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Sample records for recurrent variceal bleeding

  1. Outcome of the Pediatric Patients with Portal Cavernoma: The Retrospective Study for 10 Years Focusing on Recurrent Variceal Bleeding

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    Hongjie Guo

    2016-01-01

    Full Text Available Background. Portal cavernoma (PC is the most critical condition with risk or variceal hemorrhage in pediatric patients. We retrospectively investigated the patients with PC focusing on the predictors for recurrent variceal bleeding. Methods. Between July 2003 and June 2013, we retrospectively enrolled all consecutive patients admitted to our department with a diagnosis of PC without abdominal malignancy or liver cirrhosis. The primary endpoint of this observational study was recurrent variceal bleeding. Independent predictors of recurrent variceal bleeding were identified using the logistic regression model. Results. A total of 157 patients were enrolled in the study. During the follow-up period, 24 patients exhibited onset of recurrent variceal bleeding. Acute variceal bleeding was subjected to conservative symptomatic treatment and emergency endoscopic sclerotherapy. Surgical procedure selection was based on the severity of vascular dilation and collateral circulation. Multivariate logistic regression analysis demonstrated that the presence of ascites, collateral circulation, and portal venous pressure were independent prognostic factors of recurrent variceal bleeding for patients with portal cavernoma. Conclusions. The presence of ascites, collateral circulation, and portal venous pressure evaluation are important and could predict the postsurgical recurrent variceal bleeding in patients with portal cavernoma.

  2. Variceal recurrence, rebleeding and survival after injection ...

    African Journals Online (AJOL)

    This study tested the validity of the hypothesis that eradication of oesophageal varices by repeated injection sclerotherapy would reduce recurrent variceal bleeding and death from bleeding oesophageal varices in a high risk cohort of patients with portal hypertension and cirrhosis. Patients and Methods: 306 alcoholic ...

  3. Endoscopic ultrasound coil placement of gastric varices: Emerging modality for recurrent bleeding gastric varices

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    Yogesh Harwani

    2014-01-01

    Full Text Available Gastric varices are the probable source of bleeding in 10-36% of patients, with acute variceal bleeding and carry high mortality and rebleeding rates. Till date, cyanoacrylate glue injection is considered as the standard of care but has high complication rate. Endoscopic ultrasound (EUS guided coil placement is a new emerging technique of management of gastric varices. In this case report, we detail the EUS guided coil placement for management of gastric varices after failed glue injections.

  4. Recurrent Bacteremia, a Complication of Cyanoacrylate Injection for Variceal Bleeding: Report of Two Cases and Review of the Literature

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    T. Galperine

    2009-01-01

    Full Text Available We report the first description of recurrent bacteremia in two patients after cyanoacrylate injection for gastric varices bleeding treated with antibiotics alone. Adapted and prolonged antibiotic treatment allowed a complete resolution of the infection with no relapse after more than 6 months. According to recent data, prophylactic antibiotics should be further investigated for patients with bleeding varices undergoing cyanoacrylate injection.

  5. Bleeding esophageal varices

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000268.htm Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...

  6. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

    DEFF Research Database (Denmark)

    Ngu, JH; Laursen, Stig Borbjerg; Chin, YK

    2017-01-01

    Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study.......Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study....

  7. Percutaneous transsplenic varices embolization for upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Zhang Qiang; Li Jingyu; Lu Junliang; Xu Liyang; Liu Tao

    2010-01-01

    Objective: To investigate the value of percutaneous transsplenic varices embolization (PTSVE) for treatment of upper gastrointestinal bleeding. Methods: Twenty cases with liver cirrhosis and portal hypertension suffered upper gastrointestinal bleeding. PTSVE was administered to them with hardener and coils. Among them, 8 cases had massive hepatocellular carcinoma (HCC) in right lobe; 10 cases with hepatocellular carcinoma had portal vein tumor thrombus and occlusion; the other two cases with liver cirrhosis had portal vein thrombosis. All of these cases were not suitable for percutaneous transhepatic varices embolization (PTHVE). PTSVE was performed under the guidance of fluoroscopy. Results: Technical success was achieved in 18 patients. A total of 35 gastric coronary veins were embolized. In all these cases, upper gastrointestinal bleeding stopped after PTSVE. There was no recurrence within 1 month follow-up. No serious complication occurred. Conclusion: PTSVE is a safe and efficient alternative treatment for upper gastrointestinal bleeding, especially for cases with portal vein occlusion or with massive HCC in right lobe of liver. (authors)

  8. Bleeding stomal varices in portal hypertension

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    Karen Tran-Harding, MD

    2018-04-01

    Full Text Available We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management. Currently, there are no established standard treatments for stomal variceal bleeding. In addition, to the best of our knowledge, there are no cases in the current literature in which treatment of this entity is performed with a combination of TIPS shunt placement and N-butyl cyanoacrylate variceal embolization. Keywords: Stomal varices, TIPS, Cirrhosis, Colon cancer, Embolization, NBCA

  9. Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding.

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    Thanapirom, Kessarin; Ridtitid, Wiriyaporn; Rerknimitr, Rungsun; Thungsuk, Rattikorn; Noophun, Phadet; Wongjitrat, Chatchawan; Luangjaru, Somchai; Vedkijkul, Padet; Lertkupinit, Comson; Poonsab, Swangphong; Ratanachu-ek, Thawee; Hansomburana, Piyathida; Pornthisarn, Bubpha; Thongbai, Thirada; Mahachai, Varocha; Treeprasertsuk, Sombat

    2016-04-01

    Data regarding the efficacy of the Glasgow Blatchford score (GBS), full Rockall score (FRS) and pre-endoscopic Rockall scores (PRS) in comparing non-variceal and variceal upper gastrointestinal bleeding (UGIB) are limited. Our aim was to determine the performance of these three risk scores in predicting the need for treatment, mortality, and re-bleeding among patients with non-variceal and variceal UGIB. During January, 2010 and September, 2011, patients with UGIB from 11 hospitals were prospectively enrolled. The GBS, FRS, and PRS were calculated. Discriminative ability for each score was assessed using the receiver operated characteristics curve (ROC) analysis. A total of 981 patients presented with acute UGIB, 225 patients (22.9%) had variceal UGIB. The areas under the ROC (AUC) of the GBS, FRS, and PRS for predicting the need for treatment were 0.77, 0.69, and 0.61 in non-variceal versus 0.66, 0.66, and 0.59 in variceal UGIB. The AUC for predicting mortality and re-bleeding during admission were 0.66, 0.80, and 0.76 in non-variceal versus 0.63, 0.57, and 0.63 in variceal UGIB. AUC score was not statistically significant for predicting need for therapy and clinical outcome in variceal UGIB. The GBS ≤ 2 and FRS ≤ 1 identified low-risk non-variceal UGIB patients for death and re-bleeding during hospitalization. In contrast to non-variceal UGIB, the GBS, FRS, and PRS were not precise scores for assessing the need for therapy, mortality, and re-bleeding during admission in variceal UGIB. © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  10. Successful Management of Neobladder Variceal Bleeding

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    Atwal, Dinesh; Chatterjee, Kshitij, E-mail: kchatterjee@uams.edu [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Osborne, Scott [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Kakkera, Krishna; Deas, Steven [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Li, Ruizong [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Erbland, Marcia [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States)

    2016-10-15

    Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.

  11. Management of acute gastric varices bleeding

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    Chen-Jung Chang

    2013-10-01

    Full Text Available Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.

