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Sample records for bleeding oesophageal varices

  1. Sandostatin therapy of acute oesophageal variceal bleeding.

    Science.gov (United States)

    McKee, R F

    1993-01-01

    This communication deals with the emergency control of variceal bleeding rather than the prevention of rebleeding. The current main options of oesophageal tamponade, emergency sclerotherapy and drug therapy are discussed, with particular reference to the use of somatostatin. Sandostatin (Sandoz, Basel), a synthetic long-acting somatostatin analogue, was found to reduce transhepatic venous gradient by 30% with no effect on systemic haemodynamics in a study of 16 stable cirrhotic patients. In a trial comparing intravenous infusion of Sandostatin (SMS) to oesophageal tamponade (OT) in active variceal bleeding, 18 of 20 bleeds in the SMS group and 19 of 20 bleeds in the OT group were controlled at 4 h. Ten in the SMS group and 14 in the OT group had no further bleeding during the 48-hour study period. Thus SMS may be useful in the temporary control of active variceal bleeding. PMID:8359565

  2. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    BACKGROUND: Somatostatin and its derivatives are sometimes used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. OBJECTIVES: To study whether somatostatin or its analogues improve survival or reduce the need for blood transfusions in patients...... with bleeding oesophageal varices. SEARCH STRATEGY: PubMed and The Cochrane Library were searched (November 2007). Reference lists of publications, contacts with authors. SELECTION CRITERIA: All randomised trials comparing somatostatin or analogues with placebo or no treatment in patients suspected of acute...... 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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

    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

  5. 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...

  6. 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...

  7. 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...... difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... hospital were: vasoactive drugs 79 vs. 66% (P = 0.06), prophylactic antibiotics 55 vs. 27% (P < 0.01), endoscopic treatment 86 vs. 74% (P= 0.04) and Sengstaken-Blakemore tube was used in 5 vs. 21% (P < 0.01). Secondary prophylaxis with pharmacological, endoscopic or transjugular intrahepatic portosystemic...

  8. Outcome of band ligation in oesophageal varices

    International Nuclear Information System (INIS)

    Objective: To find out the outcome og band ligation of oesophageal varices in decompensated chronic liver disease patients. Methods: The quasi experimental study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and Civil Hospital, Karachi, unit from September 2007 to August 2011. Subjects were eligible if they had a diagnosis of cirrhosis based on history, physical examination, biochemical parameters and liver biopsy in some cases. Patients with advanced cirrhosis (Child-Pugh class C), antibodies against human immunodeficiency virus, hepatocellular carcinoma, portal vein thrombosis evident on ultrasonography, parenteral drug addiction, current alcohol abuse, previous or current treatment with β-blockers were excluded from the study. All patients were asked about alcohol intake and tested to determine the cause of liver cirrhosis. Tests for other causes of cirrhosis were carried out only if there was a suggestive clue. All patients under-went upper gastrointestinal endoscopy after consent. SPSS 15 was used for statistical analysis. Results: The age of the 173 patients who met the inclusion criteria ranged from 15 to 85 years, with a mean of 48.39+-13.38 years. There were 112 (64.7%) males. High-grade varices were seen in 130 (75.1%) patients, while low-grade varices were observed in 43 (24.9%) on first endoscopy. At initial endoscopy, 111 (64.2%) patients had portal hypertensive gastropathy. The patients were followed up for a mean period of 5.20+-2.67 months. Variceal obliteration was achieved in 138 (79.8%), while 33 (19.1%) cases developed re-bleeding. Mean number of endoscopy sessions for these patients were 2.28+-.918 with a maximum of 4. Conclusion: Band ligation eradicated oesophageal varices with less complications and a lower re-bleeding rate, but at the same time eradication was associated with more frequent development of portal hypertensive gastropathy. (author)

  9. Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2 cyanoacrylate

    OpenAIRE

    Kozieł, Sławomir; Kobryń, Konrad; Paluszkiewicz, Rafał; Krawczyk, Marek; Wróblewski, Tadeusz

    2015-01-01

    Introduction Oesophageal varices and gastric varices are naturally-formed, pathological portosystemic shunts that occur in patients with portal hypertension. Gastric varices are responsible for about 10% of variceal bleeding; however, they are also the cause of massive haemorrhage, often with dramatic progress. Aim To assess the results of endoscopic treatment of gastrointestinal bleeding from oesophageal and gastric varices using tissue glue Histoacryl. Material and methods From January 2013...

  10. 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....

  11. 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].

  12. 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...

  13. 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....

  14. 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.

  15. Endoscopic Management of Bleeding Ectopic Varices With Histoacryl

    OpenAIRE

    1999-01-01

    Bleeding from antral and duodenal varices is an uncommon feature in patients with portal hypertension. We report a patient with cirrhosis and portal vein thrombosis, who had a massive bleed from antral and duodenal varices. Bleeding was controlled with endoscopic injection of varices using histoacryl. Endoscopic treatment and the relatively uncommon occurrence of antral and duodenal varices are highlighted.

  16. Practical Approach to Endoscopic Management for Bleeding Gastric Varices

    Energy Technology Data Exchange (ETDEWEB)

    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.

  17. Treatment of bleeding gastroesophageal varices: a report of forty-four cases.

    Science.gov (United States)

    Tay, S K; Leong, Y P; Meah, F A; Abdullah, T; Zain, A R

    1992-12-01

    Bleeding gastroesophageal varices is associated with a high morbidity and mortality. Forty-four cases of bleeding gastroesophageal varices were treated at the Department of Surgery, Universiti Kebangsaan Malaysia, General Hospital, Kuala Lumpur over four and a half years. Thirty-two of them had liver cirrhosis. Hepatitis B infection was noted in 13 and alcoholic abuse was present in 14 patients. Five patients had associated hepatoma. Thirty-four percent had gastric fundal varices and a third of these bled from them. A total of 179 endoscopic injection sclerotherapy sessions were performed averaging 4 per person. Rebleeding rate was 4% and mortality was high (50%) in these cases. It was concluded that injection sclerotherapy is a safe and effective means of controlling bleeding oesophageal varices. Operative surgery was employed in those who rebled after injection and would be considered in those in Child's A. PMID:1303478

  18. 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.

  19. 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....

  20. 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...

  1. 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%.

  2. Scintigraphic demonstration of gastrointestinal bleeding due to mesenteric varices

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, M.E.; Coleman, R.E. (Duke Univ. Medical Center, Durham, NC (USA))

    1990-07-01

    Mesenteric varices can appear as massive, acute lower gastrointestinal bleeding. The small bowel or colon may be involved, varices usually developing at sites of previous surgery or inflammation in patients with portal hypertension. Two patients with alcoholic cirrhosis and protal hypertension presented with rectal bleeding. Tc-99m RBC studies demonstrated varices and extravasation into the adjacent bowel. The varices were documented by mesenteric angiography. Characteristic features of Tc-99m labeled RBC studies can identify mesenteric varices as the cause of intestinal bleeding and localize the abnormal vessels.

  3. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  5. Embolization of Bleeding Stomal Varices by Direct Percutaneous Approach

    International Nuclear Information System (INIS)

    Stomal varices can occur in patients with stoma in the presence of portal hypertension. Suture ligation, sclerotherapy, angiographic embolization, stoma revision, beta blockade, portosystemic shunt, and liver transplantation have been described as therapeutic options for bleeding stomal varices. We report the case of a 21-year-old patient with primary sclerosing cholangitis and colectomy with ileostomy for ulcerative colitis, where stomal variceal bleeding was successfully treated by direct percutaneous embolization. We consider percutaneous embolization to be an effective way of treating acute stomal bleeding in decompensated patients while awaiting decisions regarding shunt procedures or liver transplantation.

  6. Fallot′s tetralogy presenting with variceal bleed.

    Directory of Open Access Journals (Sweden)

    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.

  7. An unusual cause of upper gastrointestinal system bleeding: Duodenal varices

    OpenAIRE

    Yılmaz, Ömer; Ataseven, Hilmi

    2012-01-01

    Abstract Duodenal varices are an uncommon site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report the case of a 27- year- old man with liver cirrhosis who presented with upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed nodular varices in the second portion of the duodenum which were considered to be the source of bleeding. We decided to inject N-butyl-2-cyanoacrylate (Histoacryl), an adhesive agent, and...

  8. 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....

  9. 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.

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

    International Nuclear Information System (INIS)

    To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. Weber-Christian disease producing splenic vein occlusion and bleeding gastric varices: successful treatment with sclerotherapy.

    OpenAIRE

    Heseltine, D.; Bramble, M.; Cole, A.; Clarke, D; Castle, W

    1990-01-01

    A 48 year old woman with intra-abdominal Weber-Christian disease presented with bleeding gastric varices and evidence of splenic vein occlusion. We describe the problems encountered in making this diagnosis and subsequent treatment.

  2. Color Doppler evaluation of left gastric vein hemodynamics in cirrhosis with portal hypertension and its correlation with esophageal varices and variceal bleed

    International Nuclear Information System (INIS)

    The purpose of this study was to assess the value of Doppler evaluation of left gastric vein hemodynamics when monitoring portal hypertension patients, by correlating Doppler ultrasonography (USG) parameters with the severity of esophageal varices and occurrence of variceal bleeding. This study was carried out on 100 patients using Doppler USG and endoscopy. Forty-seven of these were patients with cirrhosis with portal hypertension, who had not had a recent variceal bleed (group 1) and 26 were patients with cirrhosis with portal hypertension, with a recent history of bleeding (group 2). The control group comprised of 27 subjects who did not have liver disease or varices on endoscopy (group 3). The hemodynamic parameters, namely the diameter of the left gastric vein and the direction and flow velocity in the vessel, were compared in these groups, with the grade of esophageal varices. Hepatofugal flow velocity in the left gastric vein was higher in patients with large-sized varices compared to those patients with small-sized varices (P < 0.001). The left gastric vein hepatofugal flow velocity was higher in patients with a recent variceal bleed than in those patients without a history of a recent variceal bleed (P < 0.0149). Large-sized varices were more commonly found in patients with a history of a recent variceal bleed (P < 0.0124). Left gastric vein hemodynamics were found to correlate with the severity of the varices and the occurrence of recent variceal bleed in patients with cirrhosis with portal hypertension. Evaluation of the left gastric vein portal dynamics could be helpful in monitoring the progress of the disease in these patients

  3. 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.

  4. Stoma-Related Variceal Bleeding: An Under-Recognized Complication of Biliary Atresia

    OpenAIRE

    Smith, Sam; Wiener, Eugene S.; Starzl, Thomas E.; Rowe, Marc I.

    1988-01-01

    The medical records of 52 children with biliary atresia treated by portoenterostomy and evaluated for liver transplantation were reviewed to determine the frequency of stoma variceal bleeding and the optimal strategies for prevention and treatment. Eighteen patients had had prior stoma closure, four by preperitoneal closure without takedown from the abdominal wall. Three of the four developed occult variceal bleeding from the stoma closure site. Twenty-two patients had a stoma present at eval...

  5. 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.

  6. 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...

  7. 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.

  8. 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.

  9. The international normalized ratio does not reflect bleeding risk in esophageal variceal hemorrhage

    Directory of Open Access Journals (Sweden)

    Tammy T Hshieh

    2015-01-01

    Full Text Available Background/Aims: The international normalized ratio (INR has not been validated as a predictor of bleeding risk in cirrhotics. The aim of this study was to determine whether elevation in the INR correlated with risk of esophageal variceal hemorrhage and whether correction of the INR prior to endoscopic therapy affects failure to control bleeding. Patients and Methods: Patient records were retrospectively reviewed from January 1, 2000 to December 31, 2010. Cases were cirrhotics admitted to the hospital due to bleeding esophageal varices. Controls were cirrhotics with a history of non-bleeding esophageal varices admitted with ascites or encephalopathy. All variceal bleeders were treated with octreotide, antibiotics, and band ligation. Failure to control bleeding was defined according to the Baveno V criteria. Results: We analyzed 74 cases and 74 controls. The mean INR at presentation was lower in those with bleeding varices compared to non-bleeders (1.61 vs 1.74, P = 0.03. Those with bleeding varices had higher serum sodium (136.1 vs 133.8, P = 0.02, lower hemoglobin (9.59 vs 11.0, P < 0.001, and lower total bilirubin (2.47 vs 5.50, P < 0.001. Multivariable logistic regression showed total bilirubin to inversely correlate with bleeding (OR = 0.74. Bleeders received a mean of 1.14 units of fresh frozen plasma (FFP prior to endoscopy (range 0-11 units. Of the 14 patients (20% with failure to control bleeding, median INR (1.8 vs 1.5, P = 0.02 and median units of FFP transfused (2 vs 0, P = 0.01 were higher than those with hemostasis after the initial endoscopy. Conclusions: The INR reflects liver dysfunction, not bleeding risk. Correction of INR with FFP has little effect on hemostasis.

  10. 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.

  11. Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience

    OpenAIRE

    Monsanto, P.; Almeida, N.; Rosa, A.; Maçôas, F; Lérias, C; Portela, F; Amaro, P.; Ferreira, MC; Gouveia, H.; Sofia, C

    2013-01-01

    BACKGROUND: Endoscopic injection of N-butyl-2-cyanoacrylate is the current recommended treatment for gastric variceal bleeding. Despite the extensive worldwide use, there are still differences related to the technique, safety, and long term-results. We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients with gastric variceal bleeding. PATIENTS AND METHODS: Between January 1998 and January 2010, 97 patients with gastric variceal bleeding underwent endoscopic...

  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. Recurrent lower gastrointestinal bleeding from idiopathic ileocolonic varices: a case report

    Directory of Open Access Journals (Sweden)

    Krishna Ravula

    2010-08-01

    Full Text Available Abstract Introduction Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction. Idiopathic colonic varices are extremely rare. Recognition of this condition is important as idiopathic colonic varices may be a cause of recurrent lower gastrointestinal bleeding. Case presentation We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding. Colonoscopy revealed varices involving the terminal ileum and colon to the sigmoid. Thorough evaluation was undertaken to rule out any underlying portal hypertension. Our patient underwent subtotal colectomy including resection of involved terminal ileum and an ileorectal anastomosis. Conclusion Colonic varices are an uncommon cause of lower gastrointestinal bleeding. Idiopathic colonic varices are diagnosed after excluding underlying liver disease and portal hypertension. Recognition of this condition is important as prognosis is good in the absence of liver disease and is curable by resection of the involved bowel.

  14. 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.

  15. 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

  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. 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. PMID:26589951

  19. 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.

  20. 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.

  1. 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.)

  2. 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.

  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. 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.

  5. 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...

  6. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

    2016-05-01

    Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. PMID:26900095

  7. 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.

  8. 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.

  9. The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

    OpenAIRE

    Choi, Moon Han; Kim, Young Seok; Kim, Sang Gyune; Lee, Yun Nah; Seo, Yu Ri; Kim, Min Jin; Lee, Sae Hwan; Jeong, Soung Won; Jang, Jae Young; Kim, Hong Soo; Kim, Boo Sung

    2013-01-01

    Background/Aims The most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl®. However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study. Methods Ninety-three patients at Soonchunhyang University Hospital with ac...

  10. 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.

  11. 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.

  12. Determination of frequency and treatment outcome in patients of fundal varices presenting with upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of fundal varices and treatment outcome with histoacryl in patients presenting with upper GI bleeding. Design: Single centre, retrospective study. Place and duration of study: Military Hospital Rawalpindi from Jan 2009 to July 2011. Methods: Total 1327 patients were included in the study. In 41(3.1%) patients fundal varices were diagnosed on upper GI endoscopy. The mean age of the patients was 48.1+-16.96 years. Minimum age was 12 years and maximum age was 85 years. Out of 41 patients 29 (70.73%) were male and 12 (29.3%) were female. GOV1 was seen in 28 (68.3%) patients, GOV2 in 10 (24.4%) patients, IGV1 in 2 (4.87%) patients, and IGV2 in 1 patient (2.43%). Conclusion: The frequency of fundal varices in our study was 3.1%, diagnosed on upper GI endoscopy. N-butyl-2-cyanoacrylate sclerotherapy was found to be highly effective for the treatment of active bleeding gastric varices. (author)

  13. Gastroesophageal Variceal Bleeding as a Complication of Cystic Fibrosis in a 3-Month-Old Patient.

    Science.gov (United States)

    Motamed, Farzaneh; Fallahi, Gholamhossein; Ahmadi, Faezeh; Bazvand, Fatemeh; Ahmadi, Maedeh; Eftekhari, Kambiz; Rezaei, Nima

    2016-03-01

    Cystic fibrosis (CF) is a hereditary disease of mucous and sweat glands, which affects the respiratory and gastrointestinal systems. Herein, we describe a 3-month-old girl with a history of recurrent episodes of urinary tract infections that required hospitalization. She was referred to our center at the age of three months, with massive gastroesophageal variceal bleeding. In physical examination, she had clubbing, hepatosplenomegaly, and mild ascites. Laboratory studies revealed high serum levels of liver enzymes and low level of Albumin. As of suspicious to CF, sweat tests were performed twice which confirmed the diagnosis of CF. Gastrointestinal bleeding due to gastroesophageal varices is a rare complication of CF, which could result as a consequence of hepatobiliary involvement of disease. Early diagnosis of CF could prevent severe complications and even death in this group of patients. PMID:27107529

  14. 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.

  15. Proton Pump Inhibitor Therapy Is Associated With Reduction of Early Bleeding Risk After Prophylactic Endoscopic Variceal Band Ligation

    Science.gov (United States)

    Kang, Seong Hee; Yim, Hyung Joon; Kim, Seung Young; Suh, Sang Jun; Hyun, Jong Jin; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Lee, Sang Woo

    2016-01-01

    Abstract Endoscopic variceal band ligation (EVL) is an effective procedure to control and prevent variceal bleeding in patients with liver cirrhosis, but it can be complicated by bleeding from post-EVL ulcers. Several studies have reported that proton pump inhibitors (PPIs) decrease the size of post-EVL ulcers. However, evidence are limited as to whether PPIs actually reduce the risk of bleeding after EVL. This study aimed to analyze the factors associated with bleeding after prophylactic EVL and to assess the effect of PPI therapy. Five hundred and five cirrhotic patients with high risk esophageal varices who received primary prophylactic EVL were included for this retrospective cohort study. Post-EVL bleeding was defined as bleeding after prophylactic EVL within 8 weeks evidenced by the occurrence of melena or hematemesis, or by a decrease of hemoglobin by >2.0 g/dL. If evidence of bleeding from ulceration of the EVL sites was confirmed by endoscopy, we defined it as post-EVL ulcer bleeding. Fourteen patients developed bleeding after prophylactic EVL. Factors associated with post-EVL bleeding included alcohol as etiology, low albumin, high total bilirubin, high Child-Pugh score, high MELD score, coexistence of gastric varices, and not administrating PPI medication by univariate analysis. In multivariate logistic analysis, Co-existing gastric varix (odds ratio [OR] 5.680, P = 0.005] and not administrating PPIs (OR 8.217, P = 0.002) were associated with bleeding after prophylactic EVL. In the subgroup analysis excluding patients whose gastric varices were treated, not administering PPI medication (OR 8.827, P = 0.008) was the sole factor associated with post-EVL bleeding. We suggest that PPI therapy needs to be considered in patients receiving prophylactic EVL to reduce the risk of bleeding after prophylactic EVL. PMID:26937932

  16. 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...... specialister, har større sandsynlighed for at modtage behandling, der følger guidelines end patienter indlagt på et sygehus, hvor behandlingen varetages af en heterogen behandlergruppe. Dette kunne vi dog ikke vise havde signifikant effekt på mortaliteten. Trods fald i mortaliteten efter en...... portaltrykket. I vort materiale fandt vi ingen signifikant forskel på de to behandlinger, dog var der en vis tendens til at carvedilol sænkede blodtrykket mere end propranolol, og carvedilol kan dermed være et alternativ til patienter der ikke responderer på eller ikke tåler propranolol behandling. Endvidere...

  17. A case of ascending colon variceal bleeding treated with venous coil embolization.

    Science.gov (United States)

    Ko, Bong Suk; Kim, Woo Tae; Chang, Su Sun; Kim, Eun Hye; Lee, Seung Woo; Park, Won Seok; Kim, Yeon Soo; Nam, Soon Woo; Lee, Dong Soo; Kim, Ji Chang; Kang, Sang Bum

    2013-01-14

    A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia. An esophagogastroduodenoscopy did not demonstrate any bleeding source, and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus. The source of the bleeding could not be found with a mesenteric artery angiography. We performed an enhanced abdominal computed tomography, which revealed a distal ascending colonic varix, and assumed that the varix was the source of the bleeding. We performed a venous coil embolization and histoacryl injection to obliterate the colon varix. The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed. We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization. PMID:23345957

  18. 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...

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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.)

  7. 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.

  8. 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

  9. Hemodynamic effects of terlipressin in patients with bleeding esophageal varices secondary to cirrhosis of liver

    International Nuclear Information System (INIS)

    To study the hemodynamics of terlipressin in bleeding esophageal varices due to cirrhosis of the liver. Seventy-eight consecutive patients with bleeding esophageal varices were evaluated. The diagnosis of cirrhosis was based on history, physical examination, laboratory data and abdominal ultrasound. Blood-pressure and pulse rate were monitored. Injection terlipressin 2 mg intravenous bolus was given followed by 2 mg i/v 6 hourly. Intravenous plasma expanders, whole blood, fresh frozen plasma and platelet concentrates were transfused as needed. Upper gastrointestinal endoscopy was performed for evaluation and grading of varices, detection of portal gastropathy, and banding. Descriptive and inferential statistics were applied as applicable. Seventy patients of either gender, aged 18 - 95 years were included in the study. Systolic blood pressure(SP) increased by 7.77 mmHg (mean SP: 108.1 mmHg, SD + 9.84, 95% CI: 105.77 - 110.43 mmHg; p-value: 0.0002); diastolic blood-pressure(DP) by 21.57 mmHg (mean DP: 79.71 mmHg, SD + 7.35, 95% CI: 77.97 - 81.45 mmHg; p-value: 0.001) and mean arterial pressure by 9.42 mmHg(mean MAP: 89.12 mmHg, SD + 6.98, 95% CI: 87.45 - 90.78 mmHg; p-value: 0.0007) within 24 hours of initiating terlipressin in majority of patients. The pulse rate decreased in 34 (48.5%) patients by 6-24 beats/min in 30 min, and by 2-12 beats/min in 24 hours; and increased in 30 (42.85)% patients by 10-15 beats/min at 30 min and by 2-8 beats/min at 24 hours. (author)

  10. 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.

  11. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  13. A case of liver cirrhosis with bleeding from stomal varices successfully treated using balloon-occluded retrograde transvenous obliteration.

    Science.gov (United States)

    Takano, Masashi; Imai, Yukinori; Nakazawa, Manabu; Chikayama, Taku; Ando, Satsuki; Sugawara, Kayoko; Nakayama, Nobuaki; Mochida, Satoshi

    2016-06-01

    A 66-year-old male patient with liver cirrhosis because of alcohol intake underwent a Hartmann's procedure for rectal cancer. Four months later, bleeding from the sigmoid stoma occurred and persisted for 2 months. A colonoscopic examination revealed bleeding from stomal varices. Three-dimensional computed tomography (CT) imaging demonstrated the inferior mesenteric vein and left superficial epigastric vein as the feeding and drainage vessels, respectively. Balloon-occluded retrograde transvenous obliteration (B-RTO) through the left epigastric vein was performed using a microballoon catheter inserted from the right femoral vein according to the Seldinger method. A CT examination performed 2 days after the B-RTO procedure revealed that the blood flow had disappeared, with thrombosis formation in both the stomal varices and the feeding vein. No recurrent bleeding from the stoma occurred. B-RTO using a microballoon catheter is useful as a therapeutic procedure for stomal varices to prevent bleeding, since the procedure can be performed with minimal invasion using the Seldinger method. PMID:27048279

  14. 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.

