the Ethics Committee of Federal University of São Paulo, SP, Brazil, approved the study. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence. RESULTS: Both groups were similar except that male gender was more common in the sclerotherapy group. There was no statistical difference regarding variceal eradication (78.3% in sclerotherapy group vs 73.9% in the ligation group, recurrence (26.7% vs 42.9%, respectively and death related to any cause (21.7% vs 13.9%. In the sclerotherapy group more sessions were need to obtain complete variceal eradication. In this group we did observe a high re-bleeding rate (34.8% and more ulcers associated with retrosternal pain right after the procedure. There was no difference regarding overall morbidity and mortality. CONCLUSIONS: Banding ligation requires fewer sessions than sclerotherapy with absolute alcohol to eradicate esophageal varices. Both methods are equally efficient regarding variceal eradication and recurrence during a short follow-up period.RACIONAL: Escleroterapia endoscópica tem indicação absoluta no tratamento das varizes de esôfago. Ressangramento é comum durante o período de tratamento, antes que as varizes sejam erradicadas. OBJETIVO: Comparar duas técnicas de

  16. TIPSS for variceal hemorrhage after living related liver transplantation: A dangerous indication

    Institute of Scientific and Technical Information of China (English)

    Peter Schemmer; Boris Radeleff; Christa Flechtenmacher; Arianeb Mehrabi; G(o)tz M Richter; Markus W Büchler; Jan Schmidt

    2006-01-01

    The introduction of transjugular intrahepatic portalsystemic stent-shunt (TIPSS) has been a major breakthrough in the treatment of portal hypertension,which has evolved to a large extent, into a routine procedure. A 21-year-old male patient with progressive graft fibrosis/cirrhosis requiring TIPSS for variceal hemorrhage in the esophagus due to portal hypertension was unresponsive to conventional measures two years after living related liver transplantation (LDLT).Subsequently, variceal hemorrhage was controlled,however, liver function decreased dramatically with consecutive multi organ failure. CT scan revealed substantial necrosis in the liver. The patient underwent successful "high urgent" cadaveric liver transplantation and was discharged on postoperative d 20 in a stable condition.

  17. A simple, high throughput method for the quantification of sodium alginates on oesophageal mucosa.

    Science.gov (United States)

    Richardson, J C; Dettmar, P W; Hampson, F C; Melia, C D

    2004-03-01

    Sodium alginate is a potential bioadhesive, but the lack of a convenient and suitable method for its quantification on the mucosal surface complicates the evaluation of its mucosal retentive properties. This paper develops and evaluates a spectrophotometric method for the rapid quantification of a range of sodium alginates differing in chemical composition, and investigates how quantification was influenced by the presence of oesophageal mucosa. The method, based on dye complexation with 1,9-dimethyl methylene blue (DMMB) was sensitive to alginate molecular weight and uronic acid composition, however, no significant correlations between assay performance and alginate molecular characteristics were demonstrated. The assay was also influenced by complexation time, calcium ions and mucin, but was unaffected by the presence of oesophageal tissue scrapings. The assay proved to be capable of quantifying sodium alginate with excellent linearity (r = 0.999), reproducibility (CV alginate on oesophageal mucosa.

  18. Challenges in Anaesthetic management of a child for thoracoscopic assisted oesophageal replacement

    Directory of Open Access Journals (Sweden)

    K R Chandrakala

    2016-01-01

    Full Text Available The loss of oesophageal length or obliteration of oesophageal lumen due to stricture acquired by accidental caustic ingestion is more common in children that may require major operative reconstruction. A number of procedures have been developed for anatomic replacement of oesophagus of which thoracoscopic assisted gastric transposition has shown the best outcome in children. This demands an extensive pre-operative evaluation, preparation and anaesthetic management since this is challenging and prolonged procedure done under one lung ventilation (OLV. Though it is a minimally invasive procedure, providing OLV and management of complications associated with it are the anaesthetic challenges among these children. We report anaesthetic management of an 8-year-old boy with oesophageal stricture following corrosive injury posted for thoracoscopic assisted gastric transposition.