  12. Gastric Varices Bleed at Lower Portosystemic Pressure Gradients than Esophageal Varices.

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    Morrison, Joseph D; Mendoza-Elias, Nasya; Lipnik, Andrew J; Lokken, R Peter; Bui, James T; Ray, Charles E; Gaba, Ron C

    2018-05-01

    To quantify and compare portosystemic pressure gradients (PSGs) between bleeding esophageal varices (EV) and gastric varices (GV). In a single-center, retrospective study, 149 patients with variceal bleeding (90 men, 59 women, mean age 52 y) with EV (n = 69; 46%) or GV (n = 80; 54%) were selected from 320 consecutive patients who underwent successful transjugular intrahepatic portosystemic shunt (TIPS) creation from 1998 to 2016. GV were subcategorized using the Sarin classification as gastroesophageal varices (GEV) (n = 57) or isolated gastric varices (IGV) (n = 23). PSG before TIPS was measured from the main portal vein to the right atrium. PSGs were compared across EV, GEV, and IGV groups using 1-way analysis of variance. Overall mean baseline PSG was 21 mm Hg ± 6. PSG was significantly higher in patients with EV versus GV (23 mm Hg vs 19 mm Hg; P IGV (16 mm Hg); this difference was statistically significant (P IGV 17 mm Hg; P IGV bled versus 9% (5/57) of GEV and 3% (2/69) of EVs (P = .169). Mean final PSG after TIPS was 8 mm Hg (IGV 6 mm Hg vs EV and GEV 8 mm Hg; P = .005). GV bleed at lower PSGs than EV. EV, GEV, and IGV bleeding is associated with successively lower PSGs. These findings highlight distinct physiology, anatomy, and behavior of GV compared with EV. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  13. Non-variceal upper gastrointestinal bleeding in cirrhotic patients in Nile Delta.

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    Gabr, Mamdouh Ahmed; Tawfik, Mohamed Abd El-Raouf; El-Sawy, Abd Allah Ahmed

    2016-01-01

    Acute upper gastrointestinal bleeding (AUGIB) in cirrhotic patients occurs mainly from esophageal and gastric varices; however, quite a large number of cirrhotic patients bleed from other sources as well. The aim of the present work is to determine the prevalence of non-variceal UGIB as well as its different causes among the cirrhotic portal hypertensive patients in Nile Delta. Emergency upper gastrointestinal (UGI) endoscopy for AUGIB was done in 650 patients. Out of these patients, 550 (84.6%) patients who were proved to have cirrhosis were the subject of the present study. From all cirrhotic portal hypertensive patients, 415 (75.5%) bled from variceal sources (esophageal and gastric) while 135 (24.5%) of them bled from non-variceal sources. Among variceal sources of bleeding, esophageal varices were much more common than gastric varices. Peptic ulcer was the most common non-variceal source of bleeding. Non-variceal bleeding in cirrhosis was not frequent, and sources included peptic ulcer, portal hypertensive gastropathy, and erosive disease of the stomach and duodenum.

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

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

    2016-03-01

    In patients with upper gastrointestinal bleeding (UGIB), identifying those with esophageal variceal hemorrhage prior to endoscopy would be clinically useful. This retrospective study of a large cohort of patients with UGIB used logistic regression analyses to evaluate the platelet count, aspartate aminotransferase (AST) to platelet ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR) and Lok index (all non-invasive blood markers) as predictors of variceal bleeding in (1) all patients with UGIB and (2) patients with cirrhosis and UGIB. 2233 patients admitted for UGIB were identified; 1034 patients had cirrhosis (46%) and of these, 555 patients (54%) had acute UGIB due to esophageal varices. In all patients with UGIB, the platelet count (cut-off 122,000/mm(3)), APRI (cut-off 5.1), AAR (cut-off 2.8) and Lok index (cut-off 0.9) had area under the curve (AUC)s of 0.80 0.82, 0.64, and 0.80, respectively, for predicting the presence of varices prior to endoscopy. To predict varices as the culprit of bleeding, the platelet count (cut-off 69,000), APRI (cut-off 2.6), AAR (cut-off 2.5) and Lok Index (0.90) had AUCs of 0.76, 0.77, 0.57 and 0.73, respectively. Finally, in patients with cirrhosis and UGIB, logistic regression was unable to identify optimal cut-off values useful for predicting varices as the culprit bleeding lesion for any of the non-invasive markers studied. For all patients with UGIB, non-invasive markers appear to differentiate patients with varices from those without varices and to identify those with a variceal culprit lesion. However, these markers could not distinguish between a variceal culprit and other lesions in patients with cirrhosis. Copyright © 2016 American Federation for Medical Research.

  15. Value of Adjusted Blood Requirement Index in determining failure to control bleed in patients with variceal bleeding.

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    Abid, Shahab; Khalid, Abdullah B; Awan, Safia; Shah, Hasnain A; Hamid, Saeed; Jafri, Wasim

    2015-03-01

    Variceal bleeding is a serious complication in patients with cirrhosis. Among the criteria that were proposed in Baveno conferences, the Adjusted Blood Requirement Index (ABRI) has not been validated prospectively in clinical practice. We therefore aim to evaluate the measurement of ABRI as a marker of failure to control bleeding and to evaluate the consistency of ABRI in relation to other criteria of failure to control variceal bleeding. All patients with variceal bleeding who presented to Aga Khan University Hospital from January 2010 to December 2012 who were administered transfusion of packed red blood cells were included after obtaining informed consent. All patients were managed as per the standard protocol with intravenous terlipressin along with band ligation and injection of cyanoacrylate in cases of esophageal and fundal varices, respectively. Hemoglobin and hematocrit were measured every 6 h for 48 h and then every 12 h until 5 days of index bleed in each patient. Packed cells were transfused if hemoglobin decreased below 8 g/dl. The number of blood units transfused, change in hemoglobin values, and ABRI were calculated after each unit of blood transfusion till 120 h. In patients in whom bleed could not be controlled, an ABRI value of 0.75 or more was compared with other Baveno IV-based parameters that define failure to control variceal bleeding. During the study period, 137 eligible patients with variceal bleed were admitted. The mean age of the patients was 52±12 years. The majority of patients (50.4%) were in Child-Pugh class B, followed by 38% in Child-Pugh class C. According to the Baveno IV criteria, overall failure to control acute variceal bleeding occurred in 52 (37.9%) patients. Excluding ABRI, failure to control bleeding was found in 22/137 (16%) patients, whereas ABRI-based criteria showed that in 34/137 (24.8%) patients, bleeding could not be controlled. There were only four (2.9%) patients with variceal bleeding in whom ABRI and

  16. 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.