  15. 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.

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

    OpenAIRE

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

    2015-01-01

    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). H...

  17. 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.

  18. Massive Esophageal Variceal Bleeding as a Rare Complication of Sickle Cell Anemia

    OpenAIRE

    Malamood, Mark; Bernstein, Gregory; Malik, Zubair; Mathur, Malini

    2016-01-01

    A 24-year-old man with sickle cell anemia presented with fatigue, dark stool, and coffee ground emesis. He was found to have large esophageal varices and experienced massive variceal hemorrhage in the hospital. The varices were caused by diffuse splanchnic venous thrombosis, and his only risk factor for hypercoagulability was sickle cell anemia. Splanchnic venous thrombosis due to sickle cell anemia is exceedingly rare.

  19. 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.

  20. 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.

  1. 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.

  2. Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

    International Nuclear Information System (INIS)

    A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy

  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

    .00005), increased serum bilirubin (p < 0.001), short central circulation time (p < 0.03), low serum albumin (p < 0.02), and decreased clotting factor 2, 7, 10 (p < 0.05) were independently associated with a higher risk. In conclusion, the results support the prognostic value of metabolic variables as described...... 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...

  4. Acute management and secondary prophylaxis of esophageal variceal bleeding: A western Canadian survey

    Science.gov (United States)

    Cheung, Justin; Wong, Winnie; Zandieh, Iman; Leung, Yvette; Lee, Samuel S; Ramji, Alnoor; Yoshida, Eric M

    2006-01-01

    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. METHODS: Gastroenterologists in the provinces of British Columbia, Alberta, Manitoba and Saskatchewan were sent a self-reporting questionnaire. RESULTS: The response rate was 70.4% (86 of 122). Intravenous octreotide was recommended by 93% for EVB patients but the duration was variable. The preferred timing for endoscopy in suspected acute EVB was within 12 h in 75.6% of respondents and within 24 h in 24.6% of respondents. Most (52.3%) gastroenterologists do not routinely use antibiotic prophylaxis in acute EVB patients. The preferred duration of antibiotic therapy was less than three days (35.7%), three to seven days (44.6%), seven to 10 days (10.7%) and throughout hospitalization (8.9%). Methods of secondary prophylaxis included repeat endoscopic therapy (93%) and beta-blocker therapy (84.9%). Most gastroenterologists (80.2%) routinely attempted to titrate beta-blockers to a heart rate of 55 beats/min or a 25% reduction from baseline. The most common form of secondary prophylaxis was a combination of endoscopic and pharmacological therapy (70.9%). CONCLUSIONS: Variability exists in some areas of EVB treatment, especially in areas for which evidence was lacking at the time of the last guideline publication. Gastroenterologists varied in the use of prophylactic antibiotics for acute EVB. More gastroenterologists used combination secondary prophylaxis in the form of band ligation eradication and beta-blocker therapy rather than either treatment alone. Future guidelines may be needed to address these practice differences. PMID:16955150

  5. 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.

  6. 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. PMID:26488031

  7. 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.

  8. Long-term outcome following trans-jugular intrahepatic portosystemic shunt for variceal bleeding due to portal hypertension

    International Nuclear Information System (INIS)

    Objective: To study the 6-year outcome following trans-jugular intrahepatic portosystemic shunt (TIPSS) for variceal bleeding due to portal hypertension. Methods: 65 patients, 51 males, 14 females, aged 35-72 years old with averaged 4.5 years, have been undergone TIPSS because of portal hypertension due to cirrhosis or Budd-Chiari syndrome. The portal pressures were measured before and after TIPSS. Follow-up study was done by color Doppler sonography or Barium esophageal radiography for 3 months to 6 years (averaged 18 months). Repeated interventional treatments were done in cases of restenosis of the shunts. Results: There were 0, 2, 10, 5, 0 cases of recurrent bleeding after 3 months, 6 months, 1 year, 2 year and 3-6 year following TIPSS respectively. Stenosis occurred in shunt paths due to thrombosis or smooth muscle cell proliferation or neo-intimal hyperplasia were relieved after thrombolytic therapy and repeated balloon angioplasty or stent plant among most of them. 2 were failed due to serious stenosis. 7 cases died, 2 of massive bleeding, 1 of the other cause and 4 of hepatic cancer. The other patients are getting well. Conclusions: Although there were very high rates of restenosis (34%), but most of them could be treated again with interventional therapy, and in kept patency effectively. TIPSS is a still practical valuable management for massive gastric bleeding

  9. 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.

  10. 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.

  11. 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.

  12. 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

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

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    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.

  14. 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.

  15. 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.

  16. RECOMMENDATION FOR MANAGING PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    G. Dimofte

    2006-01-01

    Full Text Available Upper gastrointestinal bleeding remains an important problem for all emergency hospitals. Any attempt to standardise the care for these patients is dependent on the expertise of the medical and surgical team but also on the availability of emergency endoscopy and the quality of endoscopic haemostatic therapy. The present paper does not intended to present a state of the art in the matter of upper gastrointestinal haemorrhage, but to offer a working protocol that can be implemented in an emergency hospital, as long as on call emergency diagnostic endoscopy is available. Decision making is based on accurate evaluation of the bleeding lesion and its risk of rebleeding. The protocol designates responsabilities for each department and establishes criteria for ICU admission and protocols for intensive monitorisation of patients on surgical wards. Far from being definitive we consider this paper a draft open for discussions and for further improvement.

  17. Duodenal varices

    OpenAIRE

    Yu-Peng, L; Yi-Lan, L; Wen-Ko, S

    2011-01-01

    A 76-year-old man had a history of liver cirrhosis secondary to chronic hepatitis B infection. A hepatoma had also been noted 2 years previously. This time, he presented initially at the emergency department because of dysuria and fever for 2 days and tarry stool since the afternoon. The initial upper gastrointestinal endoscopy revealed esophageal varices, gastric ulcer, and duodenitis that was not actively bleeding. Proton pump inhibitors were prescribed. Unfortunately, massive blood stools ...

  18. 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)

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  1. 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

  2. Endoscopic Therapy of Gastroesophageal Variceal Hemorrhage

    OpenAIRE

    Ljubičić, Neven; Špero, Martina

    2001-01-01

    Current concepts of endoscopic treatment of gastroesophageal variceal hemorrhage are discussed. There are two major endoscopic treatments of gastroesophageal varices: endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). EIS and EVL alone are equally effective in controlling acute variceal bleeding; however, EVL is superior to EIS because it achieves variceal obliteration faster and with a lower rate of complications and rebleeding. Considering combined technique of...

  3. Isolated non-hemorrhagic cecal varices

    OpenAIRE

    Haddad, James D.; Lacey, Brent W.

    2014-01-01

    Ectopic varices (those outside of the gastro-esophageal region) are occasionally found on endoscopy in patients with portal hypertension; however they account for a small minority of all variceal bleeds. Cases of isolated cecal varices are quite rare and, when described, often present with acute hemorrhage or evidence of occult bleeding. We present the case of a 29-year-old male with a history of idiopathic portal vein thrombosis and known esophageal varices, who presented for evaluation of a...

  4. 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。

  5. 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.

  6. Ectopic Varices in Colonic Stoma: MDCT Findings

    International Nuclear Information System (INIS)

    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

  7. Bleeding esophageal varices

    Science.gov (United States)

    ... given through an IV. Examples include octreotide or vasopressin . Rarely, a tube may be inserted through the ... Bloody or tarry stools Esophageal stricture - benign Hypovolemic shock Liver disease Shock Patient Instructions Cirrhosis - discharge Update ...

  8. Excess long-term mortality following non-variceal upper gastrointestinal bleeding: a population-based cohort study

    OpenAIRE

    Colin John Crooks; Timothy Richard Card; Joe West

    2013-01-01

    Editors' Summary Background Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of admission to hospital. Upper gastrointestinal bleeding (bleeding derived from a source above the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm) is roughly four times as common as bleeding from the lower gastrointestinal tract and is a major cause of morbidity and mortality. Upper gastrointestinal bleeding is a...

  9. EUS-Assisted Evaluation of Rectal Varices before Banding

    Directory of Open Access Journals (Sweden)

    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.

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. Percutaneous transhepatic variceal obliteration in patients with severe hepatic cirrhosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the effects of percutaneous transhepatic variceal obliteration in the treatment of acute bleeding from gastroesophageal varices in patients with severe cirrhosis. Methods: 19 patients with Child C cirrhosis suffered from active bleeding from gastroesophageal varices. Emergency procedures of percutaneous transhepatic variceal obliteration were performed in all 19 patients. Results: Successful catheterization and obliteration of the varices in all of the 19 cases. Active bleeding were controlled in 18 cases with only one failure and TIPSS was performed. During a follow-up period ranging from one to 12 months, 14 cases bled recurrently during 3 to 12 months. 15 cases died within the follow-up period. 4 cases were alive. Severe complication of intraperitoneal bleeding occurred in 1 case, and laparotomy was performed. Conclusions: Percutaneous transhepatic variceal obliteration is effective in controlling acute bleeding from gastroesophageal varices in patients with Chile C cirrhosis. It could be used as the first choice treatment method for emergency when TIPSS is contraindicated

  15. 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.

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

    International Nuclear Information System (INIS)

    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.

  17. 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...

  18. 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

  19. 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.

  20. 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.

  1. 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.)

  2. Combined radiologic and surgical treatment for portal hypertension and acute variceal hemorrhage

    International Nuclear Information System (INIS)

    This paper evaluates the use of percutaneous arterial embolization and angiographic variceal sclerosis performed during minilaparotomy to treat portal hypertension and variceal bleeding. One hundred twenty-five patients with variceal bleeding that could not be controlled by sclerotherapy were treated with angiographic mid-splenic artery and left gastric artery embolization and variceal sclerosis induced by absolute alcohol delivered through a surgically introduced catheter during minilaparotomy. The procedure was technically successful in all 135 patients. Bleeding was controlled in 122 (90%). Thirteen patients died of continued variceal bleeding, five of disseminated intravascular coagulation, and 28 hepatic failure

  3. 肝硬化并食管胃底静脉曲张出血诱因分析及护理%Analysis and Nursing of Patients With Liver Cirrhosis Complicated With Esophageal and Gastric Varices Bleeding

    Institute of Scientific and Technical Information of China (English)

    路秀清; 张桂娟

    2016-01-01

    目的:探讨肝硬化并食管胃底静脉曲张破裂出血的诱发因素及护理方法。方法选取2012年1月~2015年1月我院收治的肝硬化合并食管胃底静脉曲张破裂出血的95例患者进行回顾性分析。结果95例患者中诱因可查者共91例,饮食不当51例,劳累过度18例,寒冷季节影响8例,腹压增高8例,情绪激动3例,用药不当3例。结论饮食不当、劳累过度、气温、腹压增高、情绪激动和用药不当是引起肝硬化并食管胃底静脉曲张破裂出血的主要诱发因。%Objective To investigate the inducing factors and nursing methods of cirrhosis complicated with esophageal and gastric varices hemorrhage. Methods From January 2012 to January 2015, 95 cases of patients with cirrhosis and esophageal varices bleeding in our hospital were retrospectively analyzed. Results In 95 patients there were 91 cases of incentives can be found, improper diet in 51 cases, overwork in 18 cases, the cold season effect in 8 cases, 8 cases of increased abdominal pressure, emotional in 3 cases, improper use in 3 cases. Conclusion Improper diet, overwork, temperature, increased abdominal pressure, emotional and inappropriate medication is the main cause of cirrhosis and esophageal varices bleeding.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Endoscopic variceal ligation versus β-blockers plus isosorbide mononitrate in prevention of esophageal variceal re-bleeding: a Meta-analysis%内镜下套扎术与药物预防食管静脉曲张破裂再出血效果比较的Meta分析

    Institute of Scientific and Technical Information of China (English)

    朱长红; 吴建新

    2009-01-01

    目的 比较分析内镜下曲张静脉套扎术(EVL)与β-受体阻滞剂加5-单硝酸异山梨醇酯(ISMN)预防食管静脉曲张破裂再出血的疗效.方法 应用Meta分析方法检索有关EVL与β-受体阻滞剂加ISMN预防食管静脉曲张破裂再出血的临床随机对照试验(RCT),选取Jadad评分≥3分文献,以RevMan 4.2软件进行相关指标OR值及其95%可信区间(CI)以及敏感性分析,绘制漏斗图判断有无发表偏倚.结果 符合标准的RCT文献共4篇,患者总数为504例.随访时间为8~25个月.EVL与β-受体阻滞剂加ISMN应用后再发出血(OR=0.93,95%CI=0.41~2.11;P=0.87)、明确为食管静脉曲张破裂再出血(OR=0.68,95%CI=0.19~2.37;P=0.54)、治疗相关的不良事件(OR=1.12;95%CI=0.75~1.67;P=0.57)、严重不良事件(OR=0.89,95%CI=0.47~1.67;P=0.71)、出血性死亡率(OR:2.11,95%CI=0.88~5.08;P=0.10)以及总死亡率(OR=1.46,95%CI=0.95~2.24;P=0.09)等方面差异均无统计学意义.但相对于EVL,β-受体阻滞剂加ISMN的患者出血性死亡率和总死亡率较低.除再出血(P=0.003)和明确为食管静脉曲张破裂再出血(P<0.0001)两个指标有异质性外,其它均无异质性.敏感性分析显示上述结果稳定性好.漏斗图显示较对称,提示无明显发表偏倚.结论 β-受体阻滞剂加ISMN预防食管静脉曲张破裂再出血的死亡率和总死亡率有低于EVL的趋势,其与EVL总的不良事件及严重不良事件的发生率相当.因此,两者均可作为首选措施,用于食管静脉曲张破裂再出血的预防.%Objective To compare the therapeutic effect of endoscopic variceal ligation (EVL) and β-blockers plus isosorbide mononitrate (ISMN) in prevention of esophageal varieeal re-bleeding. Methods The randomized clinical trials (RCTs) on EVL and β-blockers plus ISMN for the prevention of esophageal varieeal re-bleeding were searched, and only the results from those with Jadad score higher than 3 were eval-uated with RevMan 4. 2

  9. Oesophageal atresia

    DEFF Research Database (Denmark)

    Pedersen, Rikke Neess; Calzolari, Elisa; Husby, Steffen;

    2012-01-01

    To describe prevalence, prenatal diagnosis and epidemiological data on oesophageal atresia from 23 well-defined European regions and compare the prevalence between these regions.......To describe prevalence, prenatal diagnosis and epidemiological data on oesophageal atresia from 23 well-defined European regions and compare the prevalence between these regions....

  10. 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.

  11. Impact of dietary intervention on esophageal and variceal bleeding pa-tients with cirrhosis%饮食干预对肝硬化合并食管胃底静脉曲张出血患者的影响

    Institute of Scientific and Technical Information of China (English)

    张桂娟; 王金华; 杨爽; 王莉莉

    2016-01-01

    目的:探讨饮食干预对肝硬化合并食管胃底静脉曲张消化道出血的影响。方法选择2011年1月~2013年6月我科收治的肝硬化合并食管胃底静脉曲张出血患者90例,按住院时间先后分为对照组45例和干预组45例。对照组按常规方法护理;干预组在积极治疗原发病基础上,从人院评估、一对一指导、饮食干预、自我管理、随访制度化等方面进行饮食干预。比较两组患者的初次出血率、再次出血率、死亡率。结果干预组患者初次出血率为28.9%,低于对照组的33.3%,差异无统计学意义(P>0.05)。干预组患者再次出血率为31.1%,明显低于对照组的64.4%,差异有统计学意义(P﹤0.05)。干预组死亡率为4.4%,明显低于对照组的15.6%,差异有统计学意义(P﹤0.05)。结论在原发病积极规范治疗基础上,进行合理的饮食干预,可预防肝硬化合并食管胃底静脉曲张出血患者再出血,降低死亡率。%Objective To explore the effects of esophageal varices patients with dietary intervention on gastrointestinal bleeding. Methods 90 patients with cirrhosis complicated by esophageal and gastric varices bleeding from January 2011 to June 2013 of our department were selected,and were divided into contrast group (n=45) and intervention group (n=45) according to hospital chronologically.The contrast group was cared by conventional methods.The intervention group was on the basis of the active treatment original disease.From the enter hospital assessment,one guidance,dietary intervention, self-management, and other aspects of comprehensive follow-up of institutionalized dietary intervention. The initial bleeding rebleeding rate and mortality between two group was compared. Results The initial bleeding rate of the patients in intervention group was 28.9%,which was lower than that of the contrast group,which rate was 33.3%, there was no significant difference

  12. Oesophageal surgery

    Institute of Scientific and Technical Information of China (English)

    Erik J. Simchuk; Derek Alderson

    2001-01-01

    @@INTRODUCTION The origins of oesophageal surgery ,like most surgical treatments ,are based in the treatment of traumatic injury .The Smith Surgical Papyrus describes the examination, diagnosis and treatment of "a gaping wound of throat, penetrating the gullet" [1].

  13. [Acute gastrointestinal bleeding].

    Science.gov (United States)

    Baumbach, Robert; Faiss, Siegbert; Cordruwisch, Wolfgang; Schrader, Carsten

    2016-04-01

    Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered. PMID:27078246

  14. Clinical outcomes of gastric variceal obliteration using N-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage

    OpenAIRE

    Jun, Chung Hwan; Kim, Ka Rham; Yoon, Jae Hyun; Koh, Han Ra; Choi, Won Suk; Cho, Kyu Man; Lim, Sung Uk; Park, Chang Hwan; Joo, Young Eun; KIM, HYUN SOO; Choi, Sung Kyu; Rew, Jong Sun

    2014-01-01

    Background/Aims To evaluate the long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (NBC; Histoacryl) for treatment of bleeding gastric varices. Methods We retrospectively analyzed the records of 455 patients with gastric variceal hemorrhage (GVH) who were consecutively treated with NBC from January 2004 to July 2013, with a mean follow-up period of 582 days. The patients' endoscopic findings, initial hemostasis, complications, rebleeding rates, and bleeding-relat...

  15. 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 ...

  16. 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....

  17. Eosinophilic oesophagitis.

    Science.gov (United States)

    Bancil, Aaron S; Hewett, Rhys; Hayat, Jamal O; Poullis, Andrew

    2016-07-01

    Eosinophilic oesophagitis is a chronic immune-mediated inflammatory disorder of the oesophagus, characterized by symptoms of dysphagia or food bolus obstruction. Diagnosis is supported by typical histological findings. This article covers pertinent aspects of the disease, pathogenic explanations and treatment options. PMID:27388380

  18. Eosinophilic oesophagitis

    DEFF Research Database (Denmark)

    Nielsen, Rasmus Gaardskjær; Husby, Steffen

    2007-01-01

    , oral steroids, inhaled (swallowed) steroids, and leucotriene receptor antagonists. Detailed information on the eosinophilic inflammatory processes in the oesophageal mucosa was initially obtained from animal models, in particular with regard to the role of interleukin-5 and the chemokine eotaxin-1...

  19. 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

  20. 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

  1. 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

  2. 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.

  3. Can proton pump inhibitors reduce rebleeding following Histoacryl sclerotherapy for gastric variceal hemorrhage?

    OpenAIRE

    Kim, Ka Rham; Jun, Chung Hwan; Cho, Kyu Man; Wi, Jin Woo; Park, Seon Young; Cho, Sung Bum; Lee, Wan Sik; Park, Chang Hwan; Joo, Young Eun; KIM, HYUN SOO; Choi, Sung Kyu; Rew, Jong Sun

    2015-01-01

    Background/Aims: To evaluate the efficacy of proton pump inhibitors (PPIs) in reducing rebleeding and bleeding-related death rates after endoscopic gastric variceal obliteration (GVO) using N-butyl-2-cyanoacrylate (NBC). Methods: This study enrolled 341 patients who were consecutively diagnosed with and treated for bleeding gastric varices. The patients were divided into PPI and non-PPI groups, and their endoscopic findings, initial hemostasis outcomes, rebleeding and bleeding-related death r...

  4. 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

  5. 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.

  6. Analysis of the Causes and Nursing of Patients With Cirrhosis and Esophageal and Gastric Varices Bleeding%肝硬化并食管胃底静脉曲张破裂出血的诱因及护理分析

    Institute of Scientific and Technical Information of China (English)

    蒲澍

    2016-01-01

    Objective To analyze cirrhosis and esophageal varices hemorrhage and nursing measures.Methods 80 patients with liver cirrhosis and esophageal variceal bleeding in patients with bleeding analysis of the observed object inducement, patients were divided into high-quality group and the conventional group, high-quality care intervention group received routine care group using conventional methods, compared to two group care satisfaction.Results Poor diet, stress and other factors can become a cause of bleeding, quality group care satisfaction higher than the conventional group.Conclusion Cirrhosis and esophageal variceal bleeding in patients with bleeding incentives diverse and complex, can improve quality of life through high-quality care interventions. Can be reduced by high incidence of bleeding events nursing intervention to ease the patient's condition improved in patients with cirrhosis satisfaction with clinical care, and promote the healthy development of the nursing profession.%目的:分析肝硬化并食管胃底静脉曲张破裂出血的诱因及护理对策。方法以80例肝硬化并食管胃底静脉曲张破裂出血患者为观察对象,分析出血的诱因;将患者分为优质组和常规组,优质组给予优质护理干预,常规组使用常规护理方法,对比两组护理满意度。结果饮食不当、精神压力等因素均能够成为出血的诱因;优质组的护理满意度高于常规组。结论肝硬化并食管胃底静脉曲张破裂出血患者的出血诱因多样且复杂,可通过优质护理的干预方法提高生存质量。

  7. 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.

  8. 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.

  9. The Management of Acute Upper Gastrointestinal Bleeding: A Comparison of Current Clinical Guidelines and Best Practice

    Directory of Open Access Journals (Sweden)

    Alison A. Taylor

    2014-12-01

    Full Text Available Acute upper gastrointestinal bleeding (AUGIB is the most common GI emergency, responsible for up to 70,000 hospital admissions in the UK and around 4,000 deaths. The latest UK national audit highlighted inconsistencies in both the management and service provision. Several national and international professional bodies have produced evidence-based recommendations on the management of AUGIB. We carried out a review of the guidance documentation published by four expert bodies including the National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network, the American College of Gastroenterology, and those published in the Annals of Internal Medicine. Consensus is still yet to be reached for initiating blood products in the emergency situation, with some evidence suggesting that liberal transfusion could exacerbate bleeding severity, although there is a lack of large randomised trials. It is widely agreed that prompt endoscopy within 24 hours improves outcomes, but evidence suggests that lowering this threshold confers no additional benefit. Use of proton pump inhibitors both pre and post-endoscopy for non-variceal bleeds is also advocated by professional bodies, with substantial evidence that it reduces the risk of re-bleeding. For patients with suspected oesophageal or gastric variceal bleeding, prophylactic antibiotics and vasopressin analogues are recommended, although guidelines vary on specific regimens. Recent UK and international guidelines provide a useful framework to guide management of patients who present to the emergency department with suspected AUGIB; however, their advice varies in some key areas due to a lack of large randomised trials as supporting evidence.