  19. Limbic encephalitis as the presenting symptom of oesophageal adenocarcinoma: another cancer to search?

    Science.gov (United States)

    Menezes, Renata Barbosa; de Lucena, Adson Freitas; Maia, Fernanda Martins; Marinho, Antônia Rosivalda Teixeira

    2013-04-16

    Limbic encephalitis is a syndrome characterised by irritability, depression, sleeping disturbance, convulsion, hallucination and short-period memory loss that is commonly associated with a malignancy even if there is no evidence of it by the time of presentation. Most reported cases of limbic encephalitis as a paraneoplastic syndrome are associated with small-cell lung cancer and lymphoma. This article is a case report of a patient with limbic encephalitis associated with an oesophageal adenocarcinoma. The patient is a middle-aged man who presented apathy and unstable mood. After months, developed diplopia, reduced visual acuity and involuntary movements. Later, gait disability, disorientation, memory loss and aggressive behaviour were detected, associated with seizures. After investigation, limbic encephalitis was diagnosed and, as the patient developed dysphagia, oesophageal adenocarcinoma was detected. Oesophageal carcinoma usually does not have neurological symptoms associated.

  20. Post-gastrectomy spleen enlargement and esophageal varices: Distal vs total gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Takatsugu; Oida; Kenji; Mimatsu; Hisao; Kano; Atsushi; Kawasaki; Youichi; Kuboi; Nobutada; Fukino; Sadao; Amano

    2010-01-01

    AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-t...

  1. Is Clinical Research in Oesophageal Cancer in South Africa in Crisis? A Systematic Review.

    Science.gov (United States)

    Loots, E; Sartorius, B; Madiba, T E; Mulder, C J J; Clarke, D L

    2017-03-01

    Oesophageal cancer (OC) is responsible for the second highest number of cancer-related deaths in South Africa (SA). Squamous cell carcinoma is the most prevalent type with an incidence of 46.7/100,000 and 19.2/100,000 for males and females. This is a systematic review of the clinical diagnosis and management of OC within the South African context. This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016034053) with adherence to PRISMA guidelines. An online search was performed using MEDLINE, EBSCOHost and PubMed. Eligibility criteria for articles included published, original peer-reviewed research addressing clinical management of oesophageal cancer in South Africa. Review articles, case reports, scientific letters and studies published in languages other than English or Afrikaans were excluded. The research terms were 'etiology', 'human', 'esophageal cancer', 'esophageal carcinoma', 'oesophageal cancer', and 'oesophageal carcinoma', 'squamous cell carcinoma', 'Africa' and 'South Africa'. A total of 336 articles were identified. Of these, 146 were immediately excluded and a further 159 were excluded after review. A total of 31 appropriate articles, i.e. 9.2% of searched articles, were included. Thirteen articles addressed chemotherapy and/or radiotherapy, 9 oesophageal luminal therapy, 7 oesophageal surgery and 2 screening. OC research of in SA over the last two decades has mainly been in the form of reviews and opinion papers. Clinical research, auditing and prospectively analysing OC management and outcomes in SA hospitals are sorely needed and should be promoted by both healthcare workers and policy makers alike.

  2. Intake of whole grains and incidence of oesophageal cancer in the HELGA Cohort.

    Science.gov (United States)

    Skeie, Guri; Braaten, Tonje; Olsen, Anja; Kyrø, Cecilie; Tjønneland, Anne; Landberg, Rikard; Nilsson, Lena Maria; Wennberg, Maria; Overvad, Kim; Åsli, Lene Angell; Weiderpass, Elisabete; Lund, Eiliv