  17. 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)

    Adithan, Subathra; Venkatesan, Bhuvaneswari; Sundarajan, Elangovan; Kate, Vikram; Kalayarasan, Raja

    2010-01-01

    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

  18. Transcatheter arterial embolization for endoscopically unmanageable non-variceal upper gastrointestinal bleeding.

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    Lee, Han Hee; Park, Jae Myung; Chun, Ho Jong; Oh, Jung Suk; Ahn, Hyo Jun; Choi, Myung-Gyu

    2015-07-01

    Transcatheter arterial embolization (TAE) is a therapeutic option for endoscopically unmanageable upper gastrointestinal (GI) bleeding. We aimed to assess the efficacy and clinical outcomes of TAE for acute non-variceal upper GI bleeding and to identify predictors of recurrent bleeding within 30 days. Visceral angiography was performed in 66 patients (42 men, 24 women; mean age, 60.3 ± 12.7 years) who experienced acute non-variceal upper GI bleeding that failed to be controlled by endoscopy during a 7-year period. Clinical information was reviewed retrospectively. Outcomes included technical success rates, complications, and 30-day rebleeding and mortality rates. TAE was feasible in 59 patients. The technical success rate was 98%. Rebleeding within 30 days was observed in 47% after an initial TAE and was managed with re-embolization in 8, by endoscopic intervention in 5, by surgery in 2, and by conservative care in 12 patients. The 30-day overall mortality rate was 42.4%. In the case of initial endoscopic hemostasis failure (n = 34), 31 patients underwent angiographic embolization, which was successful in 30 patients (96.8%). Rebleeding occurred in 15 patients (50%), mainly because of malignancy. Two factors were independent predictors of rebleeding within 30 days by multivariate analysis: coagulopathy (odds ratio [OR] = 4.37; 95% confidence interval [CI]: 1.25-15.29; p = 0.021) and embolization in ≥2 territories (OR = 4.93; 95% CI: 1.43-17.04; p = 0.012). Catheterization-related complications included hepatic artery dissection and splenic embolization. TAE controlled acute non-variceal upper GI bleeding effectively. TAE may be considered when endoscopic therapy is unavailable or unsuccessful. Correction of coagulopathy before TAE is recommended.

  19. Endoscopic Sclerotherapy for Bleeding Oesophageal Varices: Experience in Gezira State, Sudan

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    Moawia Elbalal Mohammed

    2011-01-01

    Full Text Available Introduction Bleeding due to oesophageal varices is the most common cause of upper gastrointestinal tract haemorrhage in Gezira State, Central Sudan. 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. Objectives A retrospective study to evaluate the outcome of (EST in the management of bleeding oesophageal varices due to portal hypertension in Gezira State, the centre of a developing country, Sudan. Methods A total of 1073 patients, during 2001-2010, were carefully selected particularly those with bleeding oesophageal varices consequent to portal hypertension. EST was performed using a standard technique and ethanolamine oleate (5% was utilized as sclerosing agent. Results There were 777 males (72.4% and 296 females (27.6% in a ratio of 2.6. The causes of portal hypertension were found to be schistosomal periportal fibrosis (PPF in 1001 (93.3% patients, liver cirrhosis in 60 (5.5% mixed PPF and cirrhosis in seven (0.7% and portal vein thrombosis in five (0.5% patients. Full obliteration of varices required a mean of four sessions with a range of 2-6. In the present study 350 (32.6% patients have been followed up until complete sclerosis of varices. Conclusion This study provides evidence that endoscopic injection sclerotherapy is an important component in the management of bleeding oesophageal varices caused by hypertension. It is a safe and effective procedure.

  20. Efficacy of carvedilol versus propranolol versus variceal band ligation for primary prevention of variceal bleeding.

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    Abd ElRahim, Ayman Yosry; Fouad, Rabab; Khairy, Marwa; Elsharkawy, Aisha; Fathalah, Waleed; Khatamish, Haytham; Khorshid, Omayma; Moussa, Mona; Seyam, Moataz

    2018-01-01

    Band ligation and propranolol are the current therapies for primary prevention of variceal bleeding. Carvedilol is a rising nonselective beta-blocker used for reducing portal pressure with favorable outcome. The aim of this study to assess the efficacy of carvedilol, propranolol, and band ligation for primary prevention of variceal bleeding based on the effect of each regimen on progression of Child score and portal hypertensive gastropathy after 1 year. The study included 264 cirrhotic patients with medium/large-sized varices who were candidates for primary prophylaxis of variceal bleeding. Patients were randomly divided into three groups: group I: band ligation; group II: propranolol; group III: carvedilol. Group I showed higher success rate of 75 %, followed by group III with 70.2 % and group II with 65.2 %. Risk of bleeding was comparable between the three groups, with group II carrying the highest rate of complications (34.7 %) followed by group III (14.2 %) and finally group I (5.7 %). After 1 year of follow-up, Child score did not improve in any of the studied groups, while portal hypertensive gastropathy significantly increased in group I but decreased in groups II and III. Band ligation is the best treatment option for primary prevention of variceal bleeding with minimal complications. Carvedilol is a good pharmaceutical alternative medicine to propranolol with lesser side-effects. Progress of liver disease as represented by Child score is not affected by any of the primary variceal prophylactic regimens, although medical treatment reduces portal hypertensive gastropathy. Choice of treatment depends on patient will, compliance with treatment, and endoscopist competence.

  1. Portal hypertension in children: High-risk varices, primary prophylaxis and consequences of bleeding.

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    Duché, Mathieu; Ducot, Béatrice; Ackermann, Oanez; Guérin, Florent; Jacquemin, Emmanuel; Bernard, Olivier

    2017-02-01

    Primary prophylaxis of bleeding is debated for children with portal hypertension because of the limited number of studies on its safety and efficacy, the lack of a known endoscopic pattern carrying a high-risk of bleeding for all causes, and the assumption that the mortality of a first bleed is low. We report our experience with these issues. From 1989 to 2014, we managed 1300 children with portal hypertension. Endoscopic features were recorded; high-risk varices were defined as: grade 3 esophageal varices, grade 2 varices with red wale markings, or gastric varices. Two hundred forty-six children bled spontaneously and 182 underwent primary prophylaxis. The results of primary prophylaxis were reviewed as well as bleed-free survival, overall survival and life-threatening complications of bleeding. High-risk varices were found in 96% of children who bled spontaneously and in 11% of children who did not bleed without primary prophylaxis (pportal hypertension. Life-threatening complications of bleeding were recorded in 19% of children with cirrhosis and high-risk varices who bled spontaneously. Ten-year probabilities of bleed-free survival after primary prophylaxis in children with high-risk varices were 96% and 72% for non-cirrhotic causes and cirrhosis respectively. Ten-year probabilities of overall survival after primary prophylaxis were 100% and 93% in children with non-cirrhotic causes and cirrhosis respectively. In children with portal hypertension, bleeding is linked to the high-risk endoscopic pattern reported here. Primary prophylaxis of bleeding based on this pattern is fairly effective and safe. In children with liver disease, the risk of bleeding from varices in the esophagus is linked to their large size, the presence of congestion on their surface and their expansion into the stomach but not to the child's age nor to the cause of portal hypertension. Prevention of the first bleed in children with high-risk varices can be achieved by surgery or endoscopic

  2. ENDOSCOPIC DIAGNOSIS AND THERAPY IN GASTRO-ESOPAGEAL VARICEAL BLEEDING

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    Sanyal, Arun J.

    2016-01-01

    Gastroesophageal variceal hemorrhage is a medical emergency with high morbidity and mortality. Endoscopic therapy is the mainstay of management of bleeding varices. It requires attention to technique and the appropriate choice of therapy for a given patient at a given point in time. Subjects must be monitored continuously after initiation of therapy for control of bleeding and second line definitive therapies introduced quickly if endoscopic and pharmacologic treatment fails. PMID:26142034

  3. RESEARCH Endoscopic injection sclerotherapy for bleeding varices ...

    African Journals Online (AJOL)

    Portal hypertension due to intrahepatic disease or extrahepatic portal vein obstruction (EHPVO) is an important cause of upper gastro- intestinal bleeding in children. About 50% of children with EHPVO present with bleeding from oesophageal varices.1-3 Improvements in the management of children with intrahepatic ...