  10. 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.

  11. 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

  12. Oesophageal atresia

    Directory of Open Access Journals (Sweden)

    Spitz Lewis

    2007-05-01

    Full Text Available Abstract Oesophageal atresia (OA encompasses a group of congenital anomalies comprising of an interruption of the continuity of the oesophagus with or without a persistent communication with the trachea. In 86% of cases there is a distal tracheooesophageal fistula, in 7% there is no fistulous connection, while in 4% there is a tracheooesophageal fistula without atresia. OA occurs in 1 in 2500 live births. Infants with OA are unable to swallow saliva and are noted to have excessive salivation requiring repeated suctioning. Associated anomalies occur in 50% of cases, the majority involving one or more of the VACTERL association (vertebral, anorectal, cardiac, tracheooesophageal, renal and limb defects. The aetiology is largely unknown and is likely to be multifactorial, however, various clues have been uncovered in animal experiments particularly defects in the expression of the gene Sonic hedgehog (Shh. The vast majority of cases are sporadic and the recurrence risk for siblings is 1%. The diagnosis may be suspected prenatally by a small or absent stomach bubble on antenatal ultrasound scan at around 18 weeks gestation. The likelihood of an atresia is increased by the presence of polyhydramnios. A nasogastric tube should be passed at birth in all infants born to a mother with polyhydramnios as well as to infants who are excessively mucusy soon after delivery to establish or refute the diagnosis. In OA the tube will not progress beyond 10 cm from the mouth (confirmation is by plain X-ray of the chest and abdomen. Definitive management comprises disconnection of the tracheooesophageal fistula, closure of the tracheal defect and primary anastomosis of the oesophagus. Where there is a "long gap" between the ends of the oesophagus, delayed primary repair should be attempted. Only very rarely will an oesophageal replacement be required. Survival is directly related to birth weight and to the presence of a major cardiac defect. Infants weighing over

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. Successful Endoscopic Injection Sclerotherapy of High-Risk Gastroesophageal Varices in a Cirrhotic Patient with Hemophilia A

    Directory of Open Access Journals (Sweden)

    Kohei Fukumoto

    2010-01-01

    Full Text Available A 68-year-old man with hemophilia A and liver cirrhosis caused by hepatitis C virus was referred to our hospital to receive prophylactic endoscopic treatment for gastroesophageal varices (GOV. He had large, tense, and winding esophageal varices (EV with cherry red spots extending down to lesser curve, predicting the likelihood of bleeding. Esophageal endoscopic injection sclerotherapy (EIS was performed with a total 15 mL of 5% ethanolamine oleate with iopamidol (EOI. Radiographic imaging during EIS demonstrated that 5% EOI reached the afferent vein of the varices. He was administered sufficient factor VIII concentrate before and after EIS to prevent massive bleeding from the varices. Seven days after EIS, upper gastrointestinal endoscopy (UGIE showed that the varices were eradicated almost completely. Eighteen months after EIS, the varices continued to diminish. We report a successful case of safe and effective EIS for GOV in a high-risk cirrhotic patient with hemophilia A.

  18. Evaluation of percutaneous transhepatic gastroesophageal varices embolization

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical application of percutaneous transheaptic gastroesophgeal varices embolization (PTVE) for treatment and prevention of acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Methods: 48 patients with cirrhotic portal hypertension and gastroesophageal varices were treated with PTVE for the prevention and control of upper gastrointestinal bleeding. Results: The technical success of PTVE was 97.9% and the rate of hemostasis was 100%. During the procedure, steel coil displacement occurred in 1 case, vagus nerve reflection with blood pressure degression and heart rate decline in 4 cases. After the procedure, 1 patients developed refractory ascites and 1 patients died of abdominal bleeding. 2 cases died of hepatic failure and 2 cases occurred rehaemorrhagia in fore 6 mon. after one year follow-up; 3 cases losed follow-up and 5 cases occurred rehaemorrhagia in the late 6 mon. Conclusion: PTVE is mini-invasive and efficient in treating acute upper gastrointestinal bleeding in patients with cirrhotic portal hypertension. Increase of technical success and decreases of morbidity can be achieved on the condition of' proper maneuver. (authors)

  19. Successful treatment of anastomotic jejunal varices with N-butyl-2-cyanoacrylate (Histoacryl): single-center experience.

    Science.gov (United States)

    Gubler, C; Glenck, M; Pfammatter, T; Bauerfeind, P

    2012-08-01

    Obscure gastrointestinal bleeding can lead to extensive diagnostic work-up, as well as repeated episodes of hospitalizations with significant morbidity. Patients with a previous small-bowel anastomosis seem to be prone to varices at this site, even in the absence of portal hypertension. We report here five cases with varices of this type. All the anastomoses in these patients were reached using overtube-assisted single- or double-balloon enteroscopy. The bleeding varices were treated by injecting N-butyl-2-cyanoacrylate (Histoacryl). Bleeding was stopped in all five patients without any adverse events, requiring one session in four patients and a second session in one patient. PMID:22833023

  20. Gastro-oesophageal candidiasis.

    OpenAIRE

    Scott, B B; D. Jenkins(University of York, UK)

    1982-01-01

    A prospective search for gastro-oesophageal candidiasis was made by histological examination of all the biopsies taken from 465 patients endoscoped consecutively during a 12 month period. The criterion for diagnosis was the demonstration of infiltration of tissue or ulcer slough by yeasts and hyphae. Nineteen cases of candidiasis were found giving an overall incidence of 4%. There were 12 cases with oesophageal candidiasis, two with both oesophageal and gastric candidiasis, and five with gast...

  1. Hepatic Angiosarcoma Associated with Esophageal Variceal Hemorrhage

    Directory of Open Access Journals (Sweden)

    Zensho Ito

    2016-08-01

    Full Text Available Primary hepatic angiosarcoma is a very rare malignancy with a poor prognosis. Because patients present with no specific symptoms, the cancer can grow undetected and most cases are diagnosed too late for resection. We present the case of a 78-year-old Japanese man admitted to our hospital with massive hematemesis and melena. A total gastrectomy had previously been performed on the patient to treat gastric cancer. Endoscopic injection sclerotherapy was performed to control the bleeding from varices over the anastomosis. Computed tomography revealed the presence of multiple atypical liver nodules in the enhanced image. Histological diagnosis of hepatic angiosarcoma was obtained by percutaneous ultrasound-guided liver biopsy. To our knowledge, this is the first report of a patient with hepatic angiosarcoma and acute variceal hemorrhage.

  2. Expert consensus on technical specifications of treatment of portal hypertension with esophagogastric variceal bleeding (2013 edition)%门静脉高压症食管胃曲张静脉破裂出血治疗技术规范专家共识(2013版)

    Institute of Scientific and Technical Information of China (English)

    卫生和计划生育委员会卫生公益性行业科研专项专家组

    2014-01-01

    门静脉高压症是指由各种原因导致的门静脉系统压力升高所引起的一组临床综合征.门静脉高压症导致的食管胃曲张静脉破裂出血病死率较高.目前针对门静脉高压症食管胃曲张静脉破裂出血的治疗方法很多,包括药物、内镜、经颈静脉肝内门体分流术、分流术、断流术、肝移植等.为进一步合理选择门静脉高压症治疗方法并推广应用,卫生和计划生育委员会卫生公益性行业科研专项“门静脉高压症治疗方法的合理选择和推广应用”专家组,针对门静脉高压症食管胃曲张静脉破裂出血治疗技术规范等相关问题进行充分研讨,并参照国内外有关资料,结合我国具体情况,制订了我国门静脉高压症食管胃曲张静脉破裂出血治疗技术规范专家共识,供广大临床医师参考.%Portal hypertension is a clinical syndrome of elevation of portal vein pressure caused by a variety of reasons,and the mortality of esophagogastric variceal bleeding caused by portal hypertension is still high.At present,there are many treatment methods for portal hypertension with esophagogastric variceal bleeding,including medication,endoscopy,transjugulat intrahepatic portosystemic shunt,bypass and devascularization operation,liver transplantation and et al.In order to further enhance the treatment effect,the treatment technical specifications and other related issues of portal hypertension with esophagogastric variceal bleeding were fully discussed by Experts Group from the Ministry of Health Special Fund for Research in the Public Interest "Reasonable choice and application of treatment of portal hypertension".With reference to the relevant information both at home and abroad,and combined with the specific condition of China,the expert consensus on technical specifications of treatment of portal hypertension with esophagogastric variceal bleeding is made as reference for clinical physicians.

  3. 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.

  4. 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)

  5. 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

  6. A Study of The Local Toxicity of Agents Used for Variceal Injection Sclerotherapy

    OpenAIRE

    Robertson, C. S.; Womack, C; Robson, K; Morris, D. L.

    1989-01-01

    Injection sclerotherapy is widely used in the treatment of oesophageal varices. However, few studies have compared the local toxicity of sclerosant agents which may be important if serious local complications are to be avoided. In this study the depth of injury caused by submucosal injection of increasing concentrations of sodium tetradecyl sulphate, polidocanol, 5% ethanolamine oleate and 5% varicosid in rabbits stomach, has been compared by histopathological examination. Macroscopic ulcerat...

  7. Sclerotherapy Of Esophageal Varices In Severe Hemophilia A Patient And High Titer Inhibitor – Case Report

    Directory of Open Access Journals (Sweden)

    Szczepanik Andrzej B.

    2015-09-01

    Full Text Available In cirrhotic hemophilia patients bleeding from esophageal varices is a serious clinical condition due to congenital deficiency of clotting factors VIII or IX, decreased prothrombin synthesis and hypersplenic thrombocytopenia. In hemophiliac with high-titer inhibitor bypassing therapy is required with activated prothrombin complex concentrates (aPCC or recombinant activated coagulation factor VII (rFVIIa. Doses and duration treatment with these agents following endoscopic treatment of esophageal varices have not been yet established.

  8. Safe and successful endoscopic initial treatment and long-term eradication of gastric varices by endoscopic ultrasound-guided Histoacryl (N-butyl-2-cyanoacrylate) injection

    OpenAIRE

    Gubler, Christoph; Bauerfeind, Peter

    2014-01-01

    OBJECTIVE: Optimal endoscopic treatment of gastric varices is still not standardized nowadays. Actively bleeding varices may prohibit a successful endoscopic injection therapy of Histoacryl® (N-butyl-2-cyanoacrylate). Since 2006, we have treated gastric varices by standardized endoscopic ultrasound (EUS) guided Histoacryl injection therapy without severe adverse events. MATERIAL AND METHODS: We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy o...

  9. 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.

  10. Endoscopic sclerotherapy of esophageal varices. A case report

    OpenAIRE

    Pedro Juan Vázquez González; Marcos Félix Osorio Pagola

    2010-01-01

    A case of a patient with liver cirrhosis that had been previously diagnosed in the Department of Gastroenterology of the General University Hospital "Dr. Aldereguía Gustavo Lima" of Cienfuegos is presented. This patient came to the hospital with upper gastrointestinal bleeding as a clinical presentation and an evolution characterized by esophageal varices-related rebleeding. A non-surgical treatment with endoscopic sclerosis has been used.

  11. Endoscopic sclerotherapy of esophageal varices. A case report

    Directory of Open Access Journals (Sweden)

    Pedro Juan Vázquez González

    2010-11-01

    Full Text Available A case of a patient with liver cirrhosis that had been previously diagnosed in the Department of Gastroenterology of the General University Hospital "Dr. Aldereguía Gustavo Lima" of Cienfuegos is presented. This patient came to the hospital with upper gastrointestinal bleeding as a clinical presentation and an evolution characterized by esophageal varices-related rebleeding. A non-surgical treatment with endoscopic sclerosis has been used.

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

    International Nuclear Information System (INIS)

    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

  13. 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.

  14. 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....

  15. Oesophageal candiasis in AIDS

    OpenAIRE

    Yadav, S. P. S.; Ranga, Rupender K.; Singh, Jagat; Yadav, Rohtas

    2003-01-01

    With the explosion in the number of AIDS patients, many of these are likely to consult to otolaryngologists the head & neck is a rather common site to be affected. Sometimes only oesophageal candidiasis is the presenting feature as in the present case which is being reported show typical radiological appearance. the differential diagnosis and treatment of nesophageal candidiasis is briefly discussed

  16. 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.

  17. 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.

  18. 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.

  19. 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。

  20. 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

  1. 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

  2. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis

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    Schiefke Ingolf

    2010-01-01

    Full Text Available Abstract Background Endoscopic band ligation (EBL is generally accepted as the treatment of choice for bleeding from esophageal varices. It is also used for secondary prophylaxis of esophageal variceal hemorrhage. However, there is no data or guidelines concerning endoscopic control of ligation ulcers. We conducted a retrospective study of EBL procedures analyzing bleeding complications after EBL. Methods We retrospectively analyzed data from patients who underwent EBL. We analyzed several data points, including indication for the procedure, bleeding events and the time interval between EBL and bleeding. Results 255 patients and 387 ligation sessions were included in the analysis. We observed an overall bleeding rate after EBL of 7.8%. Bleeding events after elective treatment (3.9% were significantly lower than those after treatment for acute variceal hemorrhage (12.1%. The number of bleeding events from ligation ulcers and variceal rebleeding was 14 and 15, respectively. The bleeding rate from the ligation site in the group who underwent emergency ligation was 7.1% and 0.5% in the group who underwent elective ligation. Incidence of variceal rebleeding did not vary significantly. Seventy-five percent of all bleeding episodes after elective treatment occurred within four days after EBL. 20/22 of bleeding events after emergency ligation occured within 11 days after treatment. Elective EBL has a lower risk of bleeding from treatment-induced ulceration than emergency ligation. Conclusions Patients who underwent EBL for treatment of acute variceal bleeding should be kept under medical surveillance for 11 days. After elective EBL, it may be reasonable to restrict the period of surveillance to four days or even perform the procedure in an out-patient setting.

  3. [Case of cardial varices rupture due to danaparoid sodium with portal venous thrombosis].

    Science.gov (United States)

    Kawaratani, Hideto; Matsumura, Masahiko; Tsujimoto, Tatsuhiro; Morimoto, Tomoko; Kitade, Mitsuteru; Umemoto, Norie; Sakai, Kyouko; Fukui, Hiroshi

    2008-12-01

    A 54-year-old man had been admitted to Nara city hospital because of hematemesis and dyspnea caused by physical exertion, and was given a diagnosis of esophago-cardial varices and portal venous thrombosis. He was transferred to our hospital for further examinations and treatments. Ultrasonography (US) and computed tomography (CT) revealed the progression of portal venous thrombosis. Danaparoid sodium was administered to treat the portal vein thrombus. 5 days later, the patient was found to have hematemesis resulting from a cardial varices rupture. After endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) was performed, danaparoid sodium was administered for 2 weeks. After the treatment, portal vein thrombus had almost disappeared. Due to an increased risk of bleeding, cases of esophago-cardial varices with portal venous thrombosis must be treated with care. This is the first report of upper gastrointestinal bleeding due to danaparoid sodium. Danaparoid sodium must be carefully administered when patients have portal venous thrombosis with delicate varices. PMID:19057161

  4. Ectopic Varices Rupture in the Gastroduodenal Anastomosis Successfully Treated with N-butyl-2-cyanoacrylate Injection

    Directory of Open Access Journals (Sweden)

    Takagi,Hitoshi

    2007-12-01

    Full Text Available The term "ectopic varices" is used to describe dilated portosystemic collateral veins in unusual locations other than the gastroesophageal region. We recently experienced a rare case of ectopic varices that developed in the gastroduodenal anastomosis after subtotal gastrectomy. A 70-year-old male with liver cirrhosis due to hepatitis C virus infection was admitted for hematemesis and tarry stool. He had received a subtotal gastrectomy with the Billroth-I method for gastric ulcer at 46 years of age. Although emergency endoscopy revealed esophageal and gastric fundal varices, there were no obvious bleeding points. After removal of the coagula, ectopic varices and a fibrin plug were observed on the gastroduodenal anastomosis. During the observation, blood began to spurt from the fibrin plug. N-butyl-2-cyanoacrylate with lipiodol injection succeeded in hemostasis. Splenic angiography showed gastric varices feeding from a short gastric vein and the posterior gastric vein. The blood flow around the bleeding point, as indicated by lipiodol deposition, had decreased, and no feeding vein was observed. Endoscopic and angiographic findings are shown and the treatment for such lesions is discussed.

  5. 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.

  6. 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.

  7. 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.

  8. Measurement of variceal pressure with a computerized endoscopic manometry: validation and effect of propranolol therapy in cirrhotic patients.

    Directory of Open Access Journals (Sweden)

    De-Run Kong

    Full Text Available BACKGROUND AND PURPOSE: Recently, we invented a computerized endoscopic balloon manometry (CEBM to measure variceal pressure (VP in cirrhotic patient. The purpose of this study was to evaluate the reliability and feasibility of this method, and whether this technique provided further information to pharmacological therapy. PATIENTS AND METHODS: VP measurements were performed in 83 cirrhotic patients and compared with HVPG as well as endoscopic bleeding risk parameters. Furthermore, VP was assessed before and during propranolol therapy in 30 patients without previous bleeding. RESULTS: VP measurements were successful in 96% (83/86 of all patients. Of the 83 patients, the VP correlated closely with the HVPG (P<0.001. The presence of red colour signs and the size of varices were strongly associated with VP. Patients with previous bleeding had higher VP than those who had not yet experienced bleeding. In univariate analysis, the level of VP, the size of varices, and red color signs predicted a higher risk of bleeding. The multiple logistic regression model revealed that VP was the major risk factor for bleeding. In 30 patients receiving propranolol, VP significantly decreased from 21.1 ± 3.5 mmHg before therapy to 18.1 ± 3.3 mmHg after 3 months and to 16.3 ± 4.0 mmHg after 6 months. Comparing the mean decrease in VP with that in hepatic venous pressure gradient (HVPG, the decrease in VP was more obvious than HVPG response to propranolol. CONCLUSIONS: This study showed that CEBM is safe and practical to assess VP in cirrhotic patient. It has the potential to be used as a clinical method to assess the risk of variceal bleeding and the effects of pharmacological therapy. TRIAL REGISTRATION: Effect of vasoactive drugs on esophageal variceal hemodynamics in patients with portal hypertension. Chinese Clinical Trial Registry -TRC-08000252.

  9. 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

  10. 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.

  11. 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.

  12. The safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single canadian tertiary care centre

    OpenAIRE

    Mosli, Mahmoud H.; Bandar Aljudaibi; Majid Almadi; Paul Marotta

    2013-01-01

    Background/Aim: Bleeding from Gastric Varices (GV) is not only life threatening, but also leads to many hospitalizations, contributes to morbidity and is resource intensive. GV are difficult to diagnose and their treatment can be challenging due to their location and complex structure. To assess the safety and efficacy of endoscopic gastric fundal variceal gluing using periodic endoscopic injections of N-butyl-2-cyanoacylate (NBCA) and to assess the utility of endoscopic ultrasound (EUS) in a...

  13. Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleeding.

    Science.gov (United States)

    Plotnik, Adam N; Hebroni, Frank; McWilliams, Justin

    2016-02-01

    Portomesenteric venous thrombosis is a rare but potentially life-threatening condition. The presenting symptoms of chronic portomesenteric venous thrombosis are often non-specific but may present with variceal bleeding. We present the first reported case of chronic portomesenteric venous thrombosis causing a high flow arteriovenous malformation that resulted in extensive gastrointestinal bleeding. PMID:25871943

  14. [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.

  15. Treatment of Non variceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    International Nuclear Information System (INIS)

    To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute non variceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute non variceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% post embolization ischemia in our series. In 89% of cases it was definitive without any further intervention.

  16. A RARE CASE OF OESOPHAGODUODENAL VARICES

    OpenAIRE

    Keisham; Dexter R; Lalrinmuani

    2015-01-01

    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...

  17. 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.

  18. 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.

  19. 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.

  20. Oesophageal candidiasis after omeprazole therapy.

    OpenAIRE

    Larner, A J; Lendrum, R

    1992-01-01

    Oesophageal candidiasis was diagnosed incidentally at endoscopy in two patients receiving omeprazole therapy. There were no other predisposing factors for the development of candidiasis. The infection was resolved rapidly by anti-candidal therapy and by stopping omeprazole. These findings suggest that gastric acid secretion and physiological reflux of acid into the oesophagus may play a protective role in preventing candida infection.

  1. [Gastrointestinal bleeding].

    Science.gov (United States)

    Lanas, Ángel

    2015-09-01

    In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage. The need for urgent endoscopy before 6-12 h after the onset of upper gastrointestinal bleeding episode may be beneficial in patients with hemodynamic instability and high risk for comorbidity. It is confirmed that in Western but not in Japanese populations, gastrointestinal bleeding episodes admitted to hospital during weekend days are associated with a worse prognosis associated with delays in the clinical management of the events. The strategy of a restrictive policy on blood transfusions during an upper GI bleeding event has been challenged. Several studies have shown the benefit of identifying the bleeding vessel in non varicose underlying gastric lesions by Doppler ultrasound which allows direct endoscopic therapy in the patient with upper GI bleeding. Finally, it has been reported that lower gastrointestinal bleeding diverticula band ligation or hemoclipping are both safe and have the same long-term outcomes. PMID:26520197

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Bleeding Disorders

    Science.gov (United States)

    ... times I'd miss work and skip the gym because I felt so lousy. So I decided ... cell called platelets. Your body also needs blood proteins called clotting factors. In people with bleeding disorders, ...

  7. 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

  8. Gastro-oesophageal Reflux Disease: An Update

    OpenAIRE

    Murphy, T.; EK Donaldson; Mills, M.; M Arthurs; Lee MG

    2015-01-01

    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 m...

  9. 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.

  10. 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.

  11. Colon interposition for oesophageal replacement.

    Science.gov (United States)

    Thomas, Pascal A; Gilardoni, Adrian; Trousse, Delphine; D'Journo, Xavier B; Avaro, Jean-Philippe; Doddoli, Christophe; Giudicelli, Roger; Fuentes, Pierre

    2009-01-01

    The choice of the colon as an oesophageal substitute results primarily from the unavailability of the stomach. However, given its durability and function, colon interposition keeps elective indications in patients with benign or malignant oesophageal disease who are potential candidates for long survival. The choice of the colonic portion used for oesophageal reconstruction depends on the required length of the graft, and the encountered colonic vascular anatomy, the last being characterised by the near-invariability of the left colonic vessels, in contrast to the vascular pattern of the right side of the colon. Accordingly, the transverse colon with all or part of the ascending colon is the substitute of choice, positioned in the isoperistaltic direction, and supplied either from the left colic vessels for long grafts or middle colic vessels for shorter grafts. Technical key points are: full mobilisation of the entire colon, identification of the main colonic vessels and collaterals, and a prolonged clamping test to ensure the permeability of the chosen nourishing pedicle. Transposition through the posterior mediastinum in the oesophageal bed is the shortest one and thereby offers the best functional results. When the oesophageal bed is not available, the retrosternal route is the preferred alternative option. The food bolus travelling mainly by gravity makes straightness of the conduit of paramount importance. The proximal anastomosis is a single-layer hand-fashioned end-to-end anastomosis to prevent narrowing. When the stomach is available, the distal anastomosis is best performed at the posterior part of the antrum for the reasons of pedicle positioning and reflux prevention, and a gastric drainage procedure is added when the oesophagus and vagus nerves have been removed. In the other cases, a Roux-en-Y jejunal loop is preferable to prevent bile reflux into the colon. Additional procedures include re-establishment of the colonic continuity, a careful closure of

  12. 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.