    2016-04-01

    Few prospective studies have investigated the association between whole-grain consumption and incidence of oesophageal cancer. In the Scandinavian countries, consumption of whole grains is high and the incidence of oesophageal cancer comparably low. The aim of this paper was to study the associations between consumption of whole grains, whole-grain products and oesophageal cancer, including its two major histological subtypes. The HELGA cohort is a prospective cohort study consisting of three sub-cohorts in Norway, Sweden and Denmark. Information regarding whole-grain consumption was collected through country-specific food frequency questionnaires. Cancer cases were identified through national cancer registries. Cox proportional hazards ratios were calculated in order to assess the associations between whole grains and oesophageal cancer risk. The analytical cohort had 113,993 members, including 112 cases, and median follow-up time was 11 years. When comparing the highest tertile of intake with the lowest, the oesophageal cancer risk was approximately 45 % lower (adjusted HR 0.55, 95 % CI 0.31-0.97 for whole grains, HR 0.51, 95 % CI 0.30-0.88 for whole-grain products). Inverse associations were also found in continuous analyses. Whole-grain wheat was the only grain associated with lower risk (HR 0.32, 95 % CI 0.16-0.63 highest vs. lowest tertile). Among whole-grain products, the results were less clear, but protective associations were seen for the sum of whole-grain products, and whole-grain bread. Lower risk was seen in both histological subtypes, but particularly for squamous cell carcinomas. In this study, whole-grain consumption, particularly whole-grain wheat, was inversely associated with risk of oesophageal cancer.

  3. AN UNUSUAL CAUSE OF UPPER GASTROINTESTINAL BLEEDING.

    Science.gov (United States)

    Ali, Kishwar; Zarin, Muhammad; Latif, Humera

    2015-01-01

    Gastrointestinal haemorrhage (GI) is a serious condition that presents both diagnostic as well as therapeutic challenges. Resuscitation of the patient is the first and most important step in its management followed by measures to localize and treat the exact source and site of bleeding. These modalities are upper and lower GI endoscopies, radionuclide imaging and angiography. Surgery is the last resort to handle the situation, if the patient does not respond to resuscitative measures and the various interventional procedures fail to locate and stop the bleeding. We present a case of upper GI bleeding which presented with massive per rectal bleeding and the patient was not responding to resuscitation with multiple blood transfusions. Ultimately an exploratory laparotomy was done which revealed an extra-intestinal source of bleeding into the lumen of duodenum, presenting as upper GI bleeding.

  4. Spontaneous oesophageal rupture: a diagnostic challenge in resource-limited setting.

    Science.gov (United States)

    Shao, Elichilia R; Joseph, Pantaleo M; Slootweg, Piet; Mkwizu, Elifuraha W; Kilonzo, Kajiru G; Mwasamwaja, Amos O

    2015-08-01

    Spontaneous oesophageal rupture after swallowing a bolus of food is a very rare condition. In resource-limited settings, it is very challenging to diagnose this condition especially when its presentation is atypical. Its prognosis is very poor when diagnosis is delayed due to risk of mediastinitis. We report a case of 37-year-old man who was admitted to our hospital complaining of sudden onset of chest tightness and pain after a meal 8 h prior to admission. Urgent chest radiograph revealed right hydropneumothorax with collapsed lung. Water-seal drainage was established gushing 1200 ml of food materials. Definitive diagnosis of oesophageal rupture was reached after post-mortem.

  5. Delayed-Onset Superior Mesenteric Artery Syndrome Presenting as Oesophageal Peptic Stricture

    Directory of Open Access Journals (Sweden)

    Emanuele Sinagra

    2012-02-01

    Full Text Available Superior mesenteric artery (SMA syndrome is an infrequent cause of vomiting and weight loss due to compression of the third part of the duodenum by the SMA. We describe the case of a 17-year-old woman, admitted to our department for progressive dysphagia and severe weight loss due to an oesophageal peptic stricture, caused by chronic acid reflux secondary to duodenal compression by the SMA. Symptoms improved after (parenteral nutrition and repeated oesophageal dilatation, thus supporting the role of intensive medical and endoscopic intervention as an alternative to surgery, at least in some cases.

  6. A First Comparative Study of Oesophageal and Voice Prosthesis Speech Production

    Science.gov (United States)

    Carello, Massimiliana; Magnano, Mauro

    2009-12-01

    The purpose of this work is to evaluate and to compare the acoustic properties of oesophageal voice and voice prosthesis speech production. A group of 14 Italian laryngectomized patients were considered: 7 with oesophageal voice and 7 with tracheoesophageal voice (with phonatory valve). For each patient the spectrogram obtained with the phonation of vowel /a/ (frequency intensity, jitter, shimmer, noise to harmonic ratio) and the maximum phonation time were recorded and analyzed. For the patients with the valve, the tracheostoma pressure, at the time of phonation, was measured in order to obtain important information about the "in vivo" pressure necessary to open the phonatory valve to enable speech.