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

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    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.

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

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    Asgher, S.; Saleem, M.K.

    2015-01-01

    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)

  6. Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review.

    Science.gov (United States)

    Park, Sang Woo; Cho, Eunae; Jun, Chung Hwan; Choi, Sung Kyu; Kim, Hyun Soo; Park, Chang Hwan; Rew, Jong Sun; Cho, Sung Bum; Kim, Hee Joon; Han, Mingui; Cho, Kyu Man

    2017-01-01

    Ectopic variceal bleeding is a rare (2-5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results. We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years. All patients were diagnosed with liver cirrhosis presenting melena or hematemesis. All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case). Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case. EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

  7. Endocrine carcinoma of the pancreatic tail exhibiting gastric variceal bleeding

    Directory of Open Access Journals (Sweden)

    Si-Yuan Wu

    2014-01-01

    Full Text Available Nonfunctional endocrine carcinoma of the pancreas is uncommon. Without excess hormone secretion, it is clinically silent until the enlarging or metastatic tumor causes compressive symptoms. Epigastric pain, dyspepsia, jaundice, and abdominal mass are the usual symptoms, whereas upper gastrointestinal (GI bleeding is rare. Here, we describe the case of a 24-year-old man with the chief complaint of hematemesis. Upper GI panendoscopy revealed isolated gastric varices at the fundus and upper body. Ultrasonography and computed tomography showed a tumor mass at the pancreatic tail causing a splenic vein obstruction, engorged vessels near the fundus of the stomach, and splenomegaly. After distal pancreatectomy and splenectomy, the bleeding did not recur. The final pathologic diagnosis was endocrine carcinoma of the pancreas. Gastric variceal bleeding is a possible manifestation of nonfunctional endocrine carcinoma of the pancreas if the splenic vein is affected by a tumor. In non-cirrhotic patients with isolated gastric variceal bleeding, the differential diagnosis should include pancreatic disorders.

  8. 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...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a reduction...... in portal pressure is associated with a better control of bleeding and may facilitate later endoscopic procedures. Vasopressin and its analogues Terlipressin and somatostatin and analogues are the two types of medicine, which has been evaluated. In meta-analysis, only Terlipressin have demonstrated effects...

  9. 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.

  10. Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding.

    Science.gov (United States)

    Alharbi, Ahmad; Almadi, Majid; Barkun, Alan; Martel, Myriam

    2012-04-01

    Patients with upper gastrointestinal bleeding (UGIB) require an early, tailored approach best guided by knowledge of the bleeding lesion, especially a variceal versus a nonvariceal source. To identify, by investigating a large national registry, variables that would be predictive of a variceal origin of UGIB using clinical parameters before endoscopic evaluation. A retrospective study was conducted in 21 Canadian hospitals during the period from January 2004 until the end of May 2005. Consecutive charts for hospitalized patients with a primary or secondary discharge diagnosis of UGIB were reviewed. Data regarding demographics, including historical, physical examination, initial laboratory investigations, endoscopic and pharmacological therapies administered, as well as clinical outcomes, were collected. Multivariable logistic regression modelling was performed to identify clinical predictors of a variceal source of bleeding. The patient population included 2020 patients (mean [± SD] age 66.3±16.4 years; 38.4% female). Overall, 215 (10.6%) were found to be bleeding from upper gastrointestinal varices. Among 26 patient characteristics, variables predicting a variceal source of bleeding included history of liver disease (OR 6.36 [95% CI 3.59 to 11.3]), excessive alcohol use (OR 2.28 [95% CI 1.37 to 3.77]), hematemesis (OR 2.65 [95% CI 1.61 to 4.36]), hematochezia (OR 3.02 [95% CI 1.46 to 6.22]) and stigmata of chronic liver disease (OR 2.49 [95% CI 1.46 to 4.25]). Patients treated with antithrombotic therapy were more likely to experience other causes of hemorrhage (OR 0.44 [95% CI 0.35 to 0.78]). Presenting historical and physical examination data, and initial laboratory tests carry significant predictive ability in discriminating variceal versus nonvariceal sources of bleeding.

  11. Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review.

    Science.gov (United States)

    Loudin, Michael; Anderson, Sharon; Schlansky, Barry

    2016-10-24

    Proximal or 'downhill' esophageal varices are a rare cause of upper gastrointestinal hemorrhage. Unlike the much more common distal esophageal varices, which are most commonly a result of portal hypertension, downhill esophageal varices result from vascular obstruction of the superior vena cava (SVC). While SVC obstruction is most commonly secondary to malignant causes, our review of the literature suggests that benign causes of SVC obstruction are the most common cause actual bleeding from downhill varices. Given the alternative pathophysiology of downhill varices, they require a unique approach to management. Variceal band ligation may be used to temporize acute variceal bleeding, and should be applied on the proximal end of the varix. Relief of the underlying SVC obstruction is the cornerstone of definitive treatment of downhill varices. A young woman with a benign superior vena cava stenosis due to a tunneled internal jugular vein dialysis catheter presented with hematemesis and melena. Urgent upper endoscopy revealed multiple 'downhill' esophageal varices with stigmata of recent hemorrhage. As there was no active bleeding, no endoscopic intervention was performed. CT angiography demonstrated stenosis of the SVC surrounding the distal tip of her indwelling hemodialysis catheter. The patient underwent balloon angioplasty of the stenotic SVC segment with resolution of her bleeding and clinical stabilization. Downhill esophageal varices are a distinct entity from the more common distal esophageal varices. Endoscopic therapies have a role in temporizing active variceal bleeding, but relief of the underlying SVC obstruction is the cornerstone of treatment and should be pursued as rapidly as possible. It is unknown why benign, as opposed to malignant, causes of SVC obstruction result in bleeding from downhill varices at such a high rate, despite being a less common etiology of SVC obstruction.

  12. Surgical management of bleeding esopageal varices: the Tikur Anbessa hospital experience.

    Science.gov (United States)

    Kassa, Endale; Jhonson, Orval

    2005-10-01

    Surgery is one of the modalities of treatment of portal hypertension with bleeding esophageal varices. Between 1992 and 2003, a total of 33 patients with esophageal varices secondary to hepatic or pre-hepatic causes of portal hypertension underwent proto-azygeal disconnection surgery at Tikur Anbessa Hospital, Addis Ababa University. Twenty-five, (69. 7%) were men and 8 (24.3%) were women. Their age ranged between 13 and 54 years with a mean age of 24.3 years. Eighty two percent of the patients had hematemesis and melena. Thirty-two, (97%) patients had splenomegaly and of these; 27 (84%) had splenomegaqly with hyperslenism. Twenty-one, (63.6%) and 12 (36.6%) patients had child's A and B functional class, respectively. None of the patients was in class C. The condition of the liver as assessed macroscopically at surgery showed portal fibrosis in 22 (66.7%), cirrhosis in 3 (9.1%) and normal liver in 8 (24.2%) patients. There was no significant correlation between variceal bleeding episode and type of liver pathology. Four patients (12%) died after surgery and re-bleeding occurred in one (3%) patients. Porto-azygeal disconnection surgery can be done safely in patients with esophageal varices and good liver function in order to prevent further bleeding episode.