  13. 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

  14. Barrett's ulcer: cause of spontaneous oesophageal perforation.

    OpenAIRE

    Limburg, A. J.; Hesselink, E. J.; Kleibeuker, J H

    1989-01-01

    We report two patients, who presented within six months with the classic clinical picture of 'spontaneous' oesophageal perforation, which was caused by a perforated Barrett's ulcer. These two cases underline the importance of postoperative endoscopy in ruling out intrinsic oesophageal disease as the cause of the rupture in every patient, who survives this life threatening condition.

  15. 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. PMID:22718184

  16. [Treatment of non-variceal hemorrhage of the upper digestive tract].

    Science.gov (United States)

    Abdo Francis, J M

    1998-01-01

    High digestive tract hemorrhage (HDTH) represents on average 35% of the indications for endoscopy. It shows as a complication in different digestive pathologies or secondary to coagulopathies. Endoscopic management of non-variceal HDTH includes a gamut of procedures that when grouped together, have shown to be effective and safe in its control with an important diminishing in morbidity-mortality, transfusion requirements, days of hospital stay, and the need for surgery. The most frequently employed methods are substance injections, multipolar coagulation, and thermic catheter, which achieve an average 90% hemostasis, but still inform high percentages of relapse. Approximately 25% of the patients with non-variceal hemorrhage may bleed again after endoscopic management. New procedures such as hemoclips and the combination of endoscopic methods have been used to diminish relapse. Endoscopic treatment should be carried out when we find bleeding lesions with Forrest Ia, Ib and IIa classifications, fundamentally because the risk of hemorrhagic relapse is very high among these groups. The treatment for the eradication of Helicobacter pylori in patients with bleeding peptic ulcers diminishes, in an important manner, the risk of the recurrence of hemorrhage. PMID:10068724

  17. 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.

  18. 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.

  19. Safety and efficacy of 2-octyl-cyanoacrylate in the management of patients with gastric and duodenal varices who are not candidates for transjugular intrahepatic portosystemic shunts

    Science.gov (United States)

    Burdick, James; Trotter, James F.

    2016-01-01

    Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension and cirrhosis. Options are limited for patients who are not candidates for transjugular intrahepatic portosystemic shunts (TIPS). Cyanoacrylate injections have been reported to be efficacious in previous case series. The aim of this retrospective study was to report our single-center experience with the safety and efficacy of 2-octyl-cyanoacrylate in patients who were not TIPS candidates. Electronic medical records were reviewed for 16 patients who underwent a total of 18 esophagogastroduodenoscopies for acute gastric or duodenal variceal bleeding and secondary prophylaxis of gastric varices; 14 patients had cirrhosis with an average Model for End-Stage Liver Disease score of 16, and 2 patients had noncirrhotic portal hypertension. Primary endpoints of the study included early and delayed rebleeding rate, complications, and death or liver transplantation. The rebleeding rate (early or delayed) was 7%, and no complications were found. One death was reported (unrelated to the procedure). In conclusion, 2-octyl-cyanoacrylate is a safe and effective alternative for non-TIPS candidates who present with acute gastric variceal bleeding given its low rebleeding and complication rate.

  20. 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.

  1. Congenital oesophageal hiatal hernia in a pug

    Directory of Open Access Journals (Sweden)

    Keeley B

    2008-06-01

    Full Text Available 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 type 1 oesophageal hiatal herniation with unusual clinical presentation.

  2. 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...

  3. Sclerotherapy Of Esophageal Varices In Severe Hemophilia A Patient And High Titer Inhibitor--Case Report.

    Science.gov (United States)

    Szczepanik, Andrzej B; Dąbrowski, Wojciech P; Szczepanik, Anna M; Pielaciński, Konrad; Jaśkowiak, Wojciech

    2015-09-01

    In cirrhotic hemophilia patients bleeding from esophageal varices is a serious clinical condition due to congenital deficiency of clotting factors VIII or IX, decreased prothrombin synthesis and hypersplenic thrombocytopenia. In hemophiliac with high-titer inhibitor bypassing therapy is required with activated prothrombin complex concentrates (aPCC) or recombinant activated coagulation factor VII (rFVIIa). Doses and duration treatment with these agents following endoscopic treatment of esophageal varices have not been yet established. Authors report the first case of a severe hemophilia A patient with high titer inhibitor (40 BU) treated with repeated injection sclerotherapy. The patient was admitted with symptoms of massive esophageal variceal hemorrhage ceased with emergency sclerotherapy. Bypassing therapy was administered with aPCC at initial dose of 72.5 U/kg and then with average daily dose of 162 U/kg through 5 days. To achieved a total eradication of esophageal varices the patient was then subjected to four elective sclerotherapy procedures. Two were covered by aPCC with daily dose of 120 U/kg and 145 U/kg for 4 and 3 days respectively and the following two procedures were covered by rFVIIa with the initial dose of 116 µg/kg and the next doses of 87 µg/kg administered every 3 hours in procedure day and every 4 hours on the next two days. During all procedures excellent hemostasis was achieved and no hemorrhagic or thromboembolic complications were observed. Bypassing regimen therapy with aPCC and rFVIIa we applied have been shown to be safe and effective in this patient subjected to sclerotherapy procedures. PMID:26812842

  4. Observation of endoscopic treat ment of esophageal and gastri c variceal bleeding and portal vein hemodynamics changes%内镜下治疗食管和胃静脉曲张出血的疗效及门静脉血流动力学改变的临床研究

    Institute of Scientific and Technical Information of China (English)

    蒋波涛; 徐丽; 李荣华; 晏喻婷; 李桂红; 周州; 王英; 陶杨

    2015-01-01

    Objective To evaluate the clinical effect of endoscopic ligation of esophageal varices , endoscopic variceal sclerotherapy,gastric varices tissue adhesive injection and the effects of three methods in the treatment of portal vein hemodynamics.Methods One hundred and seven cases of esophageal and gastric varices were randomly treated with endoscopic injection sclerotherapy(45 cases),tissue adhesive(29 cases ) and endoscopic variceal ligation ( 33 cases ) .The hemostatic rate, rebleeding rate, varicose vein disappearance rate,complication rate and other indicators were followed up.The hemodynamic indexes of the three groups before and after treatment were measured with color Doppler ultrasound, including pipe diameter,blood flow velocity and blood flow of portal vein, splenic vein, left gastric vein and superior mesenteric vein.Results There was no significant difference of emergency hemostasis rate and complication rate among the three groups.The varicose vein disappearance rate in ligation group(90.9%) was the higher than that in sclerotherapy group ( 71.1%) and tissue adhesive group ( 65.5%) , and the difference was significant( P<0.05 ) .The short-term and long-term rebleeding rate in tissue adhesive group ( 27.6%, 34.5%) were higher than those in sclerotherapy group ( 15.6%,17.8%) and ligation group ( 12.1 %, 18.2%),with significant differences(P<0.05).The portal vein diameters decreased and the splenic vein diameters increased in ligation group and sclerotherapy group after treatment, but there was no significant difference before and after treatment.The average blood flow velocity and blood flow of portal vein and splenic vein in ligation group(22.1 ±3.0 vs.28.9 ±5.3,23.5 ±4.1 vs.31.2 ±3.9,19.8 ±3.7 vs.26.6 ±5.1, 15.3 ±3.7 vs.20.9 ±5.2)and sclerotherapy group(20.9 ±2.6 vs.26.8 ±2.4,21.2 ±4.6 vs.28.7 ±4.1, 19.7 ±3.4 vs.25.8 ±3.8,18.8 ±3.1 vs.24.7 ±2.1) after treatment significantly increased (P<0.05) ,and the diameter,mean blood flow velocity

  5. Ectopic Jejunal Variceal Rupture in a Liver Transplant Recipient Successfully Treated With Percutaneous Transhepatic Coil Embolization: A Case Report.

    Science.gov (United States)

    Abe, Satoru; Akamatsu, Nobuhisa; Hoshikawa, Mayumi; Shirata, Chikara; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2015-11-01

    Here we present the rupture of ectopic jejunal varices developing in a liver transplant recipient without portal hypertension, which was successfully treated with percutaneous transhepatic coil embolization.A 48-year-old man with massive melena was admitted to our department. He had undergone liver transplantation for hepatitis B virus-related liver cirrhosis 8 months before, and his postoperative course was satisfactory except for an acute cellular rejection. No evidence of bleeding was detected by upper endoscopy or colonoscopy, but dynamic multidetector computed tomography of the whole abdomen revealed an intestinal varix protruding into the lumen of the jejunum with suspected extravasation. There was no evidence of portal venous stenosis or thrombosis. Immediately upon diagnosis of the ruptured ectopic jejunal varix, percutaneous transhepatic coil embolization was performed, achieving complete hemostasis. The portal venous pressure measured during the procedure was within normal limits. He was discharged from the hospital 11 days after embolization and remained in stable condition without re-bleeding 6 months after discharge.This is the first report of an ectopic intestinal variceal rupture in an uneventful liver transplant recipient that was successfully treated with interventional percutaneous transhepatic coil embolization. Clinicians encountering liver transplant recipients with melena should be aware of the possibility of late-onset rupture of ectopic varices, even in those having an uneventful post-transplant course without portal hypertension. PMID:26632745

  6. 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.

  7. 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.

  8. Embolization with NBCA for the treatment of esophago-fundal varices: its complications and nursing care

    International Nuclear Information System (INIS)

    Objective: To discuss the nursing care for patients with portal hypertension after receiving NBCA embolization treatment of esophago-fundal varices. Methods: The clinical data and nursing care effect in 28 patients with portal hypertension after NBCA embolization treatment of esophago-fundal varices were retrospectively analyzed. Results: Successful embolization was achieved in 27 patients, and the bleeding was stopped. Failure of embolization occurred in one patient. Slight pulmonary embolism was found in 4 cases, of which 2 had mild cough. Pain in different degree was seen in 24 cases, and vomiting with mild abdominal pain in 20 cases. Neither puncture site bleeding nor intraperitoneal hemorrhage occurred. Conclusion: In order to increase the success rate and to reduce the occurrence of complications, it is very important for nurses to take the following obligations seriously: to give the patient pertinent psychological nursing care before the procedure, to take a close observation on the patient's condition during and after the surgery and to deal with the complications promptly. (authors)

  9. Bleeding Disorders Treatment Options

    Science.gov (United States)

    ... Pictures Young Voices Compendium of Assessment Tools Educational Games Video Library Find a Treatment Centre Haemophilia Journal About Bleeding Disorders Bleeding Disorders The Clotting Process Drugs That Can Cause Bleeding Hemophilia How Do You ...

  10. 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)

  11. 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.

  12. 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.

  13. Could there be light at the end of the tunnel? Mesocaval shunting for refractory esophageal varices in patients with contraindications to transjugular intrahepatic portosystemic shunt.

    Science.gov (United States)

    Davis, Jessica; Chun, Albert K; Borum, Marie L

    2016-07-01

    Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement. PMID:27429715

  14. 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.

  15. A retrospective comparative study of histoacryl injection and banding ligation in the treatment of acute type 1 gastric variceal hemorrhage.

    Science.gov (United States)

    Lo, Gin-Ho; Lin, Chih-Wen; Perng, Daw-Shyong; Chang, Chi-Yang; Lee, Ching-Tai; Hsu, Chuan-Yuan; Wang, Huay-Min; Lin, Hui-Chen

    2013-10-01

    BACKGROUND. Esophageal varices extending along lesser curvature side of stomach is classified as GOV1. The optimal therapy for GOV1 bleeding is still undetermined. METHODS. One hundred and sixty-two patients diagnosed as acute hemorrhage from GOV1 were enrolled. At endoscopists' discretion, 118 patients received glue injection (Glue group) and 44 patients received ligation to arrest bleeding [endoscopic variceal ligation (EVL) group]. This study aimed to compare hemostasis, rebleeding, complications and mortality within 42 days. RESULTS. Both groups were comparable in baseline data. In 109 patients (92%) in the Glue group and 36 patients (82%) in the EVL group (p = 0.07) 48-h hemostasis was achieved . Hemostasis of active bleeding was achieved in 49 of 55 patients (89%) in the Glue group and 24 of 28 patients (85%) in the EVL group (p = 0.70). Treatment failure was noted in 14% of the Glue group and 23% in the EVL group (p = 0.22). Eight patients in the Glue group and four patients in the EVL group rebled between 5 and 42 days (p = 0.73). A total of 48 and 19 adverse events occurred in the Glue and EVL groups, respectively (p = 0.85). Six patients in the Glue group and seven patients in the EVL group encountered posttreatment gastric ulcer bleeding (p = 0.04). Seventeen patients (14%) in the Glue group and 10 (23%) patients in the EVL group died within 42 days (p < 0.001). CONCLUSIONS. Banding ligation was similar to glue injection in achieving successful hemostasis of acute bleeding from GOV1. However, a higher incidence of posttreatment ulcer bleeding and mortality may be associated with banding ligation. PMID:24047398

  16. Gastro-oesophageal reflux in mechanically ventilated patients: effects of an oesophageal balloon.

    Science.gov (United States)

    Orozco-Levi, M; Félez, M; Martínez-Miralles, E; Solsona, J F; Blanco, M L; Broquetas, J M; Torres, A

    2003-08-01

    Gastro-oesophageal reflux (GOR) and bronchoaspiration of gastric content are risk factors linked with ventilator-associated pneumonia. This study was aimed at evaluating the effect of a nasogastric tube (NGT) incorporating a low-pressure oesophageal balloon on GOR and bronchoaspiration in patients receiving mechanical ventilation. Fourteen patients were studied in a semi-recumbent position for 2 consecutive days. Inflation or deflation of the oesophageal balloon was randomised. Samples of blood, gastric content, and oropharyngeal and bronchial secretions were taken every 2 h over a period of 8 h. A radioactively labelled nutritional solution was continuously administered through the NGT. The magnitude of both the GOR and bronchoaspiration was measured by radioactivity counting of oropharyngeal and bronchial secretion samples, respectively. Inflation of the oesophageal balloon resulted in a significant decrease of both GOR and bronchoaspiration of gastric content. This protective effect was statistically significant from 4 h following inflation throughout the duration of the study. This study demonstrates that an inflated oesophageal balloon delays and decreases gastro-oesophageal and bronchial aspiration of gastric content in patients carrying a nasogastric tube and receiving enteral nutrition during mechanical ventilation. Although the method was found to be safe when applied for 8 h, longer times should be considered with caution. PMID:12952272

  17. Oesophageal squamous cell carcinoma in two cats

    International Nuclear Information System (INIS)

    Two cases of feline oesophageal squamous cell carcinoma are described. In both cases, diagnosis was achieved by radiography, endoscopy and cytology, and later confirmed by histology. One cat underwent oesophagectomy followed by end-to-end anastomosis, but died three days postsurgery; the second cat was euthanased after diagnosis

  18. Thoracoscopic Hellers myotomy for oesophageal achalasia.

    Science.gov (United States)

    Rea, S; Kelly, C J; Broe, P J

    1999-01-01

    Surgical myotomy is the mainstay of treatment for oesophageal achalasia. Minimally invasive surgical techniques, if feasible, reduce patient morbidity and mortality. In this study we review our experience of thoracoscopic Heller's myotomy. Thoracoscopic myotomy was undertaken in 9 patients (male = 3; female = 6, mean age = 37). All patients presented with dysphagia of 1 to 8 yr duration. Diagnosis was based on barium swallow and manometry. Two patients had previous dilatations and 1 had a transabdominal myotomy. All patients had a 5 port thoracoscopic technique. Thoracoscopic Heller's myotomy was completed in 8 out of 9 patients. In 1 patient extensive oesophagitis and peri-oesophagitis precluded both a thoracoscopic and an open myotomy, and oesophagectomy was subsequently performed. The mean duration of surgery was 142 min. Completion of myotomy and mucosal integrity was confirmed by intraoperative gastroscopy. All patients had an uneventful post-operative recovery. The mean hospital stay was 4 days. All patients are now asymptomatic, with documented weight gain. No patients have reflux oesophagitis symptoms. Our preliminary experience would suggest that thoracoscopic Heller's myotomy is a safe alternative to open surgery, with satisfactory results and reduced hospital stay. PMID:10098335

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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%.

  4. 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.

  5. Gastric Ulcer - A Cause of Portal Cavernoma and Upper Gastrointestinal Bleeding: Case Report

    Directory of Open Access Journals (Sweden)

    Laurențiu V Sima

    2014-10-01

    Full Text Available Gastric ulcers, with a long duration of the disease, can lead to an inflammatory process in the upper abdomen (supramesocolic floor, with repercussions on the surrounding structures. Such ulcers can penetrate the gastric wall, toward the pancreas and hepatic hilum, the inflammatory process can lead to splenic vein trombosis and teh appearance of a portal cavernoma. A complication of the portal cavernoma and the portal hypertension is the formation of esophageal varices. This paper reports the case of a 58 years old patient with multiple episodes of upper gastrointestinal bleeding, determined by both, esophageal varices and existing gastric ulcers. This patient was initially diagnosed with portal cavernoma and the esophageal varices were considered the cause of gastrointestinal bleeding. A spleno-renal shunt was proposed, but intraoperative it was found that this was not necessary because the portal vein was thrombosed and the bleeding was probably caused by the gastric lesions. We performed a distal spleno-pancreatectomy associated with a cuneiform resection of the gastric lession, as well as the resection of the hepatic tumor. The patient had a favorable postoperative outcome.

  6. 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....

  7. 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)

  8. Dysphagia as result of oesophageal dysfunction in dogs and cats

    International Nuclear Information System (INIS)

    Disturbances of the oesophageal function in dogs and cats lead to the clinical symptoms of dysphagia. An oesophageal dilatation of various degree can result from this and can be categorized as primary, i.e. idiopathic form, or secondary form, if its cause is known. This present study of our own patient population gives a survey of the symptomatology, diagnostic measures, incidence, pathogenesis, and therapy of oesophageal dilatation

  9. 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.

  10. 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. PMID:27465078

  11. Monometric and scintiscanning evaluation of esophageal function after endoscopic sclerosis of esophageal varices. Controlled prospective study

    International Nuclear Information System (INIS)

    Esophageal function was studied in twenty-one patients with esophageal varices of different etiology submitted to endoscopic sclerosis for the detection of possible alterations in the functional pattern of the organ after this treatment. The endoscopic injection sclerosis (EIS) was performed electively in 14 patients (Group I) and in the presence of bleeding in 07 (Group II). The sclerotizing agent used was a solution of equal parts of ethanolamine oleate (EthamolinR) and 50% glucose. The injections were preferentially performed by the perivascular technique at weekly intervals. Esophageal function was studied by manometry, and esophageal transit time by scintillography. Group I patients were evaluated before and two to three months and five to nine months after EIS, and Group II patients were only evaluated six to nine months after EIS. The manometry and scintillography procedures were performed in sequence on the same day. The scintillographic examinations were performed with the patient in the supine and sitting positions. (author)

  12. 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.

  13. A phase II and pharmacodynamic study of sunitinib in relapsed/refractory oesophageal and gastro-oesophageal cancers

    OpenAIRE

    Wu, C.; S. Mikhail; Wei, L; Timmers, C; Tahiri, S.; Neal, A.; Walker, J; El-Dika, S; Blazer, M; Rock, J.; Clark, D J; X. Yang; Chen, J L; Liu, J.; Knopp, M.V.

    2015-01-01

    Background: Blockade of the vascular endothelial growth factor (VEGF) pathway shows evidence of activity in gastro-oesophageal (GE) and oesophageal cancer. We investigated the efficacy of sunitinib, a multikinase VEGF inhibitor, in patients with relapsed/refractory GE/oesophageal cancer. Methods: This was a single-stage Fleming phase II study. The primary end point was progression-free survival (PFS) at 24 weeks. If five or more patients out of a total of 25 were free of progressive disease a...

  14. 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

  15. Oral presentation of an oesophageal mucosal tear

    OpenAIRE

    Uppal, S; De P, R

    1999-01-01

    Tears of the oesophageal wall following sudden forceful vomiting are well documented in literature. In Boerhaave's syndrome there is transmural rupture associated with complications including pneumothorax, pneumomediastinum, surgical emphysema and shock. In Mallory-Weiss syndrome mucosal tears are associated with haematemesis and shock. In neither of these conditions has intraluminal obstruction been described as an aetiological factor. We present a case with similar pathophysiology where oes...

  16. 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. PMID:26573424

  17. Hiatus Hernia Repair with Bilateral Oesophageal Fixation.

    Science.gov (United States)

    Mendis, Rajith; Cheung, Caran; Martin, David

    2015-01-01

    Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL), PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P < 0.01), Visick (3 to 1), and RSI (17.45 to 5, P < 0.01). PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%). 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability. PMID:26065030

  18. Hiatus Hernia Repair with Bilateral Oesophageal Fixation

    Directory of Open Access Journals (Sweden)

    Rajith Mendis

    2015-01-01

    Full Text Available Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL, PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P<0.01, Visick (3 to 1, and RSI (17.45 to 5, P<0.01. PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%. 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability.

  19. Lumbar epidural varices: An unusual cause of lumbar claudication

    Directory of Open Access Journals (Sweden)

    Meenakshisundaram Subbiah

    2016-01-01

    Full Text Available Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP. However as the magnetic resonance imaging (MRI in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings.

  20. 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.

  1. 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.

  2. Passive smoking and risk of oesophageal and gastric adenocarcinomas

    Science.gov (United States)

    Duan, L; Wu, A H; Sullivan-Halley, J; Bernstein, L

    2009-01-01

    Few studies have examined the association between passive smoking and the risk of oesophageal and gastric adenocarcinomas. In a population-based case–control study with 2474 participants in Los Angeles County, there was no evidence that passive smoking had any appreciable effect on oesophageal or gastric adenocarcinomas. PMID:19352383

  3. 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"…

  4. 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

    making the final decision for therapy. Eleven percent of the patients referred with a diagnosis of hiatal hernia or reflux had achalasia or oesophageal spasm. Nine percent of the patients referred for motility disorders had reflux-related disease. The referral diagnosis was changed to a diagnosis...

  5. Oesophageal food bolus impaction in elderly people

    Directory of Open Access Journals (Sweden)

    Mitrović Slobodan M.