  7. Combined laparoscopy and transabdominal endoscopy: Case report of dislodged oesophageal stent retrieval

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    Rajiv K Chander

    2011-01-01

    Full Text Available The patient is a 39-year-old male with a five-month history of progressive dysphagia and a 70 lb weight loss. On upper gastrointestinal (GI endoscopy he was found to have a near-obstructing mass in the lower oesophagus that was proven by biopsy to be oesophageal adenocarcinoma. Stricture caused by the adenocarcinoma mass was stented with a Cook Evolution 12.5 cm / 24 Fr stent, which dislodged subsequently. We report the first case of a dislodged Cook Evolution 12.5 cm / 24 Fr oesophageal stent that was retrieved using combined laparoscopic and transabdominal endoscopy.

  8. Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN: analysis from the German SAL-MPN-registry

    Directory of Open Access Journals (Sweden)

    A. Kaifie

    2016-03-01

    Full Text Available Abstract Background Patients with Ph-negative myeloproliferative neoplasms (MPN, such as polycythemia vera (PV, essential thrombocythemia (ET, and primary myelofibrosis (PMF, are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN. Methods The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008. For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events. Results MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length. While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95 % CI = 1.39–8.48 and splenomegaly (OR 1.76; 95 % CI = 1.15–2.71. Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95 % CI = 1.36–5.40, splenomegaly (OR = 2.22; 95 % CI 1.01–4.89, and the administration of heparin (OR = 5.64; 95 % CI = 1.84–17.34. Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups

  9. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department

    Directory of Open Access Journals (Sweden)

    José Manuel Recio-Ramírez

    2015-05-01

    Full Text Available Objectives: To assess the ability of the Glasgow Blatchford Score (GBS system to identify the need for urgent upper gastrointestinal endoscopy (UGIE in patients with upper gastrointestinal bleeding (UGIB. Methods: An observational, retrospective study was carried out in all patients attended at the ER for suspected UGIB in one year. Patients were split into two categories -high-risk (>2 and low-risk (≤2- by means of the GBS system. Results: A total of 60 patients were included. Of these, 46 were classified as "high-risk" (> 2 and 14 as "low-risk" (≤ 2 subjects. The characteristics of patients in the low-risk group included: Mean age: 46.6 ± 13.7 (18-88 years. Males/females: 7/7. Urgent endoscopy revealed: normal (50%; n = 7; esophagitis (21.4%; n = 3; gastritis (14.2%; n = 2; Mallory-Weiss syndrome (7.1%; n = 1; non-bleeding varices (7.1%; n = 1. The characteristics of patients in the high-risk group included: Mean age: 68.7 ± 19.8 (31-91 years. Males/females: 30/16. Digestive endoscopy revealed: Gastric/duodenal ulcer (56.52%; n = 26; normal (17.39%; n = 8; esophagitis (8.69%; n = 4; gastritis (8.69%; n = 4; angioectasia (4.34%; n = 2; bleeding varices (4.34%; n = 2. Low-risk patients exhibited no lesions requiring urgent management during endoscopy, and the sensitivity of the GBS scale for high-risk UGIB detection was found to be 100% (95% CI: 86.27%, 99.71%, with a specificity of 48.28% (95% CI: 29.89, 67.1%. Conclusions: The GBS scale seems to accurately identify patients with low-risk UGIB, who may be managed on an outpatient basis and undergo delayed upper GI endoscopy at the outpatient clinic.

  10. Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding? ¿Tiene aún sentido la enteroscopia intraoperatoria en pacientes con hemorragia gastrointestinal de origen oscuro?