  13. Circadian occurrence of variceal bleeding in patients with liver cirrhosis.

    Science.gov (United States)

    Siringo, S; Bolondi, L; Sofia, S; Hermida, R C; Gramantieri, L; Gaiani, S; Piscaglia, F; Carbone, C; Misitano, B; Corinaldesi, R

    1996-12-01

    Several clinical events have a rhythmicity over the 24 h period. We assessed the presence of periodic rhythm in the occurrence of haematemesis in patients with liver cirrhosis under different daylight regimens, namely during standard time and during daylight savings. Over a 48 month period there were 212 consecutive admissions of 118 cirrhotics with variceal bleeding. Complete data were available for 181 episodes of bleeding: 121 (66.9%) started with haematemesis and 60 (33.1%) started with melaena. One hundred and two (56%) episodes occurred during daylight savings and 79 (44%) occurred during standard time. The cosinor test showed a 24 h biphasic peak for the occurrence of haematemesis (09.45 and 21.45 h). Moreover, a biphasic diurnal asymmetric frequency was also found by multiple component rhythmometry. The time peaks of onset of variceal haemorrhage did not change significantly during standard time and daylight savings. Patients with more than one haematemesis episode significantly bled over the same time interval. The present study confirms that over the 24 h period variceal bleeding in cirrhotic patients occurs with a predictable rhythmicity that does not seem to be under the control of the light-dark cycle. The finding of a chronorisk for variceal haemorrhage addresses specific questions for pathophysiological studies as well as for new treatment strategies.

  14. 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.

  15. [Related factors to re-bleeding and mortality in cirrhotic patients with acute variceal bleeding at Hipolito Unanue Hospital, Lima, Peru].

    Science.gov (United States)

    Parra Pérez, Víctor Felipe; Raymundo Cajo, Roxana Magali; Gutiérrez de Aranguren, Constantino Fernando

    2013-01-01

    To determine related factors to 5 days re-bleeding and 6 week-mortality of an episode of variceal bleeding in cirrhotic patients. Observational, descriptive, co relational, retrospective study. In this study were included the cirrhotic patients who entered to Hipolito Unanue Hospital, Lima, Peru, between January 2006 and February 2012 with suspicion of variceal bleeding. Were excluded patients who bled from nonvariceal origin, or that did not have the data in clinical history to calculate the Child Pugh score, the Model for terminal diseases of the liver (MELD), or the endoscopic report detailing the bleeding source and the presence of esophageal and/or gastric varices. We include 63 patients, 35 (55.6%) were men. The median of age was of 64 years. 26 of them (41.3%) were Child Pugh C, where as the median of MELD score was 9. The multivariate analysis found that the Child Pugh score was related to 6 weeks-mortality (p=0,003), where as the presence of active bleeding during endoscopy (p=0.012) and the value of creatinine (p=0.012) were related to 5 days re-bleeding. The Child Pugh score was related to 6 weeks-mortality in cirrhotic patients with variceal bleeding. Active bleeding during endoscopy and the value of creatinine were related to 5 days re-bleeding.

  16. Obliteration of gastric bleeding varices with NBCA

    International Nuclear Information System (INIS)

    Jiang Zaibo; Li Zhengran; Qian Jiesheng; Zhu Kangshun; Huang Mingsheng; Zhao Dabing; Pang Pengfei; Guan Shouhai; Shan Hong

    2007-01-01

    Objective: To study the feasibility of obliteration with NBCA(N-Butyl-2-Cyanoacrylate)for the treatment of gastric bleeding varices in terminal stage of portal hypertension. Methods: All 17 cases of upper gastrointestinal hemorrhage with portal hypertension, mean age 54 years, including 11 cases of advanced hepatocellular carcinoma with portal venous tumor emboli, 6 eases of cirrhosis and 3 cases with moderate to severe ascites; were selected for this study. According to the Child-Pugh classification, 3 cases were in class B and 14 cases in class C at admission. Left gastric, posterior and short gastric varices were shown in all patients on CT or MRI enhancement scannings, together with splenorenal and gastrorenal shunts in 3 and 3 cases respectively. Seven cases were approached through right midaxillary line transhepatic route, 4 cases through infra-cartilago ensiformis transhepatic route, and 6 cases through transsplenic approach. Nine eases took scheduled operation, and 8 cases under emergency operation. According to blood flow rate and variceal internal diameter, the proportion 1:4 of NBCA and lipiodol was selected for the embolization. The survival and symptom relief of the patients were followed up. Results: All cases were successfully engaged in embolization with NBCA, with all varices disappeared on post-operation angiography and CT enhancement scanning during follow-up. Pressure of portal vein rised 3 cmH 2 O after operation with one case having with transient irritable cough. The average survival time was over 5 months during 3-12 months follow-up. Four cases died postoperatively because of hepatic function exhaustion. Conclusion: Utilization of NBCA in obliteration for gastric bleeding varices is effective, feasible and reliable; with less complication, Keeping strict indications would surely raise the long-term efficacy. (authors)

  17. 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.)

  18. Portographic Evaluation for Recurrent Esophagogastric Varices Following Devascularization Surgery

    International Nuclear Information System (INIS)

    Hsieh, J.-S.; Huang, C.-J.; Wang, J.-Y.; Huang, T.-J.

    1996-01-01

    Purpose: To investigate, by transhepatic portography, the changes in portosystemic collaterals and recurrent esophagogastric varices after devascularization surgery. Methods: Thirty-five patients, who had undergone devascularization surgery 2 - 8 years previously, underwent follow-up portography and the collaterals and drainage routes were compared with preoperative portography results. Results: Newly formed collaterals were present in 30 of 35 patients and the origins and drainage routes differed from preoperative ones. Most common were new collaterals arising from the junction of the portal and superior mesenteric veins; the next most frequent arose from a main portal branch, the portal trunk, or the superior mesenteric vein. New collaterals with recurrent varices were seen in 20 patients and without varices in 10; 5 patients had no collaterals or varices.Conclusion: Since the development of new collaterals is common in portal hypertensive patients following devascularization surgery, regular follow-up for recurrent varices is necessary

  19. Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed.

    Science.gov (United States)

    Mukkada, Roy J; Antony, Rajesh; Chooracken, Mathew J; Francis, Jose V; Chettupuzha, Antony P; Mathew, Pradeep G; Augustine, Philip; Koshy, Abraham

    2018-04-09

    N-butyl-cyanoacrylate injection is recommended in bleeding/recently bled gastric varices. However, cyanoacrylate injection is associated with re-bleed in 25% to 50% of patients. Endoscopic ultrasound (EUS)-guided coil application is an emerging treatment modality for bleeding gastric varices. The aim of this study was to compare EUS-guided coil application combined with or without cyanoacrylate glue injection to injection alone in post-glue gastric variceal re-bleed. A retrospective analysis of a prospectively maintained database was performed. Thirty patients who re-bled after cyanoacrylate injection and who had EUS-guided coil application to gastric varices were included. The comparison was done with data of 51 patients who had only repeat cyanoacrylate injection. Both groups had a follow up for 12 months. EUS-guided coil application was done under endosonographic guidance. A single coil was placed in 7, two coils in each of 13 patients, three in 5, four in 3, five in one, and 6 coils in one patient. In addition, cyanoacrylate glue injection was given in 15 patients. Eight patients had repeat EUS-guided coil application 1 month later. Re-bleed and mortality were assessed. Coilng: Six out of 30 (20%) patients re-bled during follow up of 9 to 365 days. Three out of 30 (10%) died. One patient died 9 days after the procedure due to acute respiratory distress syndrome, one died 4 months after the procedure due to a re-bleed and one 5 months after the procedure due to spontaneous bacterial peritonitis. Glue only: 26/51 (51%) re-bled during follow up of 45 to 365 days. EUS-guided coil application resulted in significantly less re-bleed than glue-only (Kaplan-Meir survival analysis with log-rank test, z = 5.4, p guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed.