    2014-01-01

    Full Text Available Introduction. The diagnosis of food bolus impaction in the esophagus is based on the data obtained from the patient, clinical examination, radiographic diagnosis, and endoscopy. The aim of this study was to examine the influence of possible factors causing oesophageal impaction of food boluses in elderly people. Material and Methods. This retrospective study included six male and eight female patients treated at the Department of Ear, Nose, and Throat Disease in Novi Sad. Results. Post-corrosive oesophageal stricture was diagnosed in 28.57% of patients and non-corrosive stricture was found in 21.43%. Total tooth loss was recorded in 64.29% of patients and 14.29% of patients had partial tooth loss. An impacted food bolus was located at a distance of 15-25 cm or 30-40 cm distance from the upper incisors in 42.86% of the study sample. Discussion and conclusion. The impaction of food boluses in the esophagus is significantly higher in women, usually after 76 years of age. There is a positive correlation between the presence of oesophageal stricture and recurrence of food bolus impaction. Partial and total tooth loss is present in a high percentage but there is no correlation with the food bolus impaction. Impaction of food bolus was equally found in the upper and lower third of the oesophagus and it was usually meat. Radiographic diagnosis should precede each esophagoscopy. Esophagoscopy with rigid oesophagoscope is a reliable method for the extraction of a bolus of food from the oesophagus in elderly patients.

  6. Endoscopic sclerotherapy of esophageal varices. A case report Escleroterapia endoscópica de várices esofágicas. Presentación de un caso

    OpenAIRE

    Pedro Juan Vázquez González; Marcos Félix Osorio Pagola

    2010-01-01

    A case of a patient with liver cirrhosis that had been previously diagnosed in the Department of Gastroenterology of the General University Hospital "Dr. Aldereguía Gustavo Lima" of Cienfuegos is presented. This patient came to the hospital with upper gastrointestinal bleeding as a clinical presentation and an evolution characterized by esophageal varices-related rebleeding. A non-surgical treatment with endoscopic sclerosis has been used.Se presenta el caso de una paciente con cirrosis hepát...

  7. 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.

  8. 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.

  9. 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

  10. 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)

  11. 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.

  12. Microdeletion 22q11 and oesophageal atresia

    Science.gov (United States)

    Digilio, M. C.; Marino, B.; Bagolan, P.; Giannotti, A.; Dallapiccola, B.

    1999-01-01

    Oesophageal atresia (OA) is a congenital defect associated with additional malformations in 30-70% of the cases. In particular, OA is a component of the VACTERL association. Since some major features of the VACTERL association, including conotruncal heart defect, radial aplasia, and anal atresia, have been found in patients with microdeletion 22q11.2 (del(22q11.2)), we have screened for del(22q11.2) by fluorescent in situ hybridisation (FISH) in 15 syndromic patients with OA. Del(22q11.2) was detected in one of them, presenting with OA, tetralogy of Fallot, anal atresia, neonatal hypocalcaemia, and subtle facial anomalies resembling those of velocardiofacial syndrome. The occurrence of del(22q11.2) in our series of patients with OA is low (1/15), but this chromosomal anomaly should be included among causative factors of malformation complexes with OA. In addition, clinical variability of del(22q11.2) syndrome is further corroborated with inclusion of OA in the list of the findings associated with the deletion.


Keywords: microdeletion 22q11; oesophageal atresia; VACTERL association; velocardiofacial syndrome PMID:10051013

  13. 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.

  14. Gamna-Gandy Bodies of the Spleen Detected with Susceptibility Weighted Imaging: Maybe a New Potential Non-Invasive Marker of Esophageal Varices

    OpenAIRE

    Jiuquan Zhang; Ran Tao; Zhonglan You; Yongming Dai; Yi Fan; Jinguo Cui; Qing Mao; Jian Wang

    2013-01-01

    BACKGROUND/OBJECTIVES: Portal hypertension (PH) is a clinical sequelae of liver cirrhosis, and bleeding from esophageal varices (EV) is a serious complication of PH with significant morbidity and mortality. The aims of this study were to assess the ability of 2D multislice breath-hold susceptibility weighted imaging (SWI) to detect Gamna-Gandy bodies (GGBs) in the spleens of patients with PH and to evaluate the potential role of GGB number as a non-invasive marker of PH and EV. MATERIALS AND ...

  15. 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.

  16. 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

  17. Prognosis in patients with cirrhosis and mild portal hypertension

    DEFF Research Database (Denmark)

    Ytting, Henriette; Møller, Søren; Henriksen, Jens Henrik;

    2006-01-01

    OBJECTIVE: Sixty to 70% of upper gastrointestinal bleeding episodes in patients with cirrhosis are caused by oesophageal varices. Prophylaxis is indicated in patients with varices and a hepatic venous pressure gradient (HVPG) above 12 mmHg. The study of the natural history of patients with lower...... Registries. Variceal bleeding, hepatic encephalopathy and death related to cirrhosis were registered. Thirty-nine patients were graded as Child class A, 19 as class B and 3 as class C. Median survival time was 11 years. RESULTS: Twenty-eight patients (46%) developed one or more complications: variceal...... bleeding in 10 (16%) and hepatic encephalopathy in 18 patients (30%). Twenty-three patients (38%) died from complications of cirrhosis. Two patients (3%) died from variceal bleeding, another two (3%) from gastrointestinal bleeding of unidentified source. Survival rate was significantly decreased compared...

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. Unusual presentation of oesophageal carcinoma with adrenal metastasis

    International Nuclear Information System (INIS)

    Adrenal gland is a common site of metastasis in many cancers but it is very rare in oesophageal carcinoma. We report one such case found to have adrenal metastasis on follow-up PET/computed tomography scan

  4. Gastro-Oesophageal Reflux in Noncystic Fibrosis Bronchiectasis

    Directory of Open Access Journals (Sweden)

    Annemarie L. Lee

    2011-01-01

    Full Text Available The clinical presentation of noncystic fibrosis bronchiectasis may be complicated by concomitant conditions, including gastro-oesophageal reflux (GOR. Increased acidic GOR is principally caused by gastro-oesophageal junction incompetence and may arise from lower oesophageal sphincter hypotension, including transient relaxations, hiatus hernia, and oesophageal dysmotility. Specific pathophysiological features which are characteristic of respiratory diseases including coughing may further increase the risk of GOR in bronchiectasis. Reflux may impact on lung disease severity by two mechanisms, reflex bronchoconstriction and pulmonary microaspiration. Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence of 26 to 75%. The cause and effect relationship has not been established, but preliminary reports suggest that GOR may influence the severity of bronchiectasis. Further studies examining the implications of GOR in this condition, including its effect across the disease spectrum using a combination of diagnostic tools, will clarify the clinical significance of this comorbidity.

  5. Oesophageal and gastric carcinoma in the Republic of Yemen.

    OpenAIRE

    Gunaid, A. A.; Sumairi, A. A.; Shidrawi, R G; al-Hanaki, A.; al-Haimi, M.; al-Absi, S.; al-Hureibi, M. A.; Qirbi, A. A.; al-Awlagi, S.; el-Guneid, A. M.

    1995-01-01

    We conducted a preliminary survey on 3064 patients who underwent upper gastrointestinal endoscopy at the Al-Thawra Hospital in Sana'a, Republic of Yemen, between January and December 1991. The age/sex distribution, demographic features and social habits with respect to cigarette and water-pipe smoking and Qat chewing were compared for patients with oesophageal and gastric cancers (n = 183). A preponderance of women with carcinoma of the mid-oesophageal was noted, previously only recorded in a...

  6. Pharyngo oesophageal strictures and its reconstruction by delto pectoral flaps

    OpenAIRE

    Guha, Goutam; S Gupta; Chakraborty, S

    2005-01-01

    Delto pectoral flap is a thin and pliable cutaneous axial flap suitable for the reconstruction of pharynx and upper oesophagus. Corrosive stricture of the pharyngo oesophageal area can very well be reconstructed by deltopectoral flap. Oesophageal reconstruction by viscera like stomach or colon often produces anastomic stricture at the upper anastomic site with hypopharynx or upper oesophagus. Delto pectoral flap can also be used to reconstruct this anastomotic stricture. Postoperative swallow...

  7. An unusual oesophageal foreign body in neonate – case report

    International Nuclear Information System (INIS)

    Foreign bodies in the esophagus in children are usually swallowed accidentally during play. An oesophageal foreign body in neonate is rare and thus the diagnostic work-up may be difficult. We present a case of an 8-day-old baby with symptoms of oesophageal obstruction. An unusual foreign body was found. Foreign bodies in neonate’s esophagus are rare; non-accidental action should be suspected. Atypical clinical and radiological symptoms may cause diagnostic difficulties

  8. 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.

  9. Pharyngo-oesophageal webs in dysphageal patients

    International Nuclear Information System (INIS)

    Among 1134 patients, cineradiologically examined because of dysphagia, 85 (7.5%) had webs in the pharyngo-oesophageal segment. Webs were more common in women (10%) compared to men (5%). Radiologic characteristics of the webs such as precise location, multiplicity, circumferential extension, thickness, accompanying streamline phenomenon and encroachment on the lumen, were compared to the presence of concomitant anaemia, thyroid disease, neoplasm, as well as the age and sex of the patients. Webs were regularly deeper in women compared to men. Patients with iron deficiency anaemia had thicker webs compared to patients without such anaemia. No other radiologic characteristics were found that could be used for distinguished these potentially more significant webs from those in patients without such concomitant diseases. (orig.)

  10. Computed tomography in staging of oesophageal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Salonen, O.; Kivisaari, L.; Standertskjoeld-Nordenstam, C.G.; Somer, K.; Virkkunen, P.

    1987-01-01

    The computed tomographic (CT) findings in 45 patients with histologically proved oesophageal carcinoma are reviewed. In 20 of these patients the CT findings were correlated with findings at surgery (19 patients) or autopsy (1 patient). Correlation analysis showed that the accuracy of CT in assessing both invasion of adjacent organs and mediastinal and abdominal lymph node involvement is limited. 25 patients were considered inoperable. In 15 of these conclusion was based on CT findings of distant metastases (14 patients) or definite local invasion (1 patient). 10 patients were inoperable for other reasons (general health condition). The value of CT was found to be in detecting distant metastases, thus avoiding unnecessary radical surgery. It is not a reliable way of defining the primary tumour.

  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. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

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

    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.

  18. 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

  19. Bleeding during Pregnancy

    Science.gov (United States)

    ... have placenta accreta, you are at risk of life-threatening blood loss during delivery. Your ob-gyn will plan your ... to be done right after delivery to prevent life-threatening blood loss. Can bleeding be a sign of preterm labor? ...

  20. 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.

  1. Pulmonary Functions After Injection Sclerotherapy Of Esophageal Varices & After Band Ligation

    OpenAIRE

    Mohamed A. Metwally*, Ahmad Abdelsadek Mohammad,**Galal A. Moawad,*.

    2013-01-01

    Aim of the study: To study changes in pulmonary function tests after esophageal variceal injection sclerotherapy in comparison to changes after esophageal variceal band ligation.Patients & methods:This study was designed as non randomized controlled study. Thirty patients with hepatic cirrhosis & portal hypertension who were admitted to Hepatology, Gastroenterology and Infectious Diseases department , Benha university hospital for elective esophageal variceal therapy (secondary prophylaxis) ...

  2. 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.

  3. 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.

  4. 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.

  5. Scintimetric objectification of the pathological gastro-oesophageal reflux

    International Nuclear Information System (INIS)

    In this investigation, the author initially made animal experiments to find out: - if and how the gastro-oesophageal reflux in a cardiac insufficiency caused by cardiomyotomy could be proven quantitatively by scintiscanning as often as wanted and how the course of the arising oesophagitis correlated with the findings of the scintiscanning. For the clinical examinations, he referred to patients complaining the reflux difficulties or patients who had had a Balanced Operation because of a reflux disease. The main concern was to clarify the special characteristics and the reliability of reflux scintiscanning and to compare them to conventional methods of radiological and endoscopic reflux diagnostics. (orig./MG)

  6. 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.

  7. Risk factors associated with oesophageal cancer in Bulawayo, Zimbabwe.

    OpenAIRE

    Vizcaino, A. P.; Parkin, D M; Skinner, M. E.

    1995-01-01

    This report presents information on risk factors for oesophageal cancer in Bulawayo, Zimbabwe. The data analysed were from the Cancer Registry of Bulawayo for the years 1963-77, when all registered patients were interviewed using a standard questionnaire. The age-standardised incidence rates in the urban population of Bulawayo in the first 10 year period were 58.6 per 100,000 in men and 8.1 in women. The distribution of risk factors was assessed in 881 oesophageal cancer cases (826 male, 55 f...

  8. Detection of hemorrhage in a patient with cecal varices using /sup 99m/Tc-sulfur colloid

    International Nuclear Information System (INIS)

    Colonic or ileal varices secondary to portal hypertension or superior mesenteric vein obstruction may present with significant hemorrhage which is difficult to diagnose by angiography. In a patient with lower gastrointestinal hemorrhage and colonic varices, a /sup 99m/Tc-sulfur colloid scan demonstrated the varices and extravasation into the cecum. Extravasation was not demonstrable by angiography

  9. The management of gastro-oesophageal reflux disease

    OpenAIRE

    Keung, Charlotte; Hebbard, Geoffrey

    2016-01-01

    If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4–8 weeks. This should be taken 30–60 minutes before food for optimal effect.

  10. Apparent diffusion coefficient correlation with oesophageal tumour stroma and angiogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Aoyagi, Tomoyoshi; Shuto, Kiyohiko; Okazumi, Shinichi; Hayano, Kohichi; Satoh, Asami; Saitoh, Hiroshige; Shimada, Hideaki; Nabeya, Yoshihiro; Matsubara, Hisahiro [Chiba University, Department of Frontier Surgery, Graduate School of Medicine, Chiba (Japan); Kazama, Toshiki [Chiba University, Department of Radiology, Graduate School of Medicine, Chiba (Japan)

    2012-06-15

    Because diffusion-weighted imaging (DWI) can predict the prognosis of patients with oesophageal squamous cell carcinoma (ESCC), we hypothesised that apparent diffusion coefficient (ADC) values might be correlated with the collagen content and tumour angiogenesis. The purpose of this study was to determine the correlation between ADC values of ESCC before treatment and oesophageal tumour stroma and angiogenesis. Seventeen patients with ESCC were enrolled. The ADC values were calculated from the DWI score. Seventeen patients who had undergone oesophagectomy were analysed for tumour stroma, vascular endothelial growth factor (VEGF) and CD34. Tissue collagen was stained with azocarmine and aniline blue to quantitatively analyse the extracellular matrix in cancer stroma. Tissues were stained with VEGF and CD34 to analyse the angiogenesis. The ADC values decreased with stromal collagen growth. We found a negative correlation between the tumour ADC and the amount of stromal collagen (r = -0.729, P = 0.001), i.e. the ADC values decreased with growth of VEGF. We also found a negative correlation between the ADC of the tumours and the amount of VEGF (r = 0.538, P = 0.026). Our results indicated that the ADC value may be a novel prognostic factor and contribute to the treatment of oesophageal cancer. circle Magnetic resonance apparent diffusion coefficient values inversely indicate tumour stromal collagen circle There is also negative correlation between ADCs and vascular endothelial growth factor circle ADC values may contribute to the treatment of oesophageal cancer. (orig.)

  11. 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...

  12. 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...

  13. A prospective randomised controlled clinical trial comparing somatostatin and vasopressin in controlling acute variceal haemorrhage.

    OpenAIRE

    S. A. Jenkins; Baxter, J. N.; Corbett, W; Devitt, P.; Ware, J; Shields, R

    1985-01-01

    Twenty two patients were entered into a randomised controlled clinical trial comparing the efficacy of somatostatin and vasopressin in controlling acute variceal haemorrhage. Somatostatin was significantly more successful in controlling acute variceal haemorrhage than vasopressin (p = 0.003). Furthermore, no complications were observed during treatment with somatostatin.

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. 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.

  19. The safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single canadian tertiary care centre

    Directory of Open Access Journals (Sweden)

    Mahmoud H Mosli

    2013-01-01

    Full Text Available Background/Aim: Bleeding from Gastric Varices (GV is not only life threatening, but also leads to many hospitalizations, contributes to morbidity and is resource intensive. GV are difficult to diagnose and their treatment can be challenging due to their location and complex structure. To assess the safety and efficacy of endoscopic gastric fundal variceal gluing using periodic endoscopic injections of N-butyl-2-cyanoacylate (NBCA and to assess the utility of endoscopic ultrasound (EUS in assessing for the eradication of GV post-NBCA treatment. Materials and Methods: Analysis of prospectively collected data of a cohort of patients with GV who underwent periodic endoscopic variceal gluing from 2005 to 2011. Outcomes included success of GV obliteration, incidence of rebleeding, complications from the procedure, and analysis of factors that might predict GV rebleeding. The success of GV eradication was assessed by both EUS and direct endoscopy. Results: The cohort consisted of 29 consecutive patients that had undergone NBCA injection for GV. The mean age was 60.8 years standard deviations (SD 13.3, range 20-81. The average follow-up was 28 months (SD 19.61, range 1-64 and the most common cause for GV was alcoholic liver cirrhosis (34.48%. A total of 91 sessions of NBCA injections were carried out for 29 patients (average of 3.14 sessions/patient, SD 1.79, range 1-8 with a total of 124 injections applied (average of 4.28 injections/patient, SD 3.09, range 1-13. 24 patients were treated for previously documented GV bleeding while five were treated for primary prevention. Overall, 79% of patients were free of rebleeding once three sessions of histoacryl ® injection were completed. None of the patients treated for primary prevention developed bleeding during follow-up. 11 of the 24 patients (46% with previous bleeding however had rebleeding. 4/11 (36% patients had GV rebleeding while awaiting scheduled additional NBCA sessions. 19/29 (60% patients had

  20. Chest pain following oesophageal stenting for malignant dysphagia

    Energy Technology Data Exchange (ETDEWEB)

    Golder, Mark; Tekkis, Paris P.; Kennedy, Colette; Lath, Sadaf; Toye, Rosemary; Steger, Adrian C

    2001-03-01

    AIM: The palliative use of self-expanding metallic stents has been widely reported to relieve dysphagia in cases of oesophageal carcinoma. Little has been documented on the severity of chest pain following oesophageal stenting. The aim of this study was to investigate the association of pain with oesophageal stenting for malignant dysphagia. METHODS: Fifty-two patients with inoperable oesophageal carcinoma underwent stent placement between 1995-1999. Daily opioid analgesic requirements (mg of morphine equivalent doses) were monitored for 3 days before and 7 days after stenting. The degree of palliation was expressed as a dysphagia score (0-3). Hospital stay, readmission days, stent complications and patient survival time were also recorded. RESULTS: Twenty-six patients (50%) required opioid analgesia for chest pain (median dose: 80 mg morphine/day) within 48 h of the procedure compared to 11 (21.2%) patients before stenting (P = 0.0041). A significant increase was evident in the analgesic consumption following stent deployment (P < 0.001). The dysphagia score improved by a median value of 1 (CI 0.25)P < 0.001, with a re-intervention rate of 11.5%. The median survival time was 40 days post stenting (range 1-120). CONCLUSION: A significant proportion of patients developed chest pain after oesophageal stenting, requiring high dose opioid analgesia. As the origin of the pain is still unknown, pre-emptive analgesia may a play role in reducing stent-related morbidity and possibly in-hospital stay. Golder, M. et al. (2001)

  1. 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.

  2. 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

  3. RESECTION FOR RUPTURED DUODENAL VARICES SECONDARY TO PORTAL HYPERTENSION

    Institute of Scientific and Technical Information of China (English)

    Hai-quan Qiao; Bing Liu; Wen-jie Dai; Hong-chi Jiang

    2004-01-01

    @@ Apatient complicated by gastrointestinal bleeding was treated successfully using resection of ruptured duodenal varies. The paper reviewed the literatures and introduced surgical procedures and its indications.

  4. Abnormal uterine bleeding.

    Science.gov (United States)

    Whitaker, Lucy; Critchley, Hilary O D

    2016-07-01

    Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. A structured approach for establishing the cause using the Fédération International de Gynécologie et d'Obstétrique (FIGO) PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system will facilitate accurate diagnosis and inform treatment options. Office hysteroscopy and increasing sophisticated imaging will assist provision of robust evidence for the underlying cause. Increased availability of medical options has expanded the choice for women and many will no longer need to recourse to potentially complicated surgery. Treatment must remain individualised and encompass the impact of pressure symptoms, desire for retention of fertility and contraceptive needs, as well as address the management of AUB in order to achieve improved quality of life. PMID:26803558

  5. Effects of ranitidine and cisapride on acid reflux and oesophageal motility in patients with reflux oesophagitis: a 24 hour ambulatory combined pH and manometry study.

    Science.gov (United States)

    Inauen, W; Emde, C; Weber, B; Armstrong, D; Bettschen, H U; Huber, T; Scheurer, U; Blum, A L; Halter, F; Merki, H S

    1993-08-01

    The effect of ranitidine and cisapride on acid reflux and oesophageal motility was investigated in 18 patients with endoscopically verified erosive reflux oesophagitis. Each patient was treated with placebo, ranitidine (150 mg twice daily), and ranitidine (150 mg twice daily) plus cisapride (20 mg twice daily) in a double blind, double dummy, within subject, three way cross over design. Oesophageal acidity and motility were monitored under ambulatory conditions for 24 hours on the fourth day of treatment, after a wash out period of 10 days during which patients received only antacids for relief of symptoms. Acid reflux was monitored by a pH electrode located 5 cm above the lower oesophageal sphincter. Intraoesophageal pressure was simultaneously recorded from four transducers placed 20, 15, 10, and 5 cm above the lower oesophageal sphincter. Upright reflux was three times higher than supine reflux (median (range) 13.3 (3.7-35.0)% v 3.7 (0-37.6)% of the time with pH upright reflux (p conventional dose of ranitidine (150 mg twice daily) can be improved to more than 60% by combination with cisapride (20 mg twice daily). The cisapride induced increase in oesophageal contractile force and propagation velocity seems to enhance the clearance of gastro-oesophageal reflux. Combination of a histamine H2 receptor antagonist with a prokinetic agent may therefore provide an alternative treatment for reflux oesophagitis. PMID:8174947

  6. 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.

  7. Effects of thoracic epidural analgesia with morphine or bupivacaine on lower oesophageal motility--an experimental study in man.

    Science.gov (United States)

    Thorén, T; Carlsson, E; Sandmark, S; Wattwil, M

    1988-07-01

    Lower oesophageal peristalsis and lower oesophageal sphincter (LOS) pressure during thoracic epidural analgesia (TEA) were studied in 20 healthy volunteers. After oesophageal manometric baseline recordings, 10 volunteers received 4 mg epidural morphine. The other ten received 0.5% bupivacaine epidurally in sufficient amounts to block the sympathetic innervation of the oesophagus. Thereafter oesophageal manometry was repeated. During epidural morphine oesophageal peristalsis, resting LOS pressure and the contraction of LOS after swallowing did not change, but the relaxation of the LOS in response to swallowing decreased significantly (P less than 0.01). Following TEA with bupivacaine, neither distal oesophageal peristalsis nor LOS pressure changed. PMID:3414347

  8. Coronary interventions in patients with bleeding and bleeding tendency

    Institute of Scientific and Technical Information of China (English)

    Thach Nguyen; Lan Nguyen

    2007-01-01

    @@ In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system.

  9. 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. PMID:27644905

  10. 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.

  11. 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.

  12. 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.)