    Directory of Open Access Journals (Sweden)

    Pedro Monsanto

    2012-04-01

    Full Text Available Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleed-ing lesion in 94%. Small bowel findings included: angiodysplasia (n = 6, ulcers (n = 4, small bowel Dieulafoy's lesion (n = 2, bleed-ing from anastomotic vessels (n = 1, multiple cavernous hemangiomas (n = 1 and bleeding ectopic jejunal varices (n = 1. Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

  11. 肝硬化食管静脉曲张程度门脾静脉内径及Child-Pugh分级的关系%Research on the Relationship among the Esophageal Varices, the Diameter of Portal Vein and Spleen Vein, and ChildPugh's Score in Patients with Liver Cirrhosis

    Institute of Scientific and Technical Information of China (English)

    蒋志凌; 陈旭平; 付冰; 陈霞; 付丹

    2011-01-01

    Objective To discuss the relationship among the esophageal varices, the diameter of portal vein and spleen vein, and Child-Pugh score in patients with liver cirrhosis. Methods The study included 56 patients who had liver cirrhosis between January 2007 and January 2010. We measured their portal vein and spleen vein diameter with CT; used Child-Pugh score to grade their hepatic function; and detected the degree of the esophageal varices by endoscopy. Results There was a positive correlation between the degree of esophageal varices and diameter of portal vein and spleen vein, while no correlation showed between portal vein and spleen vein diameter, degree of esophageal varices, and Child-Pugh score. Conclusion The upper gastrointestinal bleeding in patients with liver cirrhosis can be predicted by the diameter of portal vein and spleen vein, assessment of upper gastrointestinal bleeding based on ChildPugh score should also be taken into account.%目的 探讨肝硬化食管静脉曲张程度与门脾静脉内径、肝功能Child-Pugh分级间的关系.方法 对2007年1月-2010年1月间56例肝硬化患者行增强CT,测量门静脉主十及脾门部脾静脉直径,采用Child-Pugh分级标准进行肝功能分级,并行胃镜了解食管静脉曲张的程度.结果 食管静脉曲张程度与门、脾静脉内径呈正相关,而Child-Pugh分级与门脾静脉内径、食管静脉曲张程度无相关性.结论 根据门、脾静脉内径可预测肝硬化上消化道出血的可能性;在Child-Pugh分级基础上对患者上消化道出血的风险进行评估显得尤为重要.

  12. Factors Associated With Major Bleeding Events

    Science.gov (United States)

    Goodman, Shaun G.; Wojdyla, Daniel M.; Piccini, Jonathan P.; White, Harvey D.; Paolini, John F.; Nessel, Christopher C.; Berkowitz, Scott D.; Mahaffey, Kenneth W.; Patel, Manesh R.; Sherwood, Matthew W.; Becker, Richard C.; Halperin, Jonathan L.; Hacke, Werner; Singer, Daniel E.; Hankey, Graeme J.; Breithardt, Gunter; Fox, Keith A. A.; Califf, Robert M.

    2014-01-01

    Objectives This study sought to report additional safety results from the ROCKET AF (Rivaroxaban Once-daily oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). Background The ROCKET AF trial demonstrated similar risks of stroke/systemic embolism and major/nonmajor clinically relevant bleeding (principal safety endpoint) with rivaroxaban and warfarin. Methods The risk of the principal safety and component bleeding endpoints with rivaroxaban versus warfarin were compared, and factors associated with major bleeding were examined in a multivariable model. Results The principal safety endpoint was similar in the rivaroxaban and warfarin groups (14.9 vs. 14.5 events/100 patient-years; hazard ratio: 1.03; 95% confidence interval: 0.96 to 1.11). Major bleeding risk increased with age, but there were no differences between treatments in each age category (<65, 65 to 74, ≥75 years; pinteraction = 0.59). Compared with those without (n = 13,455), patients with a major bleed (n = 781) were more likely to be older, current/prior smokers, have prior gastrointestinal (GI) bleeding, mild anemia, and a lower calculated creatinine clearance and less likely to be female or have a prior stroke/transient ischemic attack. Increasing age, baseline diastolic blood pressure (DBP) ≥90 mm Hg, history of chronic obstructive pulmonary disease or GI bleeding, prior acetylsalicylic acid use, and anemia were independently associated with major bleeding risk; female sex and DBP <90 mm Hg were associated with a decreased risk. Conclusions Rivaroxaban and warfarin had similar risk for major/nonmajor clinically relevant bleeding. Age, sex, DBP, prior GI bleeding, prior acetylsalicylic acid use, and anemia were associated with the risk of major bleeding. (An Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non

  13. Early oesophageal cancer: results of a European multicentre survey. Group Européen pour l'Etude des Maladies de l'Oesophage.