  20. Comparison of Endoscopic Variceal Ligation and Nadolol Plus Isosorbide-5-mononitrate in the Prevention of First Variceal Bleeding in Cirrhotic Patients

    Directory of Open Access Journals (Sweden)

    Huay-Min Wang

    2006-10-01

    Conclusion: Our preliminary results suggest that endoscopic variceal ligation is similar to the combination of nadolol plus ISMN with regard to effectiveness and safety in the prevention of first variceal bleeding in patients with cirrhosis.

  1. 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. © 2016 Japan Gastroenterological Endoscopy Society.

  2. Efficacy of endoscopic histoacryl injection in treatment of gastric variceal bleeding caused by regional portal hypertension

    Directory of Open Access Journals (Sweden)

    TANG Shanhong

    2015-08-01

    Full Text Available Objective To analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. Methods The endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis-related portal hypertension. Between-group comparison of categorical data was made by Fisher′s test. Results In patients with regional portal hypertension, five of them had severe isolated gastric varices (IGV and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis-related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short-term response rate (1/6 vs 6/6, P=0.015 and long-term response rate (0/6 vs 5/6, P=0.015. Conclusion The gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.

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

    Science.gov (United States)

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Ectopic Varices in the Gastrointestinal Tract: Short- and Long-Term Outcomes of Percutaneous Therapy

    International Nuclear Information System (INIS)

    Macedo, Thanila A.; Andrews, James C.; Kamath, Patrick S.

    2005-01-01

    To evaluate the results of percutaneous management of ectopic varices, a retrospective review was carried out of 14 patients (9 men, 5 women; mean age 58 years) who between 1992 and 2001 underwent interventional radiological techniques for management of bleeding ectopic varices. A history of prior abdominal surgery was present in 12 of 14 patients. The interval between the surgery and percutaneous intervention ranged from 2 to 38 years. Transhepatic portal venography confirmed ectopic varices to be the source of portal hypertension-related gastrointestinal bleeding. Embolization of the ectopic varices was performed by a transhepatic approach with coil embolization of the veins draining into the ectopic varices. Transjugular intrahepatic portosystemic shunt (TIPS) was performed in the standard fashion. Eighteen procedures (12 primary coil embolizations, 1 primary TIPS, 2 re-embolizations, 3 secondary TIPS) were performed in 13 patients. One patient was not a candidate for percutaneous treatment. All interventions but one (re-embolization) were technically successful. In 2 of 18 interventions, re-bleeding occurred within 72 hr (both embolization patients). Recurrent bleeding (23 days to 27 months after initial intervention) was identified in 9 procedures (8 coil embolizations, 1 TIPS due to biliary fistula). One patient had TIPS revision because of ultrasound surveillance findings. New encephalopathy developed in 2 of 4 TIPS patients. Percutaneous coil embolization is a simple and safe treatment for bleeding ectopic varices; however, recurrent bleeding is frequent and reintervention often required. TIPS can offer good control of bleeding at the expense of a more complex procedure and associated risk of encephalopathy

  5. [Comparison of band ligation with sclerotherapy for the treatment of bleeding esophageal varices].

    Science.gov (United States)

    Ríos, Eddy; Sierralta, Armando; Abarzúa, Marigraciela; Bastías, Joaquín; Barra, María Inés

    2012-06-01

    Endoscopic band ligation is the treatment of choice for bleeding esophageal varices. However it is not clear if this procedure is associated with less early and late mortality than sclerotherapy. To assess rates of re-bleeding and mortality in cohorts of patients with bleeding esophageal varices treated with endoscopic injection or band ligation. Analysis of medical records and endoscopy reports of two cohorts of patients with bleeding esophageal varices, treated between 1990 and 2010. Of these, 54 patients were treated with sclerotherapy and 90 patients with band ligation. A third cohort of 116 patients that did not require endoscopic treatment, was included. The mean analyzed follow up period was 2.5 years (range 1-16). Collection of data was retrospective for patients treated with sclerotherapy and prospective for patients treated with band ligation. Rates of re-bleeding and medium term mortality were assessed. During the month ensuing the first endoscopic treatment, re-bleeding was recorded in 39 and 72% of patients treated with band ligation and sclerotherapy, respectively (p < 0.01). The relative risk of bleeding after band ligation was 0.53 (95% confidence limits 0.390.73). Death rates until the end of follow up were 20 and 48% among patients with treated with band ligation and sclerotherapy, respectively (p < 0.01), with a relative risk of dying for patients subjected to band ligation of 0.41 (95% confidence limits 0.25-0.68). Band ligation was associated with lower rates of re-bleeding and mortality in these cohorts of patients.

  6. A Randomized Controlled Study of Fuzheng Huayu Capsule for Prevention of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis

    Directory of Open Access Journals (Sweden)

    Jie Gu

    2013-01-01

    Full Text Available To elucidate the role of Fuzheng Huayu Capsule, a herbal formula, in the prevention of esophageal variceal bleeding in cirrhotic patients, a multicenter randomized and placebo-controlled trial was carried out. One hundred forty-six cirrhotic patients with esophageal varices were enrolled to compare the probability of upper gastrointestinal bleeding and survival between Fuzheng Huayu Capsule group and controlled group for the duration of 2 years. The results demonstrated that the FZHYC could effectively reduce the risk of variceal bleeding and improve survival rates for cirrhotic patients with varices, especially the combination of the capsule and Propranolol, which presented a better effect; FZHYC could reduce the varices size in patients with small ones. Its effect may be related to the amelioration of hepatic fibrosis.

  7. Early initiation of beta blockers following primary endoscopic therapy for bleeding esophageal varices in cirrhotics

    International Nuclear Information System (INIS)

    Salim, A.; Malik, K.; Farooq, M.O.; Butt, U.; Butt, A.K.

    2017-01-01

    Beta-blockers provide secondary prophylaxis following endoscopic therapy for variceal bleeding. Guidelines recommend starting beta-blockers 6 days after endoscopy to prevent masking hemodynamic signs of rebleeding. We aimed to see safety of earlier initiation of beta-blockers. Methods: Cirrhotic patients with upper GI bleed were given I.V vasoactive agents until undergoing endoscopy. Patients with only esophageal varices as source of bleed were recruited. Vasoactive agents were discontinued following variceal banding. The patients were observed for 12-18 hours, discharged on oral carvedilol 6.25 mg BID and monitored for 6 weeks for rebleeding and mortality. Results: 50 patients were included, 27 (54%) male and 23 (46%) female. Average age was 43+3 years. Etiology of cirrhosis was HCV in 42 (84%), HBV in 6 (12%), HCV and HBV in 2 (4%) and indeterminate in 1 (2%) patient. 17 (34%) patients had Child A, 22 (44%) Child B and 11 (22%) had Child C disease. Hospital stay was under 24 hours in 24 (48%), 24-48 hours in 15 (30%) and 48-72 hours in 11 (22%) patients. 5 (10%) patients underwent EGD within 6 hours of admission, 28 (56%) within 12 hours, 14 (28%) within 24 hours and 3 (6%) within 36 hours. No rebleeding, mortality or drug related adverse effects were noted during 6 weeks after discharge. Conclusions:Our study proves possibility of shorter management of variceal bleeding by having a 12-18 hour monitoring after endoscopic banding, followed by beta-blocker initiation and discharge. This will safely reduce physical and financial burden on health services. Background: Beta-blockers provide secondary prophylaxis following endoscopic therapy for variceal bleeding. Guidelines recommend starting beta-blockers 6 days after endoscopy to prevent masking hemodynamic signs of re-bleeding. We aimed to see safety of earlier initiation of beta-blockers. Methods: Cirrhotic patients with upper GI bleed were given intravenous vasoactive agents until undergoing endoscopy. Patients