  13. Gastro-oesophageal reflux demonstrated by radiography: a supplement to 24-h pH monitoring

    International Nuclear Information System (INIS)

    Purpose: Gastro-oesophageal reflux (GOR) is demonstrated by radiography as a supplement to 24-h pH monitoring. Material and Methods: Forty-two patients (mean age 44 years) with suspicion of GOR disease were assessed according to a standard questionnaire. GOR was investigated by 24-h pH-monitoring and by radiography. Oesophageal emptying and the presence of rings or strictures were registered as well. Mucosal biopsies, classified as normal, light oesophagitis, severe oesophagitis, or Barrett's oesophagus, were correlated to age, gender, symptomatology, pH monitoring, and oesophageal emptying. GOR and morphological changes demonstrated by radiography were correlated to pH monitoring and mucosa biopsies. Results: Based on pH monitoring, patients with severe oesophagitis and Barrett's oesophagus had a significantly higher acid exposure compared to patients with normal mucosa and light oesophagitis, with no difference concerning age, gender, and symptoms. Severe oesophagitis, including Barrett's oesophagus, was found only in patients with a positive test for radiologic GOR. Eleven patients had rings or strictures independent of oesophageal mucosal changes. Conclusion: GOR demonstrated by radiography identified patients where complications could be expected, which was not possible by pH monitoring alone

  14. Extent of thrombi following sclerotherapy of esophageal varices.

    Science.gov (United States)

    Matsumoto, S; Arakawa, M; Toyonaga, A

    1986-10-01

    Fifteen autopsy cases who died within 20 days after intravariceal endoscopic injection sclerotherapy using 5% ethanolamine oleate were examined to clarify the planar extent of thrombi. In 11 of the 15 cases, thrombi extended to part of the fundus of the stomach, as well as the lower esophagus. In addition to these cases, six autopsy cases who survived more than a month after the first injection were studied for the extent of thrombi on the basis of the angioarchitectural characteristics of esophageal varices. The extent could be divided into 3 groups: Group 1 included 5 cases with thrombosis in the main trunk of the varix alone, which connected with longitudinal veins (so-called "Venetian blind-like or sudare-like veins") running for 3-4 cm upward from the esophago-gastric junction. Group 2 included 9 cases with thrombosis in the main trunk and Venetian blind-like veins in the submucosa alone. Group 3 included 7 cases with thrombosis in the main trunk and Venetian blind-like veins in both the submucosa and lamina propria. These results obtained may provide basic information concerning this treatment. Furthermore, the mechanism of the recurrence of varices after eradication induced by treatment was discussed on the basis of the results. PMID:3781169

  15. 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

  16. Oesophageal subepithelial fibrosis: an extension of oral submucosal fibrosis.

    OpenAIRE

    Misra, S. P.; Misra, V; Dwivedi, M.; Gupta, S. C.

    1998-01-01

    Fifty-five patients with oral submucosal fibrosis and an equal number of patients with no evidence of the disease were studied. All patients underwent upper gastrointestinal endoscopy and any abnormality was noted. Multiple oesophageal biopsies were obtained from the upper end of the oesophagus and from any endoscopically observed abnormality. The histological changes in the two groups were assessed blindly by an experienced histopathologist. Histological abnormalities were noted in the oesop...

  17. Golestan cohort study of oesophageal cancer: feasibility and first results

    OpenAIRE

    Pourshams, A; Saadatian-Elahi, M; M Nouraie; Malekshah, A F; Rakhshani, N.; Salahi, R; Yoonessi, A; S. Semnani; Islami, F; Sotoudeh, M.; Fahimi, S.; Sadjadi, A R; Nasrollahzadeh, D; Aghcheli, K; Kamangar, F

    2004-01-01

    To investigate the incidence of oesophageal cancer (EC) in the Golestan province of North-East Iran, we invited 1349 rural and urban inhabitants of Golestan province aged 35–80 to undergo extensive lifestyle interviews and to provide biological samples. The interview was repeated on a subset of 130 participants to assess reliability of questionnaire and medical information. Temperature at which tea was consumed was measured on two occasions by 110 subjects. Samples of rice, wheat and sorghum ...

  18. 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...

  19. 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...

  20. 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...

  1. Effect of octreotide on systemic, central, and splanchnic haemodynamics in cirrhosis

    DEFF Research Database (Denmark)

    Møller, Søren; Brinch, K; Henriksen, Jens Henrik;

    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...

  2. 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...

  3. 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...

  4. 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...

  5. 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

  6. 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 ...

  7. Irinotecan, cisplatin and mitomycin in inoperable gastro-oesophageal and pancreatic cancers – a new active regimen

    OpenAIRE

    Slater, S.; Shamash, J; Wilson, P.; Gallagher, C. J.; Slevin, M L

    2002-01-01

    Irinotecan, mitomycin and cisplatin all demonstrate activity in gastro-oesophageal cancers. This novel combination was administered to outpatients with previously untreated inoperable gastro-oesophageal or pancreatic cancer, in a 28-day cycle. A total of 26 out of 31 patients with gastro-oesophageal cancer and 12 out of 14 patients with pancreatic cancer have been treated with this combination, and were evaluable for response. The overall response rates for patients with gastro-oesophageal ca...

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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)

  13. 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

  14. Development of infantile hypertrophic pyloric stenosis in patients treated for oesophageal atresia. A case report

    DEFF Research Database (Denmark)

    Qvist, N; Rasmussen, L; Hansen, L P;

    1986-01-01

    Two cases of infantile hypertrophic pyloric stenosis (IHPS) developed in 74 patients treated for oesophageal atresia. Treatment of oesophageal atresia is frequently followed by vomiting and failure to thrive due to gastrooesophageal reflux or anastomotic stricture. The diagnose of IHPS must...

  15. The role of hiatus hernia in gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    van Herwaarden, MA; Samsom, M; Smout, AJPM

    2004-01-01

    This article gives an overview of the role of sliding hiatus hernia in gastro-oesophageal reflux disease (GORD). The crural diaphragm acts as an external sphincter of the antireflux barrier. Contractions of the crural diaphragm increase lower-oesophageal-sphincter (LOS) pressure during each inspirat

  16. 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.

  17. 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/

  18. Bleeding in the Digestive Tract

    Science.gov (United States)

    ... lining of the esophagus, stomach, or duodenum. The bacteria Helicobacter pylori (H. pylori) and use of nonsteroidal ... paleness shortness of breath vomit that looks like coffee grounds weakness A person with acute bleeding may ...

  19. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    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...

  20. 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...

  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. The Pain System in Oesophageal Disorders: Mechanisms, Clinical Characteristics, and Treatment

    Directory of Open Access Journals (Sweden)

    Christian Lottrup

    2011-01-01

    Full Text Available Pain is common in gastroenterology. This review aims at giving an overview of pain mechanisms, clinical features, and treatment options in oesophageal disorders. The oesophagus has sensory receptors specific for different stimuli. Painful stimuli are encoded by nociceptors and communicated via afferent nerves to the central nervous system. The pain stimulus is further processed and modulated in specific pain centres in the brain, which may undergo plastic alterations. Hence, tissue inflammation and long-term exposure to pain can cause sensitisation and hypersensitivity. Oesophageal sensitivity can be evaluated ,for example, with the oesophageal multimodal probe. Treatment should target the cause of the patient's symptoms. In gastro-oesophageal reflux diseases, proton pump inhibitors are the primary treatment option, surgery being reserved for patients with severe disease resistant to drug therapy. Functional oesophageal disorders are treated with analgesics, antidepressants, and psychological therapy. Lifestyle changes are another option with less documentation.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Gastrointestinal bleeding from vascular malformations: Is octreotide effective to rescue difficult-to-treat patients?

    Science.gov (United States)

    Iannone, Andrea; Principi, Mariabeatrice; Barone, Michele; Losurdo, Giuseppe; Ierardi, Enzo; Di Leo, Alfredo

    2016-09-01

    Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations". The first line therapy of acute/chronic bleeding from digestive vascular malformations is endoscopy, followed by angiographic embolization and surgical resection when this is unsuccessful. In the setting of difficult-to-treat patients, octreotide has been proposed as an alternative therapeutic strategy. Studies reported in the literature show a high efficacy and safety of octreotide, but described only a small number of enrolled patients, heterogeneous therapeutic schedules and short-term follow-up, with the exception of acute bleeding from esophageal varices. As a consequence, the use of octreotide is not approved in this setting and it is currently still prescribed as an off-label drug. Studies in larger populations are needed to confirm the promising results observed in the small case series reports, so as to provide physicians with a treatment option for patients without available alternatives. Octreotide could also determine a strong decrease in the management costs of these clinical conditions, and especially, could dramatically reduce hospital admission costs. PMID:27595456

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. Postprandial gastro-oesophageal reflux demonstrated by radiology

    International Nuclear Information System (INIS)

    An investigation to detect food-stimulated gastro-oesophageal (GE) reflux was carried out in 54 consecutive fasting patients, 35 of whom experienced reflux while 19 did not. All patients then received a standard meal (566 kcal), and the investigation was repeated 1 h afterward. Of the 35 with GE reflux in the fasting state, 33 also had GE reflux in the postprandial state, and 17 of the 19 patients with no GE reflux while fasting also had none in the postprandial state. It is concluded that the radiological method can identify most patients in whom food-stimulated GE reflux could be of clinical significance. (orig.)

  15. Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices.

    Science.gov (United States)

    Chikamori, Fumio; Kuniyoshi, Nobutoshi; Shibuya, Susumu; Takase, Yasuhiro

    2004-01-01

    The treatment of chronic portosystemic encephalopathy with esophageal varices has not yet been established. We were able to control a case of chronic portosystemic encephalopathy with esophageal varices using a combination treatment of transjugular retrograde obliteration and endoscopic embolization. A 57-year-old man came to our hospital in a confused, apathetic and tremulous state. The grade of encephalopathy was II. The plasma ammonia level was abnormally elevated to 119 microg/dL, and the ICGR15 was 59%. Endoscopic examination revealed nodular esophageal varices with cherry-red spots. There were no gastric varices. Ultrasonography and CT revealed liver cirrhosis with a splenorenal shunt. We first applied endoscopic embolization for the esophageal varices before transjugular retrograde obliteration. We injected 5% ethanolamine oleate with iopamidol retrogradely into the esophageal varices and their associated blood routes under fluoroscopy and obliterated the palisade vein, the cardiac venous plexus and left gastric vein. Transjugular retrograde obliteration was performed 14 days after endoscopic embolization. Retrograde shunt venography visualized the splenorenal shunt and communicating route to the retroperitoneal vein. There was no communicating route to the azygos vein. After obliteration of the communicating route to the retroperitoneal vein with absolute ethanol, 5% ethanolamine oleate with iopamidol was injected into the splenorenal shunt as far as the root of the posterior gastric vein. After transjugular retrograde obliteration, the encephalopathy improved to grade 0 even without the administration of lactulose and branched-chain amino acid. The plasma ammonia level and ICGR15 were reduced to 62 microg/dL and 26%. We conclude that combination treatment of transjugular retrograde obliteration and endoscopic embolization is a rational, effective and safe treatment for chronic portosystemic encephalopathy complicated with esophageal varices. PMID:15362757

  16. 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.

  17. 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.

  18. 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.

  19. [Direct oral anticoagulant associated bleeding].

    Science.gov (United States)

    Godier, A; Martin, A-C; Rosencher, N; Susen, S

    2016-07-01

    Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements. PMID:27297642

  20. 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.

  1. 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.

  2. 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...

  3. Balloon dilatation in children for oesophageal strictures other than those due to primary repair of oesophageal atresia, interposition or restrictive fundoplication

    Energy Technology Data Exchange (ETDEWEB)

    Fasulakis, Stephen [Royal Children' s Hospital, Melbourne (Australia); Andronikou, Savvas [Royal Children' s Hospital, Melbourne (Australia); Department of Paediatric Radiology, Red Cross Children' s Hospital, Klipfontein Road, Rondebosch, 7700, Cape Town (South Africa)

    2003-10-01

    Balloon dilatation of the oesophagus in children has been performed predominantly for treating strictures, which are the result of primary repair of oesophageal atresia, interposition surgery or restrictive Nissen's fundoplication. Reports of the use of this technique for alternative causes of stricture are few. To report our experience and success with balloon dilatation of strictures due to caustic ingestion, achalasia, oesophagitis, congenital stenosis, and epidermolysis bullosa (EB) and to make comparisons with our treatment of patients with primary repair of oesophageal atresia (OA), as well as with reports in the English language literature. Retrospective review of fluoroscopically guided balloon oesophageal dilatation procedures in 19 patients over a 5-year period, and comparison of those performed for OA repair complications with those due to other diseases. The average radiation dose, per procedure, was calculated by a medical physicist. Ten patients had strictures as a result of primary repair of OA. Three patients had stricture as a result of EB, two from achalasia, two from caustic injury, one due to an oesophageal web and one from reflux oesophagitis. Our results show that the technique can also be curative for the last group and that it may be used intermittently to alleviate symptoms in ongoing diseases. We have not experienced any complications and have also calculated that, even with prolonged use of multiple procedures, the radiation exposure is comparable to other radiological techniques. Patients with alternative causes for oesophageal stricture may be treated to resolution within 2 years using balloon dilatation. Ongoing diseases such as EB require ongoing dilatation, but balloon dilatation of strictures has been successful in alleviating swallowing difficulty. Patients with stricture from OA repair sometimes need ongoing dilatation. Radiation exposure for multiple procedures, over an extended period, is comparable to that from a single

  4. Water syphon test and gastrooesophageal reflux during childhood (correlation with the clinical findings and oesophageal manometry)

    International Nuclear Information System (INIS)

    The water syphon test is a simple and easily performed method for demonstrating gastro-oesophageal reflux with a high degree of reliability. It is carried out following a conventional barium swallow. Compared with clinical findings and oesophageal manometry, the water syphon test is very reliable for demonstrating gastro-oesophageal reflux during childhood. Prolonged irradiation in order to see spontaneous reflux becomes unnecessary. This results in a significant reduction in radiation dose. Barium swallow and the water syphon test are the most useful initial examinations in children with symptoms which suggest reflux. (orig.)

  5. 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.

  6. 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.

  7. Role of Spiral and Multislice Computed Tomography in the evaluation of traumatic and spontaneous oesophageal perforation. Our experience

    International Nuclear Information System (INIS)

    Purpose: To assess the role of CT in the evaluation of traumatic and spontaneous oesophageal perforation. Materials and methods: From March 2001 to May 2003, we studied 12 patients (7 males and 5 females; age range: 25-66 years, mean age: 43.5 years) with suspected oesophageal perforation due to motor-vehicle accidents (4 cases), stab wound (one case), post-intubation (2 cases), foreign body ingestion (2 cases) and spontaneous (3 cases). Five patients underwent standard chest and cervical radiography; two patients with suspected foreign body ingestion also underwent a gastrografin swallow study; all of the 12 patients underwent CT of the neck, chest and abdomen before and after intravenous, and in four cases oral, administration of contrast material. Results: In 5 patients with cervical, thoracic and abdominal trauma, the CT examination showed the presence of pleuroparenchymal injury (pneumothorax, pleural effusion and subcutaneous emphysema) as well as findings suggestive of oesophageal perforation: peri-oesophageal air (5 cases), peri-oesophageal fluid (4 cases), oesophageal wall thickening (3 cases), oesophageal wall laceration (2 cases) with abnormal course of the nasogastric tube in one of them and extraluminal extravasation of oral contrast material (2 cases). In two patients with post-intubation complications, CT showed the presence of a small peri-oesophageal fluid collection containing small gas bubbles in one case, and a gross peri-oesophageal abscess-like collection in the second case. In the 2 patients with foreign body ingestion, the plain radiography associated with CT showed the presence of a thin metal object in the cervical region (fragment of a dental plate) and a small extraluminal extravasation of gastrografin in one case, whereas in the other case CT showed the presence of a foreign body (chicken bone) in the hypopharynx with oesophageal wall thickening and peri-oesophageal oedema. In the remaining three patients with suspected spontaneous

  8. Emergency cesarean delivery in primigravida with portal hypertension, esophageal varices, and preeclampsia.

    Science.gov (United States)

    Khanna, Puneet; Garg, Rakesh; Roy, Kajari; Punj, Jyotsna; Pandey, Ravindra; Darlong, Vanlal

    2012-10-01

    The incidence of cirrhosis and advanced portal hypertension during pregnancy is very low, and the literature is scarce with regard to the anesthetic management of a parturient with this coexisting disease. We report the successful perioperative management of a parturi- ent with a history of cirrhosis and portal hypertension with esophageal varices and mild preeclampsia who presented at 38 weeks' gestation in active labor with a breech presentation requiring emergency cesarean delivery. She required endoscopic esophageal varices banding during the second trimester of pregnancy. After correction of her coagulopathy, she was administered subarachnoid block and cesarean delivery, which was conducted uneventfully. Anesthetic management of these patients depends on understanding and avoiding variceal hemorrhage, encephalopathy, renal failure, and careful fluid and electrolyte management. PMID:26050279

  9. 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

  10. 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.

  11. Globular adiponectin, acting via adiponectin receptor-1, inhibits leptin-stimulated oesophageal adenocarcinoma cell proliferation

    OpenAIRE

    Ogunwobi, Olorunseun O.; Beales, Ian L.P.

    2008-01-01

    Globular adiponectin, acting via adiponectin receptor-1, inhibits leptin-stimulated oesophageal adenocarcinoma cell proliferation UNITED KINGDOM (Ogunwobi, Olorunseun O.) UNITED KINGDOM Received: 2007-09-18 Revised: 2008-01-14 Accepted: 2008-01-23

  12. 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....

  13. Epicardial oesophageal duplication with hiatal hernia in a case of Turner's syndrome

    International Nuclear Information System (INIS)

    The authors of this paper report the first case of epicardial oesophageal duplication causing hiatal hernia in a patient afflicted with Turner's syndrome, and they discuss its possible etiology. (orig.)

  14. Correlation of Major Scan Findings and Esophageal Varices in Liver Cirrhosis

    International Nuclear Information System (INIS)

    In an endeavor to help understand some typical scan findings and portal hemodynamics in liver cirrhosis, several commonly occurring scan changes and esophageal varices as demonstrated by esophagram were correlated one another from quantitative and qualitative stand points. Clinical materials consisted of 34 patients with proven diagnosis of liver cirrhosis and esophageal varices. Liver scan was performed with colloidal 198-Au and the changes in the size and internal architecture of the Liver, splenic uptake and splenomegaly were graded and scored by repeated double-blind readings. The variceal changes on esophagrams were also graded according to the classification of Shanks and Kerley following modification. Of 34 patients, 91% showed definite reducing in liver volume(shrinkage) constituting the most frequent scan change. The splenic uptake and splenomegaly were noted in 73.5 and 79.4%, respectively. The present study revealed no positive correlation between the graded scan findings including shrinkage of the liver, splenic uptake or splenomegaly and severity of variceal changes of the esophagus. Exceptionally, however, apparently paradoxical correlation was noted between the severity of mottling and varices. Thus, in the majority(73.5%) of patients mottling were either absent or mild. This interesting observation is in favor of the view held by Christie et al. who consider the mottlings to be not faithful expression of actual scarring of the cirrhosis liver. This also would indicate that variceal changes are to be the results of intrahepatic arteriovenous shunting of blood with hypervolemic load to the portal system rather than simple hypertension secondary to fibrosis and shrinkage.

  15. A life-threatening respiratory complication of gastro-oesophageal reflux in a patient with tetraplegia.

    OpenAIRE

    Donald, I P; Gear, M. W.; Wilkinson, S P

    1987-01-01

    Recurrent attacks of life-threatening dyspnoea and choking occurred in a patient with tetraplegia. Conventional investigations for gastro-oesophageal reflux were normal, but 24-hour oesophageal pH recording revealed gross reflux in association with an attack of dyspnoea. Surgical correction of the reflux abolished the attacks. The possibility of autonomic dysreflexia as the mechanism linking reflux and respiratory symptoms in this patient is discussed.

  16. Africa’s Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies

    OpenAIRE

    Torin Schaafsma; Jon Wakefield; Rachel Hanisch; Freddie Bray; Joachim Schüz; Joy, Edward J. M.; Watts, Michael J.; Valerie McCormack

    2015-01-01

    Background The aetiology of Africa’s easterly-lying corridor of squamous cell oesophageal cancer is poorly understood. Micronutrient deficiencies have been implicated in this cancer in other areas of the world, but their role in Africa is unclear. Without prospective cohorts, timely insights can instead be gained through ecological studies. Methods Across Africa we assessed associations between a country’s oesophageal cancer incidence rate and food balance sheet-derived estimates of mean nati...

  17. Delayed-Onset Superior Mesenteric Artery Syndrome Presenting as Oesophageal Peptic Stricture

    OpenAIRE

    Sinagra, Emanuele; Montalbano, Luigi Maria; Linea, Cristina; Giunta, Marco; Tesè, Lorenzo; La Seta, Francesco; Malizia, Giuseppe; Orlando, Ambrogio; Marasà, Marta; D'Amico, Gennaro

    2012-01-01

    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 (par)enteral nutrition and repeated oesophageal dilatation, thus supporting th...

  18. Radiation-induced oesophagitis in lung cancer patients. Is susceptibility for neutropenia a risk factor?

    Energy Technology Data Exchange (ETDEWEB)

    Ruysscher, D. de [MAASTRO Clinic, Maastricht (Netherlands). Dept. of Radiation Oncology; Meerbeeck, J. van [Ghent Univ. Hospital (Belgium). Dept. of Respiratory Medicine; Vandecasteele, K. [Ghent Univ. Hospital (BE). Dept. of Radiation Oncology] (and others)

    2012-07-15

    Background: Radiation-induced oesophagitis is a major side effect of concurrent chemotherapy and radiotherapy. A strong association between neutropenia and oesophagitis was previously shown, but external validation and further elucidation of the possible mechanisms are lacking. Methods and patients: A total of 119 patients were included at two institutions. The concurrent group comprised 34 SCLC patients treated with concurrent carboplatin and etoposide, and concurrent chest irradiation, and 36 NSCLC patients with concurrent cisplatin and etoposide, and concurrent radiotherapy, while the sequential group comprised 49 NSCLC patients received sequential cisplatin and gemcitabine, and radiotherapy. Results: Severe neutropenia was very frequent during concurrent chemoradiation (grade: 4 41.4%) and during induction chemotherapy in sequentially treated patients (grade 4: 30.6%), but not during radiotherapy (only 4% grade 1). In the concurrent group, the odds ratios of grade 3 oesophagitis vs. neutropenia were the following: grade 2 vs. grade 0/1: 5.60 (95% CI 1.55-20.26), p = 0.009; grade 3 vs. grade 0/1: 10.40 (95% CI 3.19-33.95); p = 0.0001; grade 4 vs. grade 0/1: 12.60 (95% CI 4.36-36.43); p < 0.00001. There was no correlation between the occurrence of neutropenia during induction chemotherapy and acute oesophagitis during or after radiotherapy alone. In the univariate analysis, total radiation dose (p < 0.001), overall treatment time of radiotherapy (p < 0.001), mean oesophageal dose (p = 0.038) and neutropenia (p < 0.001) were significantly associated with the development of oesophagitis. In a multivariate analysis, only neutropenia remained significant (p = 0.023). Conclusion: We confirm that neutropenia is independently correlated with oesophagitis in concurrent chemoradiation, but that the susceptibility for chemotherapy-induced neutropenia is not associated with radiation-induced oesophagitis. Further studies focusing on the underlying mechanisms are thus

  19. Psychological distress among family carers of oesophageal cancer survivors the role of illness cognitions and coping

    OpenAIRE

    Dempster, Martin; McCorry, Noleen; Brennan, Emma; Donnelly, Michael; Murray, Liam,; Johnston, Brian T.