    Science.gov (United States)

    Bonavina, L

    1995-01-01

    Early oesophageal cancer has been extensively studied in Far-Eastern countries, where its prevalence is high. A multicentre survey was conducted within the Groupe Européen pour l'Etude des Maladies de l'Oesophage to analyse results of surgical treatment in patients with disease staged as pTis-T1 N0 M0 according to the tumour node metastasis classification. Of 9743 patients with squamous cell oesophageal carcinoma observed since 1980, 4663 underwent resection; 253 (5.4 per cent) of these fulfilled the criteria for inclusion in the study. The overall mortality rate was 9.1 per cent (23 patients), and was higher after transthoracic than transhiatal oesophagectomy (10.7 versus 6 per cent, P not significant). Pathological examination showed an intraepithelial tumour in 46 patients (18.2 per cent), intramucosal carcinoma in 64 (25.3 per cent) and a submucosal lesion in 143 (56.5 per cent). The overall 5-year survival rate for patients with intraepithelial, intramucosal and submucosal tumours was 92.8, 72.8 and 44.3 per cent respectively. The 5-year survival rate was higher after transthoracic than transhiatal oesophagectomy (66 versus 52 per cent). No survival advantage was observed after either operation in patients with mucosal tumours. Of 21 patients with recurrent disease, 20 had a submucosal lesion. The 5-year survival rate in patients with submucosal tumour was higher after transthoracic than transhiatal oesophagectomy (54.2 versus 25.5 per cent).

  14. Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes

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    Fumio Uchiyama

    2013-01-01

    Full Text Available Our aim was to evaluate the long-term efficacy and safety of percutaneous transhepatic obliteration (PTO alone and combined with balloon-occluded retrograde transvenous obliteration (BRTO for gastroesophageal varices refractory to BRTO alone. Between July 1999 and December 2010, 13 patients with gastroesophageal varices refractory to BRTO were treated with PTO (n = 6 or a combination of PTO and BRTO (n = 7. We retrospectively investigated the rates of survival, recurrence, or worsening of the varices; hepatic function before and after the procedure; and complications. The procedure achieved complete obliteration or significant reduction of the varices in all 13 patients without major complications. During follow-up, the varices had recurred in 2 patients, of which one had hepatocellular carcinoma, and the other died suddenly from variceal rebleeding 7 years after PTO. The remaining 11 patients did not experience worsening of the varices and showed significant improvements in the serum ammonia levels and prothrombin time. The mean follow-up period was 90 months, and the cumulative survival rate at 1, 3, and 5 years was 92.9%, 85.7%, and 85.7%, respectively. Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

  15. The clinical results of balloon-occluded retrograde transvenous obliteration in treatment of gastric varices compared with transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nam Kyung; Kim, Chang Won; Jeon, Ung Bae; Kim, Suk; Lee, Jun Woo; Jo, Mong; Heo, Jeong [Pusan National University School of Medicine, Busan (Korea, Republic of)

    2007-03-15

    To compare the clinical results of BRTO in the gastric varices with those of TIPS. From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with than of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n = 4), encephalopathy (n = 7) and a worsening of the gastric (n = 5) or esophageal varices (n = 2) occurred. BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO.

  16. Helical CT in acute lower gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Ernst, Olivier; Leroy, Christophe; Sergent, Geraldine [Department of Radiology, Hopital Huriez, 1 rue Polonovski, 59037 Lille (France); Bulois, Philippe; Saint-Drenant, Sophie; Paris, Jean-Claude [Department of Gastroenterology, Hopital Huriez, 1 rue Polonovski, 59037 Lille (France)