  8. Prevention and management of gastroesophageal varices.

    Science.gov (United States)

    Seo, Yeon Seok

    2018-03-01

    Bleeding from gastroesophageal varices is a serious complication in patients with liver cirrhosis and portal hypertension. Although there has been significance improvement in the prognosis of variceal bleeding with advancement in diagnostic and therapeutic modalities for its management, mortality rate still remains high. Therefore, appropriate prevention and rapid, effective management of bleeding from gastroesophageal varices is very important. Recently, various studies about management of gastoesophageal varices, including prevention of development and aggravation of varices, prevention of first variceal bleeding, management of acute variceal bleeding, and prevention of variceal rebleeding, have been published. The present article reviews published articles and practice guidelines to present the most optimal management of patients with gastroesophageal varices.

  9. 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.

  10. 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

  11. 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....

  12. Usefulness of Transjugular Intrahepatic Portosystemic Shunt in the Management of Bleeding Ectopic Varices in Cirrhotic Patients

    International Nuclear Information System (INIS)

    Vidal, V.; Joly, L.; Perreault, P.; Bouchard, L.; Lafortune, M.; Pomier-Layrargues, G.

    2006-01-01

    Purpose. To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the control of bleeding from ectopic varices. Methods. From 1995 to 2004, 24 cirrhotic patients, bleeding from ectopic varices, mean age 54.5 years (range 15-76 years), were treated by TIPS. The etiology of cirrhosis was alcoholic in 13 patients and nonalcoholic in 11 patients. The location of the varices was duodenal (n = 5), stomal (n = 8), ileocolic (n = 6), anorectal (n = 3), umbilical (n = 1), and peritoneal (n 1). Results. TIPS controlled the bleeding in all patients and induced a decrease in the portacaval gradient from 19.7 ± 5.4 to 6.4 ± 3.1 mmHg. Postoperative complications included self-limited intra-abdominal bleeding (n = 2), self-limited hemobilia (n = 1), acute thrombosis of the shunt (n = 1), and bile leak treated by a covered stent (n = 1). Median follow-up was 592 days (range 28-2482 days). Rebleeding occurred in 6 patients. In 2 cases rebleeding was observed despite a post-TIPS portacaval gradient lower than 12 mmHg and was controlled by variceal embolization; 1 patient underwent surgical portacaval shunt and never rebled; in 3 patients rebleeding was related to TIPS stenosis and treated with shunt dilatation with addition of a new stent. The cumulative rate of rebleeding was 23% and 31% at 1 and 2 years, respectively. One- and 2-year survival rates were 80% and 76%, respectively. Conclusion. The present series demonstrates that bleeding from ectopic varices, a challenging clinical problem, can be managed safely by TIPS placement with low rebleeding and good survival rates

  13. Costs and clinical outcomes of primary prophylaxis of variceal bleeding in patients with hepatic cirrhosis: a decision analytic model.

    Science.gov (United States)

    Saab, Sammy; DeRosa, Vincent; Nieto, Jose; Durazo, Francisco; Han, Steven; Roth, Bennett

    2003-04-01

    Current guidelines recommend upper endoscopic screening for patients with hepatic cirrhosis and primary prophylaxis with a nonselective beta-blocker for those with large varices. However, only 25% of cirrhotics develop large varices. Thus, the aim of this study is to evaluate the most cost-effective approach for primary prophylaxis of variceal hemorrhage. Using a Markov model, we compared the costs and clinical outcomes of three strategies for primary prophylaxis of variceal bleeding. In the first strategy, patients were given a beta-blocker without undergoing upper endoscopy. In the second strategy, patients underwent upper endoscopic screening; those found to have large varices were treated with a beta-blocker. In the third strategy, no prophylaxis was used. Selected sensitivity analyses were performed to validate outcomes. Our results show screening prophylaxis was associated with a cost of $37,300 and 5.72 quality-adjusted life yr (QALYs). Universal prophylaxis was associated with a cost of $34,100 and 6.65 QALYs. The no prophylaxis strategy was associated with a cost of $36,600 and 4.84 QALYs. The incremental cost-effectiveness ratio was $800/QALY for the endoscopic strategy relative to the no prophylaxis strategy. Screening endoscopy was cost saving when the compliance, bleed risk without beta-blocker, and variceal bleed costs were increased, and when the discount rate, bleed risk on beta-blockers, and cost of upper endoscopy were decreased. In contrast, the universal prophylaxis strategy was persistently cost saving relative to the no prophylaxis strategy. In comparing the strategies, sensitivity analysis on the death rates from variceal hemorrhage did not alter outcomes. Our results provide economic and clinical support for primary prophylaxis of esophageal variceal bleeding in patients with hepatic cirrhosis. Universal prophylaxis with beta-blocker is preferred because it is consistently associated with the lowest costs and highest QALYs.

  14. 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...

  15. 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...

  16. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

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

  17. Poor endoscopic findings in children with non variceal upper gastrointestinal bleeding: is biopsy necessary?

    OpenAIRE

    Giannakopoulos, A; Logothetis, A; Panayiotou, J; Van-Vliet, K; Orfanou, I; Roma-Giannikou, E

    2010-01-01

    Background: Gastrointestinal bleeding in infants and children is a potentially serious condition in the practice of general pediatrics that requires investigation. The objective of this study is to describe the endoscopic and histopathological findings in children with upper gastrointestinal (UGI) bleeding of non variceal origin.

  18. An observational European study on clinical outcomes associated with current management strategies for non-variceal upper gastrointestinal bleeding (ENERGIB-Turkey).

    Science.gov (United States)

    Mungan, Zeynel

    2012-01-01

    This observational, retrospective cohort study assessed outcomes of the current management strategies for nonvariceal upper gastrointestinal bleeding in several European countries (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) (NCT00797641; ENERGIB). Turkey contributed 23 sites to this study. Adult patients (≥18 years old) consecutively admitted to hospital and who underwent endoscopy for overt non-variceal upper gastrointestinal bleeding (hematemesis, melena or hematochezia, with other clinical/laboratory evidence of acute upper GI blood loss) were included in the study. Data were collected from patient medical records regarding bleeding continuation, re-bleeding, pharmacological treatment, surgery, and mortality during a 30-day follow-up period. A total of 423 patients (67.4% men; mean age: 57.8 ± 18.9 years) were enrolled in the Turkish study centers, of whom 96.2% were admitted to hospital with acute non-variceal upper gastrointestinal bleeding. At admission, the most common symptom was melena (76.1%); 28.6% of patients were taking aspirin, 19.9% were on non-steroidal anti-inflammatory drugs, and 7.3% were on proton pump inhibitors. The most common diagnoses were duodenal (45.2%) and gastric (27.7%) ulcers and gastritis/gastric erosions (26.2%). Patients were most often managed in general medical wards (45.4%). A gastrointestinal team was in charge of treatment in 64.8% of cases. Therapeutic procedures were performed in 32.4% of patients during endoscopy. After the endoscopy, most patients (94.6%) received proton pump inhibitors. Mean (SD) hospital stay was 5.36 ± 4.91 days. The cumulative proportions of continued bleeding/re-bleeding, complications and mortality within 30 days of the non-variceal upper gastrointestinal bleeding episode were 9.0%, 5.7% and 2.8%, respectively. In the Turkish sub-group of patients, the significant risk factors for bleeding continuation or re-bleeding were age >65 years, presentation with hematemesis or shock

  19. Esophageal variceal ligation for hemostasis of acute variceal bleeding

    African Journals Online (AJOL)

    Introduction: Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of ...