    2011-01-01

    Objective: The research aimed to determine the extent to which illness cognitions and coping explain psychological distress (fear of cancer recurrence, anxiety and depression symptoms) among family carers of survivors of oesophageal cancer.Methods: Carers of patients registered with the Oesophageal Patients' Association in the UK were mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire-Revised, the Cancer Coping Que...

  20. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer

    DEFF Research Database (Denmark)

    Vilmann, Peter; Clementsen, Paul Frost; Colella, Sara;

    2015-01-01

    New guidelines for combined endobronchial and oesophageal mediastinal nodal staging of lung cancer. This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic...... Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and oesophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence....

  1. The effect of pinaverium bromide (LA 1717) on the lower oesophageal sphincter.

    Science.gov (United States)

    Wöltje, M; Huchzermeyer, H

    1982-01-01

    An acute, double-blind study was carried out in 8 healthy male volunteers to investigate any effect of a new antispasmodic, pinaverium bromide, compared with placebo on the lower oesophageal sphincter. Manometric measurements showed no significant differences in resting pressures either after placebo or a therapeutic dose (200 mg) of pinaverium bromide, suggesting that the active drug does not cause any impairment of function of the lower oesophageal sphincter. PMID:7128186

  2. Corticosteroid induced remission of oesophageal involvement in mixed connective tissue disease

    OpenAIRE

    Pines, Amos; Goldhammer, Ehud; Kaplinsky, Naomi; Bregman, Joseph; Frankl, Otto

    1982-01-01

    Oesophageal involvement is known to be one of the most severe and resistant manifestations of connective tissue diseases, mainly progressive systemic sclerosis (PSS). A patient who had manifestations of systemic lupus erythematosus, PSS and polymyositis is described. Since some features of mixed connective tissue disease (MCTD) respond to corticosteroid treatment, fluocortolone was administered and both clinical and radiological remission of the oesophageal involvement were observed. At the s...

  3. Pulmonary compliance in sick low birthweight infants. How reliable is the measurement of oesophageal pressure?

    OpenAIRE

    Thomson, A.; Elliott, J.; Silverman, M

    1983-01-01

    Measurements of dynamic lung compliance (Cdyn) were made on 42 occasions in a group of 15 intubated very low birthweight infants with respiratory distress syndrome, using an oesophageal balloon and pneumotachograph system. Values of Cdyn were compared with those of total respiratory system compliance (Crs) using an occlusion technique. Ten very low birthweight infants with no respiratory disease were similarly studied while breathing through a facemask. The occlusion tests for oesophageal bal...

  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. 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.

  6. 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.

  7. Comparative in vitro study of oesophageal adhesiveness of different commercial formulations containing alendronate.

    Science.gov (United States)

    Shakweh, Monjed; Bravo-Osuna, Irene; Ponchel, Gilles

    2007-08-01

    Cases of oesophageal irritation have been reported in patients ingesting alendronate with little liquid or reclining shortly after taking the medication. Pill-induced oesophagitis principally occurs because of adherence of ingested tablets to the epithelial surface. The objective of this in vitro study was to evaluate the oesophageal bioadhesive characteristics of alendronate generics marketed in Europe, the proprietary Fosamax((R)), one negative and two positive polymer controls. A texture analyser was used for qualitative analysis and to determine the maximal detachment force and the adhesion work developed by each formulation on porcine oesophageal mucosa. Fosamax showed few or no bioadhesive characteristics, but the detachment of few tablets powder particles in some of the experiments does not preclude the potential risk of oesophageal lesions. The 10-mg generic Teva tablets had bioadhesive characteristics similar to a positive control. Other generic formulations (Alenat, Stada, Aliud, Ratiopharm showed "cleavage" rupture, leaving a large piece of the tablet mass attached to the mucosa. The bioadhesive characteristics seem to be related to the inactive ingredients: the presence of adhesive polymers such as HPC or very active disintegration agents, such as sodium croscarmellose. The demonstrated differences in adhesiveness suggest that differences in oesophageal tolerance between Fosamax tablets and generics of sodium alendronate may exist. PMID:17576054

  8. Transcriptional profiling of the oesophageal gland region of male worms of Schistosoma mansoni.

    Science.gov (United States)

    Nawaratna, Sujeevi S K; Gobert, Geoffrey N; Willis, Charlene; Chuah, Candy; McManus, Donald P; Jones, Malcolm K

    2014-09-01

    The intestinal tract of schistosomes opens at the mouth and leads into the foregut or oesophageal region that is lined with syncytium continuous with the apical cytoplasm of the tegument. The oesophagus is surrounded by a specialised gland, the oesophageal gland. This gland releases materials into the lumen of the oesophagus and the region is thought to initiate the lysis of erythrocytes and neutralisation of immune effectors of the host. The oesophageal region is present in the early invasive schistosomulum, a stage potentially targetable by anti-schistosome vaccines. We used a 44k oligonucleotide microarray to identify highly up-regulated genes in microdissected frozen sections of the oesophageal gland of male worms of S. mansoni. We show that 122 genes were up-regulated 2-fold or higher in the oesophageal gland compared with a whole male worm tissue control. The enriched genes included several associated with lipid metabolism and transmembrane transport as well as some micro-exon genes. Since the oesophageal gland is important in the initiation of digestion and the fact that it develops early after invasion of the mammalian host, further study of selected highly up-regulated functionally important genes in this tissue may reveal new anti-schistosome intervention targets for schistosomiasis control. PMID:25149559

  9. 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.

  10. Association of oesophageal radiation dose volume metrics, neutropenia and acute radiation oesophagitis in patients receiving chemoradiotherapy for non-small cell lung cancer

    International Nuclear Information System (INIS)

    The relationship between oesophageal radiation dose volume metrics and dysphagia in patients having chemoradiation (CRT) for non-small cell lung cancer (NSCLC) is well established. There is also some evidence that neutropenia is a factor contributing to the severity of oesophagitis. We retrospectively analysed acute radiation oesophagitis (ARO) rates and severity in patients with NSCLC who received concurrent chemotherapy and high dose radiation therapy (CRT). We investigated if there was an association between grade of ARO, neutropenia and radiation dose volume metrics. Patients with NSCLC having concurrent CRT who had RT dose and toxicity data available were eligible. Exclusion criteria included previous thoracic RT, treatment interruptions and non-standard dose regimens. RT dosimetrics included maximum and mean oesophageal dose, oesophagus dose volume and length data. Fifty four patients were eligible for analysis. 42 (78 %) patients received 60 Gy. Forty four (81 %) patients received carboplatin based chemotherapy. Forty eight (89 %) patients experienced ARO ≥ grade 1 (95 % CI: 78 % to 95 %). ARO grade was associated with mean dose (rs = 0.27, p = 0.049), V20 (rs = 0.31, p = 0.024) and whole oesophageal circumference receiving 20 Gy (rs = 0.32 p = 0.019). In patients who received these doses, V20 (n = 51, rs = 0.36, p = 0.011), V35 (n = 43, rs = 0.34, p = 0.027) and V60 (n = 25, rs = 0.59, P = 0.002) were associated with RO grade. Eleven of 25 (44 %) patients with ARO ≥ grade 2 also had ≥ grade 2 acute neutropenia compared with 5 of 29 (17 %) patients with RO grade 0 or 1 (p = 0.035). In addition to oesophageal dose-volume metrics, neutropenia may also be a risk factor for higher grades of ARO

  11. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre;

    2013-01-01

    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...... 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......-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA...

  12. 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.

  13. Scintigraphic diagnosis of lower GI bleeding

    International Nuclear Information System (INIS)

    Abdominal scintigraphy with 99mTc HSA, 99mTc Sn colloid, or 99mTc RBC was performed in 28 patients with melena to detect bleeding and determine the bleeding site in the lower gastrointestinal tract. Active bleedings and/or vascular lesions were identified in 16 patients. They were proved by antiography, endoscopy or barium enema in 14. We concluded that scintigraphy was an accurate and effective method to detect the bleeding and determine the bleeding site in the lower gastrointestinal tract. (author)

  14. 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.

  15. 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

  16. Bleeding

    Science.gov (United States)

    ... NY: McGraw-Hill; 2004:chap 251. Lammers RL. Principles of wound management. In: Roberts JR, Hedges JR, eds. Roberts: Clinical ... 2009:chap 39. Simon BC, Hern HG. Wound management principles. In: Marx JA, Hockberger RS, Walls RM, et ...

  17. Prediction of octreotide efficacy by electrogastrography in the treatment of patients with esophageal variceal hemorrhage

    International Nuclear Information System (INIS)

    Our aim is to investigate the significance of electrogastrography in the treatment of esophageal variceal hemorrhage with octreotide. Electrogastrography was performed in patients with esophageal variceal hemorrhage before and during the treatment consisting of various doses of octreotide (25 ug h−1 group and 50 ug h−1 group). The dominant power of electrogastrography and its relationship with the hemostatic efficacy of octreotide treatment were evaluated. Dominant power of electrogastrography decreased significantly during treatment with octreotide (P < 0.05). The reduction in the amplitude of dominant power in the 50 ug h−1 group was significantly larger than in the 25 ug h−1 group (P < 0.05), and it was correlated with hemostatic efficacy of octreotide treatment. We conclude that octreotide treatment in patients with esophageal variceal hemorrhage can result in a significant decrease of dominant power, which correlates with the hemostatic efficacy of octreotide, so the change of dominant power could be used as a predictor of evaluating the treatment efficacy of octreotide in esophageal variceal hemorrhage patients. (paper)

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. Correlation of thrombocytopenia with grading of esophageal varices in chronic liver disease patients

    International Nuclear Information System (INIS)

    To determine the severity of thrombocytopenia in different grades of esophageal varices. Study Design: Cross-sectional analytical study. Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January to December 2008. Methodology: Subjects were eligible if they had a diagnosis of cirrhosis. Patient with advanced cirrhosis (Child-Pugh class C), human immunodeficiency virus (HIV) infection, hepatocellular carcinoma, portal vein thrombosis, parenteral drug addiction, current alcohol abuse and previous or current treatment with b-blockers, diuretics and other vasoactive drugs were excluded from the study. All patients under went upper gastrointestinal endoscopy after consent. On the basis of platelet count patients were divided into four groups. Group I with platelets greater or equal to 20000/mm/sup 3/, Group II with values of 21000- 50000/mm/sup 3/, Group III with count of 51000-99000/mm/sup 3/ and Group IV with count of 100000-150000/mm/sup 3/. Correlation of severity of thrombocytopenia with the grading of esophageal varices was assessed using Spearman's correlation with r-values of 0.01 considered significant. Results: One hundred and two patients with thrombocytopenia and esophageal varices were included in the study. There were 62 (60.8%) males and 40 (39.2%) females. The mean age of onset of the disease in these patients was 49.49 +- 14.3 years with range of 11-85 years. Major causes of cirrhosis were hepatitis C (n=79, 77.5%), hepatitis B (n=12, 11.8%), mixed hepatitis B and C infection (n=8, 7.8%) and Wilson's disease (n=3,2.9%). Seven patients had esophageal grade I, 24 had grade II, 35 had grade III, and 36 had grade IV. Gastric varices were detected in 2 patients. Portal hypertensive gastropathy were detected in 87 patients. There was an inverse correlation of platelet count with grading of esophageal varices (r=-0.321, p < 0.001). Conclusion: The severity of thrombocytopenia increased as the grading of

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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)....

  10. Clinical validation of FDG-PET/CT in the radiation treatment planning for patients with oesophageal cancer

    NARCIS (Netherlands)

    Muijs, Christina T.; Beukema, Jannet C.; Woutersen, Dankert; Mul, Veronique E.; Berveling, Maaike J.; Pruim, Jan; van der Jagt, Eric J.; Hospers, Geke A. P.; Groen, Henk; Plukker, John Th.; Langendijk, Johannes A.

    2014-01-01

    Background: The aim of this prospective study was to determine the proportion of locoregional recurrences (LRRs) that could have been prevented if radiotherapy treatment planning for oesophageal cancer was based on PET/CT instead of CT. Materials and methods: Ninety oesophageal cancer patients, elig

  11. [Diagnosis and therapy of bleeding in ENT].

    Science.gov (United States)

    Schulz, T; Eßer, D

    2013-12-01

    Bleeding in the oral cavity, nose or ear are common events in the daily routine of ENT specialists. Apart from trivial cases that often get outpatient treatment, there are numerous cases of serious bleeding that require stationary treatment and if necessary, an operative or interventional therapy. In the following section the most frequent types of bleeding, their diagnosis and therapy will be explained. PMID:24285208

  12. Oesophageal atresia: Diagnosis and prognosis in Dakar, Senegal

    Directory of Open Access Journals (Sweden)

    Mbaye Fall

    2015-01-01

    Full Text Available Background: Oesophageal atresia is a neonatal emergency surgery whose prognosis has improved significantly in industrialised countries in recent decades. In sub-Saharan Africa, this malformation is still responsible for a high morbidity and mortality. The objective of this study was to analyse the diagnostic difficulties and its impact on the prognosis of this malformation in our work environment. Patients and Methods: We conducted a retrospective study over 4 years on 49 patients diagnosed with esophageal atresia in the 2 Paediatric Surgery Departments in Dakar. Results: The average age was 4 days (0-10 days, 50% of them had a severe pneumonopathy. The average time of surgical management was 27 h (6-96 h. In the series, we noted 10 preoperative deaths. The average age at surgery was 5.7 days with a range of 1-18 days. The surgery mortality rate is 28 patients (72% including 4 late deaths. Conclusion: The causes of death were mainly sepsis, cardiac decompensation and anastomotic leaks.

  13. Golestan cohort study of oesophageal cancer: feasibility and first results.

    Science.gov (United States)

    Pourshams, A; Saadatian-Elahi, M; Nouraie, M; Malekshah, A F; Rakhshani, N; Salahi, R; Yoonessi, A; Semnani, S; Islami, F; Sotoudeh, M; Fahimi, S; Sadjadi, A R; Nasrollahzadeh, D; Aghcheli, K; Kamangar, F; Abnet, C C; Saidi, F; Sewram, V; Strickland, P T; Dawsey, S M; Brennan, P; Boffetta, P; Malekzadeh, R

    2005-01-17

    To investigate the incidence of oesophageal cancer (EC) in the Golestan province of North-East Iran, we invited 1349 rural and urban inhabitants of Golestan province aged 35-80 to undergo extensive lifestyle interviews and to provide biological samples. The interview was repeated on a subset of 130 participants to assess reliability of questionnaire and medical information. Temperature at which tea was consumed was measured on two occasions by 110 subjects. Samples of rice, wheat and sorghum were tested for fumonisin contamination. An active follow-up was carried out after 6 and 12 months. A total of 1057 subjects (610 women and 447 men) participated in this feasibility study (78.4% participation rate). Cigarette smoking, opium and alcohol use were reported by 163 (13.8%), 93 (8.8%) and 39 (3.7%) subjects, respectively. Tobacco smoking was correlated with urinary cotinine (kappa = 0.74). Most questionnaire data had kappa > 0.7 in repeat measurements; tea temperature measurement was reliable (kappa = 0.71). No fumonisins were detected in the samples analysed. During the follow-up six subjects were lost (0.6%), two subjects developed EC (one dead, one alive); in all, 13 subjects died (with cause of death known for 11, 84.6%). Conducting a cohort study in Golestan is feasible with reliable information obtained for suspected risk factors; participants can be followed up for EC incidence and mortality. PMID:15597107

  14. Our experience with caustic oesophageal burn in South of Iran

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    Seyed M. V. Hosseini

    2011-01-01

    Full Text Available Context: The alkaline oesophageal burn (EB is a very debilitating injury and common in the southern rural area of Iran, where the air conditioning systems are cleaned with an alkaline liquid, which is accidentally ingested by children. Aims: The aim is to share our experiences with caustic injury in children. Settings and Design : A ′before′ and ′after′ clinical trial. Materials and Methods: From November 2006-2009, 35 cases of alkaline burns were referred to our center. All underwent flexible endoscopy and thereafter received steroid, antibiotic and H2 blocker. They subsequently underwent rigid oesophagoscopy, with grade IIb or higher burns, for inserting the two different kinds of stents. Results: Four out of 10 (GIIa < underwent dilatation occasionally. Fifteen (GIIb with early large stent (eight weeks developed complications (three antral contractures, one oesophagotracheal fistula, one tracheobronchial fistula, three perforations, three deaths, and the remaining cases had not undergone dilatation yet. Four out of 10 with (GIIb, who had small stents (Six months and early gastrostomy needed dilatation every four to six weeks and all recovered, with no significant complications. Conclusions: Early use of gastrostomy prevents malnutrition in patients. Small size stents are much more tolerable for a prolonged time are not obstructed by saliva that washes the wall of the damaged oesophagus continuously and promotes healing.

  15. Cyclical rectal bleeding in colorectal endometriosis.

    Science.gov (United States)

    Levitt, M D; Hodby, K J; van Merwyk, A J; Glancy, R J

    1989-12-01

    Three case reports of cyclical rectal bleeding in endometriosis affecting rectum and sigmoid colon emphasize the close relationship between such cyclical bleeding and intestinal endometriosis. The cause of bleeding, however, is still unclear. The predilection of endometriotic deposits for the outer layers of the bowel wall suggests that mucosal involvement is not a prerequisite for rectal bleeding. The frequent absence of identifiable intramural haemorrhage casts doubt on the premise that intestinal endometriotic deposits 'menstruate'. The cause may simply be a transient tear in normal mucosa due to swelling of an underlying endometriotic deposit at the time of menstruation. PMID:2597100

  16. A diagnostic approach to mild bleeding disorders.

    Science.gov (United States)

    Boender, J; Kruip, M J H A; Leebeek, F W G

    2016-08-01

    Mild inherited bleeding disorders are relatively common in the general population. Despite recent advances in diagnostic approaches, mild inherited bleeding disorders still pose a significant diagnostic challenge. Hemorrhagic diathesis can be caused by disorders in primary hemostasis (von Willebrand disease, inherited platelet function disorders), secondary hemostasis (hemophilia A and B, other (rare) coagulant factor deficiencies) and fibrinolysis, and in connective tissue or vascular formation. This review summarizes the currently available diagnostic methods for mild bleeding disorders and their pitfalls, from structured patient history to highly specialized laboratory diagnosis. A comprehensive framework for a diagnostic approach to mild inherited bleeding disorders is proposed. PMID:27208505

  17. Challenges in Anaesthetic management of a child for thoracoscopic assisted oesophageal replacement.

    Science.gov (United States)

    Chandrakala, K R; Nagaraj, Bindu; Bhagya, D V; Chandrika, Y R

    2016-02-01

    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. PMID:27013752

  18. Childhood body mass index in relation to future risk of oesophageal adenocarcinoma

    DEFF Research Database (Denmark)

    Cook, M B; Freedman, N D; Gamborg, M;

    2015-01-01

    oesophageal adenocarcinoma in a cohort from the Copenhagen School Health Records Register. Analyses included 255 053 children born during 1930-1971. Danish Cancer Registry linkage provided outcomes. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression......BACKGROUND: Middle-aged obese adults are at substantially elevated risk of oesophageal adenocarcinoma. It is unclear whether this risk originates earlier in life. METHODS: We assessed associations between childhood body mass index (BMI) and height-measured annually between ages 7 and 13-with adult....... RESULTS: During 5.4 million person-years of follow-up, 254 (216 males) incident oesophageal adenocarcinomas occurred. At each examined age, cancer risk increased linearly per unit BMI z-score, although associations were only statistically significant for ages 9-13. The HR for the age of 13 years was 1...

  19. 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

  20. Diagnostic Strategies for Postmenopausal Bleeding

    Directory of Open Access Journals (Sweden)

    M. C. Breijer

    2010-01-01

    Full Text Available Postmenopausal bleeding (PMB is a common clinical problem. Patients with PMB have 10%–15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

  1. Delayed-Onset Superior Mesenteric Artery Syndrome Presenting as Oesophageal Peptic Stricture

    Science.gov (United States)

    Sinagra, Emanuele; Montalbano, Luigi Maria; Linea, Cristina; Giunta, Marco; Tesè, Lorenzo; La Seta, Francesco; Malizia, Giuseppe; Orlando, Ambrogio; Marasà, Marta; D'Amico, Gennaro

    2012-01-01

    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 (par)enteral 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. PMID:22619653

  2. 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.

  3. Risk of oesophageal cancer among patients previously hospitalised with eating disorder

    Science.gov (United States)

    Brewster, David H.; Nowell, Siân L.; Clark, David N.

    2015-01-01

    Background It has been suggested that the risk of oesophageal adenocarcinoma might be increased in patients with a history of eating disorders due to acidic damage to oesophageal mucosa caused by self-induced vomiting practiced as a method of weight control. Eating disorders have also been associated with risk factors for squamous cell carcinoma of the oesophagus, including alcohol use disorders, as well as smoking and nutritional deficiencies, which have been associated with both main sub-types of oesophageal cancer. There have been several case reports of oesophageal cancer (both main sub-types) arising in patients with a history of eating disorders. Methods We used linked records of hospitalisation, cancer registration and mortality in Scotland spanning 1981–2012 to investigate the risk of oesophageal cancer among patients with a prior history of hospitalisation with eating disorder. The cohort was restricted to patients aged ≥10 years and eating disorder. Disregarding the first year of follow-up, we calculated indirectly standardised incidence ratios using the general population as the reference group to generate expected numbers of cases (based on age-, sex-, socio-economic deprivation category-, and calendar period-specific rates of disease). Results After exclusions, the cohort consisted of 3617 individuals contributing 52,455 person-years at risk. The median duration of follow-up was 13.9 years. Seven oesophageal cancers were identified, as compared with 1.14 expected, yielding a standardised incidence ratio of 6.1 (95% confidence interval: 2.5–12.6). All were squamous cell carcinomas arising in females with a prior history of anorexia nervosa. Conclusions Patients hospitalised previously with eating disorders are at increased risk of developing oesophageal cancer. Confounding by established risk factors (alcohol, smoking, and nutritional deficiency) seems a more likely explanation than acidic damage through self-induced vomiting because none of the

  4. 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.

  5. 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.

  6. 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

  7. Obstetric management of adolescents with bleeding disorders.

    Science.gov (United States)

    James, Andra H

    2010-12-01

    Adolescents with bleeding disorders who become pregnant must contend with the dual challenges of their bleeding disorder and their pregnancy. Adolescents are more likely to terminate a pregnancy than adult women, and when they do carry a pregnancy, they are more likely to deliver prematurely. Otherwise, they are at risk for the same complications that adult women with bleeding disorders experience, particularly bleeding complications postpartum. Since one half to two thirds of adolescent pregnancies are unplanned, issues related to reproduction should be addressed during routine visits with the pediatrician, hematologist or gynecologist. Girls who are at risk of being carriers for hemophilia A and B, severe von Willebrand disease, and other severe bleeding disorders should have their bleeding disorder status determined before they become pregnant. During pregnancy, a plan should be established to ensure that both mother and fetus deliver safely. Young women at risk for severe bleeding or at risk of having a severely affected infant should be referred for prenatal care and delivery to a center where, in addition to specialists in high-risk obstetrics, there is a hemophilia treatment center or a hematologist with expertise in hemostasis. Prior to delivery or any invasive procedures, young women at risk for severe bleeding should receive prophylaxis. Since administration of desmopressin may result in hyponatremia, whenever available, virally inactivated or recombinant clotting factor concentrates should be used for replacement as opposed to fresh frozen plasma or cryoprecipitate. PMID:20934895

  8. First trimester bleeding and maternal cardiovascular morbidity

    DEFF Research Database (Denmark)

    Lykke, Jacob A; Langhoff-Roos, Jens

    2012-01-01

    First trimester bleeding without miscarriage is a risk factor for complications later in the pregnancy, such as preterm delivery. Also, first trimester miscarriage has been linked to subsequent maternal ischemic heart disease. We investigated the link between maternal cardiovascular disease prior...... to and subsequent to first trimester bleeding without miscarriage....