    2003-01-01

    The purpose of this study was to assess the usefulness of helical CT in depicting the location of acute lower gastrointestinal bleeding. A three-phase helical CT of the abdomen was performed in 24 patients referred for acute lower gastrointestinal bleeding. The diagnosis of the bleeding site was established by CT when there was at least one of the following criteria: spontaneous hyperdensity of the peribowel fat; contrast enhancement of the bowel wall; vascular extravasation of the contrast medium; thickening of the bowel wall; polyp or tumor; or vascular dilation. Diverticula alone were not enough to locate the bleeding site. The results of CT were compared with the diagnosis obtained by colonoscopy, enteroscopy, or surgery. A definite diagnosis was made in 19 patients. The bleeding site was located in the small bowel in 5 patients and the colon in 14 patients. The CT correctly located 4 small bowel hemorrhages and 11 colonic hemorrhages. Diagnosis of the primary lesion responsible for the bleeding was made in 10 patients. Our results suggest that helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician to diagnose the bleeding site. (orig.)

  17. Recurrent Midgut Bleeding due to Jejunal Angioleiomyoma

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    Mahir Gachabayov

    2016-01-01

    Full Text Available Angioleiomyoma being a type of true smooth muscle gastrointestinal tumors can lead to serious life-threatening gastrointestinal bleeding. We report a case of 21-year-old male patient with recurrent midgut bleeding. Contrast-enhanced CT revealed highly vascular small bowel neoplasm. The patient underwent laparotomy with bowel resection and recovered uneventfully. Histopathology revealed jejunal angioleiomyoma.

  18. Recurrent Midgut Bleeding due to Jejunal Angioleiomyoma

    OpenAIRE

    2016-01-01

    Angioleiomyoma being a type of true smooth muscle gastrointestinal tumors can lead to serious life-threatening gastrointestinal bleeding. We report a case of 21-year-old male patient with recurrent midgut bleeding. Contrast-enhanced CT revealed highly vascular small bowel neoplasm. The patient underwent laparotomy with bowel resection and recovered uneventfully. Histopathology revealed jejunal angioleiomyoma.

  19. Role of the insulin-like growth factor 1 axis and visceral adiposity in oesophageal adenocarcinoma.

    LENUS (Irish Health Repository)

    Donohoe, C L

    2012-03-01

    Epidemiological studies have linked obesity with many cancers. The insulin-like growth factor (IGF) 1 axis may be an important mediator in obesity-associated cancer. This study examined the relationship between IGF-1 and its receptor (IGF-1R) in oesophageal adenocarcinoma, a cancer strongly linked to obesity.

  20. The contribution of fetal MR imaging to the assessment of oesophageal atresia

    Energy Technology Data Exchange (ETDEWEB)

    Hochart, V.; Verpillat, P.; Bigot, J.; Avni, F.E. [CHRU Lille, Jeanne de Flandre Hospital, Department of Pediatric Radiology, Lille (France); Langlois, C. [EA2694 USDL CHRU Lille, Department of Biostatistics, Lille (France); Garabedian, C.; Debarge, V.H. [CHRU Lille, Jeanne de Flandre Hospital, Department of Obstetrics and Gynecology, Lille (France); Sfeir, R. [CHRU Lille, Jeanne de Flandre Hospital, Department of Pediatric Surgery, Reference Center for Congenital Anomalies of the Esophagus, Lille (France)

    2014-10-11

    Present challenges are to improve the diagnosis rate of oesophageal atresia (OA) and evaluate as completely as possible a fetus affected by OA, specifically the type of OA and the length of the gap. Our aim was to evaluate the accuracy of fetal MR imaging (fMRI) for diagnosis of OA. We reviewed fMRI performed because of sonographic suspicion of an OA. The signs reviewed included stomach size, ''pouch sign'', bowing of the trachea and visualization of the lower oesophageal lumen. The fetuses were assigned by consensus as having or not having EA, as well as having a tracheaoesophageal fistula (TOF). All findings were correlated with postnatal data. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Se, Sp, PPV and NPV of the technique were respectively 91 %, 100 %, 100 % and 88 %. The presence of the pouch sign yielded corresponding values of 82 %, 100 %, 100 % and 78 %. Mid-tracheal bowing was correlated positively with EA. The type of atresia was correctly evaluated in 90 % of patients. fMRI is useful for the diagnosis of EA through the visualization of the oesophageal pouch or through associated signs such as tracheal bowing. Visualization of the lower oesophageal lumen seems to be a good sign of TEF. (orig.)