  9. 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.

  10. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  11. 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...

  12. Gastric Varices with Remarkable Collateral Veins in Valpronic Acid-Induced Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Y. Hattori

    2008-08-01

    Full Text Available Valproic acid (VPA is a commonly prescribed and approved treatment for epilepsy, including Angelman syndrome, throughout the world. However, the long-term administration of drugs like VPA is associated with the possible development of gastric varices and splenic obstruction as a result of chronic pancreatitis. Such cases can be difficult to treat using endoscopy or interventional radiology because of hemodynamic abnormalities; therefore, surgical treatment is often necessary.

  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. 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.

  15. Oesophageal chemoreceptors of blue crabs, Callinectes sapidus, sense chemical deterrents and can block ingestion of food.

    Science.gov (United States)

    Aggio, Juan F; Tieu, Ryan; Wei, Amy; Derby, Charles D

    2012-05-15

    Decapod crustaceans such as blue crabs possess a variety of chemoreceptors that control different stages of the feeding process. All these chemoreceptors are putative targets for feeding deterrents that cause animals to avoid or reject otherwise palatable food. As a first step towards characterizing the chemoreceptors that mediate the effect of deterrents, we used a behavioral approach to investigate their precise location. Data presented here demonstrate that chemoreceptors located on the antennules, pereiopods and mouthparts do not mediate the food-rejection effects of a variety of deterrents, both natural and artificial to crabs. Crabs always searched for deterrent-laced food and took it to their oral region. The deterrent effect was manifested as either rejection or extensive manipulation, but in both cases crabs bit the food. The biting behavior is relevant because the introduction of food into the oral cavity ensured that the deterrents gained access to the oesophageal taste receptors, and so we conclude that they are the ones mediating rejection. Additional support comes from the fact that a variety of deterrent compounds evoked oesophageal dilatation, which is mediated by oesophageal receptors and has been linked to food rejection. Further, there is a positive correlation between a compound's ability to elicit rejection and its ability to evoke oesophageal dilatation. The fact that deterrents do not act at a distance is in accordance with the limited solubility of most known feeding deterrents, and likely influences predator-prey interactions and their outcome: prey organisms will be attacked and bitten before deterrents become relevant.

  16. TAK1-regulated expression of BIRC3 predicts resistance to preoperative chemoradiotherapy in oesophageal adenocarcinoma patients

    Science.gov (United States)

    Piro, G; Giacopuzzi, S; Bencivenga, M; Carbone, C; Verlato, G; Frizziero, M; Zanotto, M; Mina, M M; Merz, V; Santoro, R; Zanoni, A; De Manzoni, G; Tortora, G; Melisi, D

    2015-01-01

    Background: About 20% of resectable oesophageal carcinoma is resistant to preoperative chemoradiotherapy. Here we hypothesised that the expression of the antiapoptotic gene Baculoviral inhibitor of apoptosis repeat containing (BIRC)3 induced by the transforming growth factor β activated kinase 1 (TAK1) might be responsible for the resistance to the proapoptotic effect of chemoradiotherapy in oesophageal carcinoma. Methods: TAK1 kinase activity was inhibited in FLO-1 and KYAE-1 oesophageal adenocarcinoma cells using (5Z)-7-oxozeaenol. The BIRC3 mRNA expression was measured by qRT–PCR in 65 pretreatment frozen biopsies from patients receiving preoperatively docetaxel, cisplatin, 5-fluorouracil, and concurrent radiotherapy. Receiver operator characteristic (ROC) analyses were performed to determine the performance of BIRC3 expression levels in distinguishing patients with sensitive or resistant carcinoma. Results: In vitro, (5Z)-7-oxozeaenol significantly reduced BIRC3 expression in FLO-1 and KYAE-1 cells. Exposure to chemotherapeutic agents or radiotherapy plus (5Z)-7-oxozeaenol resulted in a strong synergistic antiapoptotic effect. In patients, median expression of BIRC3 was significantly (P<0.0001) higher in adenocarcinoma than in the more sensitive squamous cell carcinoma subtype. The BIRC3 expression significantly discriminated patients with sensitive or resistant adenocarcinoma (AUC-ROC=0.7773 and 0.8074 by size-based pathological response or Mandard's tumour regression grade classifications, respectively). Conclusions: The BIRC3 expression might be a valid biomarker for predicting patients with oesophageal adenocarcinoma that could most likely benefit from preoperative chemoradiotherapy. PMID:26291056

  17. Oesophageal cancer: exploring controversies overview of experts’ opinions of Austria, Germany, France, Netherlands and Switzerland

    International Nuclear Information System (INIS)

    Oesophageal carcinoma is a rare disease with often dismal prognosis. Despite multiple trials addressing specific issues, currently, many questions in management remain unanswered. This work aimed to specifically address areas in the management of oesophageal cancer where high level evidence is not available, performing trials is very demanding and for many questions high-level evidence will not be available in the forseeable future. Two experts of each national, oesophageal cancer research group from Austria, France, Germany, the Netherlands and Switzerland were asked to provide statements to controversial issues. After an initial survey, further questions were formulated and answered by all experts. The answers were then discussed and qualitatively analysed for consensus and controversy. Topics such as indications for PET-CT, reasons for induction chemotherapy, radiotherapy dose, the choice of definitive chemo-radiotherapy versus surgery in squamous cell cancer, the role of radiotherapy in adenocarcinoma and selected surgical issues were identified as topics of interest and discussed. Areas of significant controversy exist in the management of oesophageal cancer, mostly due to high-level evidence. This is not expected to change in the upcoming years. The online version of this article (doi:10.1186/s13014-015-0418-4) contains supplementary material, which is available to authorized users

  18. The influence of Helicobacter pylori on oesophageal acid exposure in GERD during acid suppressive therapy

    NARCIS (Netherlands)

    Peters, FTM; Kuipers, EJ; Ganesh, S; Sluiter, WJ; Klinkenberg-Knol, EC; Lamers, CBHW; Kleibeuker, JH

    1999-01-01

    Background: Helicobacter pylori exaggerates the effect of acid suppressive drugs on intragastric pH. It is unknown whether this is relevant for the treatment of GERD. Aim: To compare oesophageal acid exposure and symptoms in H. pylori-negative and H. pylori-positive GERD patients during low and prof

  19. 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.)

  20. The contribution of fetal MR imaging to the assessment of oesophageal atresia

    International Nuclear Information System (INIS)

    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.)

  1. Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical?

    Directory of Open Access Journals (Sweden)

    F. Argenti

    2016-03-01

    Conclusion: This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity.

  2. Erosive oesophagitis revealing acute zinc deficiency during parenteral nutrition. A case report.

    Science.gov (United States)

    Amoussou-Guenou, D; Boland, B; Rousseau, C; Lambert, M; Marbaix, E; Bourlond, J; Stein, F

    1989-01-01

    We report a case of acute zinc deficiency which occurred during parenteral nutrition in a patient with anorexia nervosa and which was characterized by a painful erosive oesophagitis preceding the typical oro-cutaneous symptoms. We also discuss the interpretation of plasma and urine zinc levels, the predisposing role of total parenteral alimentation and the specific therapeutic implications. PMID:2518587

  3. Relationships between air swallowing, intragastric air, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Bredenoord, AJ; Weusten, BLAM; Timmer, R; Akkermans, LMA; Smout, AJPM

    2005-01-01

    Background: With each swallow a certain amount of air is transported to the stomach. The stomach protects itself against excessive distention by swallowed air through belching (gas reflux). The mechanism of belching (transient lower oesophageal sphincter relaxation) is also one of the mechanisms und

  4. Simultaneous tracheal and oesophageal pH monitoring during mechanical ventilation.

    Science.gov (United States)

    Hue, V; Leclerc, F; Gottrand, F; Martinot, A; Crunelle, V; Riou, Y; Deschildre, A; Fourier, C; Turck, D

    1996-01-01

    OBJECTIVE: To simultaneously record tracheal and oesophageal pH in mechanically ventilated children to determine: (1) the feasibility and safety of the method; (2) the incidence of gastro-oesophageal reflux (GOR) and pulmonary contamination; and (3) their associated risk factors. DESIGN: Prospective study. SETTING: Paediatric intensive care unit in a university hospital. PATIENTS: Twenty mechanically ventilated children (mean age 6.7 years) who met the following inclusion criteria: endotracheal tube with an internal diameter of 4 mm or more (cuffed or uncuffed), mechanical ventilation for an acute disease, no treatment with antiacids, prokinetics, or H2-receptor blockers, and no nasogastric or orogastric tube. METHODS: The tracheal antimony pH probe was positioned 1 cm below the distal end of the endotracheal tube. The oesophageal antimony pH probe was positioned at the lower third of the oesophagus. pH was recorded on a double channel recorder and analysed with EsopHogram 5.01 software and by examination of the trace. The following definitions were used: GOR index, percentage of time pH 4.8%; tracheal reflux, fall in tracheal pH Tracheal reflux (pH aspiration. Episodes of tracheal reflux were associated with a GOR index > 10% (p tracheal and oesophageal pH monitoring was feasible in the setting of this study. Tracheal reflux can occur without pathological GOR, and GOR may occur without tracheal reflux. Further prospective studies in larger groups of patients are now justified. PMID:8813870

  5. Helicobacter pylori eradication does not exacerbate gastro-oesophageal reflux disease

    OpenAIRE

    Malfertheiner, P

    2004-01-01

    The reciprocal influence of Helicobacter pylori infection and gastro-oesophageal reflux disease (GORD), if both conditions occur concomitantly, has been an issue of debate for many years. The critical question is whether eradication of H pylori has a more beneficial, harmful, or simply no effect on the course of GORD.

  6. A single session of intraluminal brachytherapy in palliation of oesophageal cancer

    NARCIS (Netherlands)

    Jager, J; Langendijk, H; Pannebakker, M; Rijken, J; deJong, J

    1995-01-01

    Between September 1987 and September 1993, 88 patients with oesophageal cancer were treated by a single session of intraluminal brachytherapy of 15 Gy prescribed at 1 cm distance from the central axis, using MDR Cs-137 (n = 51) during the first part of the study and HDR Ir-192 (n = 37) during the se

  7. Compressor bleed cooling fluid feed system

    Science.gov (United States)

    Donahoo, Eric E; Ross, Christopher W

    2014-11-25

    A compressor bleed cooling fluid feed system for a turbine engine for directing cooling fluids from a compressor to a turbine airfoil cooling system to supply cooling fluids to one or more airfoils of a rotor assembly is disclosed. The compressor bleed cooling fluid feed system may enable cooling fluids to be exhausted from a compressor exhaust plenum through a downstream compressor bleed collection chamber and into the turbine airfoil cooling system. As such, the suction created in the compressor exhaust plenum mitigates boundary layer growth along the inner surface while providing flow of cooling fluids to the turbine airfoils.

  8. Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Fahad Saeed

    2011-01-01

    Full Text Available Gastrointestinal (GI bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI in chronic kidney disease (CKD and end-stage renal disease (ESRD patients. We suggest an approach to diagnosis and management of this problem.

  9. Knockdown of LRP/LR Induces Apoptosis in Breast and Oesophageal Cancer Cells.

    Science.gov (United States)

    Khumalo, Thandokuhle; Ferreira, Eloise; Jovanovic, Katarina; Veale, Rob B; Weiss, Stefan F T

    2015-01-01

    Cancer is a global burden due to high incidence and mortality rates and is ranked the second most diagnosed disease amongst non-communicable diseases in South Africa. A high expression level of the 37kDa/67kDa laminin receptor (LRP/LR) is one characteristic of cancer cells. This receptor is implicated in the pathogenesis of cancer cells by supporting tumor angiogenesis, metastasis and especially for this study, the evasion of apoptosis. In the current study, the role of LRP/LR on cellular viability of breast MCF-7, MDA-MB 231 and WHCO1 oesophageal cancer cells was investigated. Western blot analysis revealed that total LRP expression levels of MCF-7, MDA-MB 231 and WHCO1 were significantly downregulated by targeting LRP mRNA using siRNA-LAMR1. This knockdown of LRP/LR resulted in a significant decrease of viability in the breast and oesophageal cancer cells as determined by an MTT assay. Transfection of MDA-MB 231 cells with esiRNA-RPSA directed against a different region of the LRP mRNA had similar effects on LRP/LR expression and cell viability compared to siRNA-LAMR1, excluding an off-target effect of siRNA-LAMR1. This reduction in cellular viability is as a consequence of apoptosis induction as indicated by the exposure of the phosphatidylserine protein on the surface of breast MCF-7, MDA-MB 231 and oesophageal WHCO1 cancer cells, respectively, detected by an Annexin-V/FITC assay as well as nuclear morphological changes observed post-staining with Hoechst. These observations indicate that LRP/LR is crucial for the maintenance of cellular viability of breast and oesophageal cancer cells and recommend siRNA technology targeting LRP expression as a possible novel alternative technique for breast and oesophageal cancer treatment. PMID:26427016

  10. Knockdown of LRP/LR Induces Apoptosis in Breast and Oesophageal Cancer Cells.

    Directory of Open Access Journals (Sweden)

    Thandokuhle Khumalo

    Full Text Available Cancer is a global burden due to high incidence and mortality rates and is ranked the second most diagnosed disease amongst non-communicable diseases in South Africa. A high expression level of the 37kDa/67kDa laminin receptor (LRP/LR is one characteristic of cancer cells. This receptor is implicated in the pathogenesis of cancer cells by supporting tumor angiogenesis, metastasis and especially for this study, the evasion of apoptosis. In the current study, the role of LRP/LR on cellular viability of breast MCF-7, MDA-MB 231 and WHCO1 oesophageal cancer cells was investigated. Western blot analysis revealed that total LRP expression levels of MCF-7, MDA-MB 231 and WHCO1 were significantly downregulated by targeting LRP mRNA using siRNA-LAMR1. This knockdown of LRP/LR resulted in a significant decrease of viability in the breast and oesophageal cancer cells as determined by an MTT assay. Transfection of MDA-MB 231 cells with esiRNA-RPSA directed against a different region of the LRP mRNA had similar effects on LRP/LR expression and cell viability compared to siRNA-LAMR1, excluding an off-target effect of siRNA-LAMR1. This reduction in cellular viability is as a consequence of apoptosis induction as indicated by the exposure of the phosphatidylserine protein on the surface of breast MCF-7, MDA-MB 231 and oesophageal WHCO1 cancer cells, respectively, detected by an Annexin-V/FITC assay as well as nuclear morphological changes observed post-staining with Hoechst. These observations indicate that LRP/LR is crucial for the maintenance of cellular viability of breast and oesophageal cancer cells and recommend siRNA technology targeting LRP expression as a possible novel alternative technique for breast and oesophageal cancer treatment.

  11. Reproductive factors and oesophageal cancer in Chinese women: a case-control study

    Directory of Open Access Journals (Sweden)

    Zhang Xia

    2011-05-01

    Full Text Available Background Previous studies showed that sex hormone might play a role in the development of oesophageal cancer in Western countries. However, evidence from Chinese populations is still lacking. Methods We performed a hospital-based case-control study in Guangzhou, China. From June 2006 to May 2009, face-to-face interviews were conducted on 73 cases and 157 controls. Cases were Chinese females with newly diagnosed primary oesophageal cancer. Controls were hospitalized individuals without cancer and frequency matched by age groups. The interviews included questions about childbearing and menarche history, together with potential confounders. Unconditional logistic regression was used to estimate the risk of factors. Results Women who had given birth before were not at increased risk compared to childless women (adjusted OR = 1.17, 95% CI: 0.48 ~ 2.85. The risk of oesophageal cancer increased with age at first birth: the adjusted OR for women first giving birth at age 25 or later was 2.02 (95% CI: 1.01 ~ 4.04 compared with those reporting their first birth before age 22. History of spontaneous abortion was not significantly associated with increased risk (adjusted OR = 1.37, 95% CI: 0.49 ~ 3.83. No significant association was observed between menstrual variables (age at menarche, age at menopause, and years of menstruation and risk of oesophageal cancer. Conclusions Giving birth at later age may increase the risk of oesophageal cancer in women. Further studies in Chinese populations with larger sample sizes are still needed.

  12. Genetic analysis of bleeding disorders.

    Science.gov (United States)

    Edison, E; Konkle, B A; Goodeve, A C

    2016-07-01

    Molecular genetic analysis of inherited bleeding disorders has been practised for over 30 years. Technological changes have enabled advances, from analyses using extragenic linked markers to next-generation DNA sequencing and microarray analysis. Two approaches for genetic analysis are described, each suiting their environment. The Christian Medical Centre in Vellore, India, uses conformation-sensitive gel electrophoresis mutation screening of multiplexed PCR products to identify candidate mutations, followed by Sanger sequencing confirmation of variants identified. Specific analyses for F8 intron 1 and 22 inversions are also undertaken. The MyLifeOurFuture US project between the American Thrombosis and Hemostasis Network, the National Hemophilia Foundation, Bloodworks Northwest and Biogen uses molecular inversion probes (MIP) to capture target exons, splice sites plus 5' and 3' sequences and to detect F8 intron 1 and 22 inversions. This allows screening for all F8 and F9 variants in one sequencing run of multiple samples (196 or 392). Sequence variants identified are subsequently confirmed by a diagnostic laboratory. After having identified variants in genes of interest through these processes, a systematic procedure determining their likely pathogenicity should be applied. Several scientific societies have prepared guidelines. Systematic analysis of the available evidence facilitates reproducible scoring of likely pathogenicity. Documentation of frequency in population databases of variant prevalence and in locus-specific mutation databases can provide initial information on likely pathogenicity. Whereas null mutations are often pathogenic, missense and splice site variants often require in silico analyses to predict likely pathogenicity and using an accepted suite of tools can help standardize their documentation.

  13. Genetic analysis of bleeding disorders.

    Science.gov (United States)

    Edison, E; Konkle, B A; Goodeve, A C

    2016-07-01

    Molecular genetic analysis of inherited bleeding disorders has been practised for over 30 years. Technological changes have enabled advances, from analyses using extragenic linked markers to next-generation DNA sequencing and microarray analysis. Two approaches for genetic analysis are described, each suiting their environment. The Christian Medical Centre in Vellore, India, uses conformation-sensitive gel electrophoresis mutation screening of multiplexed PCR products to identify candidate mutations, followed by Sanger sequencing confirmation of variants identified. Specific analyses for F8 intron 1 and 22 inversions are also undertaken. The MyLifeOurFuture US project between the American Thrombosis and Hemostasis Network, the National Hemophilia Foundation, Bloodworks Northwest and Biogen uses molecular inversion probes (MIP) to capture target exons, splice sites plus 5' and 3' sequences and to detect F8 intron 1 and 22 inversions. This allows screening for all F8 and F9 variants in one sequencing run of multiple samples (196 or 392). Sequence variants identified are subsequently confirmed by a diagnostic laboratory. After having identified variants in genes of interest through these processes, a systematic procedure determining their likely pathogenicity should be applied. Several scientific societies have prepared guidelines. Systematic analysis of the available evidence facilitates reproducible scoring of likely pathogenicity. Documentation of frequency in population databases of variant prevalence and in locus-specific mutation databases can provide initial information on likely pathogenicity. Whereas null mutations are often pathogenic, missense and splice site variants often require in silico analyses to predict likely pathogenicity and using an accepted suite of tools can help standardize their documentation. PMID:27405681

  14. Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes

    Directory of Open Access Journals (Sweden)

    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. Dysfunctional Uterine Bleeding (DUB) (For Teens)

    Science.gov (United States)

    ... the body's hormones. Problems like compulsive exercise , not eating healthy foods, or too much stress can cause hormone changes. Some severe cases of AUB are caused by bleeding disorders such as von Willebrand disease . What Are the ...

  17. Fibrinogen concentrate for bleeding - a systematic review

    DEFF Research Database (Denmark)

    Lunde, J; Stensballe, J; Wikkelsø, A;

    2014-01-01

    Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...

  18. Extensive hemangiomatosis diagnosed by scintigraphy with 99mTc-labeled red blood cells in a patient with lower gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Souza, D.S.F.; Ichiki, W.A.; Borges, A.C.; Coura Filho, G.B.; Vecchia, J.F.; Sapienza, M.T.; Ono, C.R.; Watanabe, T.; Costa, P.L.A.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Inst. de Radiologia. Servico de Medicina Nuclear

    2008-07-01

    Full text: Introduction: The gastrointestinal bleeding may be caused by vascular tumors and other lesions like inflammatory disorders, intestinal obstruction or vascular malformation. The Klippel-Trenaunay syndrome and blue rubber bleb nevus syndrome are hemangiomatosis diseases that may involve the gastrointestinal tract and cause recurrent hemorrhage. The signs and symptoms usually appear at childhood. Case report: male patient, 31 years old, presenting three days of gastrointestinal bleeding and an hemorrhage shock (Hb=3,9). Previous reports of small volume bleeding since childhood and schistossomosis. Dilated veins, hemorrhoid and port wine stain lesions were detected at physical examination in perineal region, penis and scrotum. Inferior limbs were symmetric at inspection. The upper endoscopy showed esophageal varices with no signs of active bleeding. The scintigraphy with {sup 99m}Tc-labeled red blood cells showed active hemorrhage at recto-sigmoid topography during the first hour of study. Extensive and heterogeneous uptake was seen in gluteus, posterior right thigh and scrotum at the second and fifth hours of study. Then the hypothesis of vascular tumor was considered. The magnetic resonance (MR) of pelvis demonstrated extensive hemangiomatosis at the regions described by the scintigraphy. The clinical and imaging findings suggested the diagnosis of Klippel-Trenaunay syndrome. Discussion: The Klippel-Trenaunay syndrome is a rare disease characterized by congenital vascular and lymphatic malformations (port wine stain lesions, congenital varices) and bone growth and soft tissue disorder. Dilated veins may involve abdominal and pelvic structures, with rectal bleeding and haematuria occurring on average of 20%. The clinical investigation must approach the type, the extent and the severity of the malformation, since the morbidity and the mortality depends on the visceral involvement. The Doppler ultrasound, scanometry of lower extremities, MR, angiography and

  19. Cough-induced Tracheobronchial Mucosal Bleeding.

    Science.gov (United States)

    Hira, Harmanjit Singh

    2011-01-01

    A 56-year-old man presented with moderate hemoptysis. It was preceded by a severe bout of cough. Flexible bronchoscopy showed diffuse tracheobronchial mucosal petechiae and bleeding. The patient was not suffering with any coagulopathies. He did not receive antiplatelet drugs. Hemoptysis resolved with cough suppressant. Subsequent bronchoscopy revealed the complete resolution of petechiae. The mechanism of bleeding after the bout of coughing is discussed. PMID:23169019

  20. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

    This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy. PMID:22310222