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

    Directory of Open Access Journals (Sweden)

    Fuad Maufa

    2012-01-01

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

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

    International Nuclear Information System (INIS)

    Naseer, M.; Khan, A.U.; Gillani, F.M.; Saeed, F.; Ahmed, S.

    2012-01-01

    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)

  2. Excess Long-Term Mortality following Non-Variceal Upper Gastrointestinal Bleeding: A Population-Based Cohort Study

    Science.gov (United States)

    Crooks, Colin John; Card, Timothy Richard; West, Joe

    2013-01-01

    Background It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population. Methods and Findings Linked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤50 years, 95% CI 3.0%–4.3%) to 15.2% (≥80 years, 14.2%–16.3%), representing an excess over controls of between 3.6% (3.0%–4.2%) and 13.4% (12.4%–14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤50 years, 3.4%–4.8%) to 46.6% (≥80 years, 45.2%–48.1%), representing an excess over controls of between 3.8% (3.1%–4.5%) and 19.0% (17.5%–20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets. Conclusions Deaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co

  3. A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Tammaro, Leonardo; Buda, Andrea; Di Paolo, Maria Carla; Zullo, Angelo; Hassan, Cesare; Riccio, Elisabetta; Vassallo, Roberto; Caserta, Luigi; Anderloni, Andrea; Natali, Alessandro

    2014-09-01

    Pre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding. To validate a new simplified clinical score (T-score) to assess the need of an early upper endoscopy in non variceal bleeding patients. Secondary outcomes were re-bleeding rate, 30-day bleeding-related mortality. In this prospective, multicentre study patients with bleeding who underwent upper endoscopy were enrolled. The accuracy for high risk endoscopic stigmata of the T-score was compared with that of the Glasgow Blatchford risk score. Overall, 602 patients underwent early upper endoscopy, and 472 presented with non-variceal bleeding. High risk endoscopic stigmata were detected in 145 (30.7%) cases. T-score sensitivity and specificity for high risk endoscopic stigmata and bleeding-related mortality was 96% and 30%, and 80% and 71%, respectively. No statistically difference in predicting high risk endoscopic stigmata between T-score and Glasgow Blatchford risk score was observed (ROC curve: 0.72 vs. 0.69, p=0.11). The two scores were also similar in predicting re-bleeding (ROC curve: 0.64 vs. 0.63, p=0.4) and 30-day bleeding-related mortality (ROC curve: 0.78 vs. 0.76, p=0.3). The T-score appeared to predict high risk endoscopic stigmata, re-bleeding and mortality with similar accuracy to Glasgow Blatchford risk score. Such a score may be helpful for the prediction of high-risk patients who need a very early therapeutic endoscopy. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

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

    International Nuclear Information System (INIS)

    Chevallier, P.; Motamedi, J.P.; Oddo, F.; Padovani, B.; Demuth, N.; Caroli-Bosc, F.X.

    2000-01-01

    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.)

  5. Balloon-occluded retrograde transvenous obliteration versus endoscopic injection sclerotherapy for isolated gastric varices: a comparative study.

    Science.gov (United States)

    Emori, Keigo; Toyonaga, Atsushi; Oho, Kazuhiko; Kumamoto, Masafumi; Haruta, Tsuyoshi; Inoue, Hiroto; Morita, Yukihiko; Mitsuyama, Keiichi; Tsuruta, Osamu; Sata, Michio

    2014-01-01

    Isolated gastric varices (IGV) have a lower risk of bleeding than esophageal varices, however IGV bleeding is associated with a higher mortality than bleeding of esophageal varices. In recent years, two widely used treatments for IGV have been balloon-occluded retrograde transvenous obliteration (B-RTO) and endoscopic injection sclerotherapy (EIS) using cyanoacrylate or ethanolamine oleate (EO). This study compared these two treatment methods for IGV. The subjects were 112 patients who were treated at our hospital for IGV bleeding between October 1990 and December 2003. Forty-nine (49) patients were treated with B-RTO and 63 patients with EIS. These two patient groups were compared as regards content of treatment, post-treatment incidence of variceal bleeding, incidence of IGV rebleeding, survival rate, cause of death, and complications. Multivariate analysis was performed on post-treatment variceal bleeding and survival. Although EO was used in higher amounts in the B-RTO group than in the EIS group, the B-RTO group had a significantly lower number of treatment sessions and a significantly shorter treatment period (pIGV rebleeding after treatment than the B-RTO group. Treatment method was the only independent prognostic factor of IGV bleeding after treatment (p=0.024). The two groups did not differ significantly in the percentage of patients with aggravated esophageal varices after treatment. Bleeding from ectopic varices was not observed in any patient. There was no significant difference in survival by treatment method. The presence of hepatocellular carcinoma was the only independent prognostic factor for survival (p=0.003). It is concluded that B-RTO was more effective than EIS in the eradication of IGV and prevention of IGV recurrence and rebleeding.

  6. 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...... in the study and followed up after an average observation period of 446 days (range: 5-1211 days). A total of 55 clinical, biochemical, haemodynamic, and endoscopic variables were classified as systemic haemodynamic, portal haemodynamic, or metabolic. Using univariate analysis, the following variables showed....... The prognostic significance of central circulation time stresses the importance of the hyperdynamic systemic circulation in assessing the increased risk of bleeding or death.(ABSTRACT TRUNCATED AT 250 WORDS)...

  7. 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.

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

    International Nuclear Information System (INIS)

    Chang, Min Yung; Kim, Man Deuk; Shin, Won Seon; Shin, Min Woo; Kim, Gyoung Min; Won, Jong Yun; Park, Sung Il; Lee, Do Yun; Kim, Tae Hwan

    2016-01-01

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

  9. 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.

  10. 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.

  11. Clinical outcomes and prognostic factors associated with survival after balloon-occluded retrograde transvenous obliteration of gastric varices

    International Nuclear Information System (INIS)

    Uozumi, Shojiro; Baba, Toshiyuki; Sai, Syouei; Seino, Noritaka; Hashimoto, Toshi; Honda, Minoru; Gokan, Takehiko; Imawari, Michio

    2011-01-01

    We evaluated clinical outcomes and prognostic factors associated with survival after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices in patients with portal hypertension. Of 50 patients with gastric varices who underwent B-RTO, 46 (94.0%) patients in whom B-RTO was technically successful were reviewed retrospectively. Gastric and esophageal varices after B-RTO were evaluated by contrast-enhanced computer tomography and endoscopy, respectively. Liver function parameters and Child-Pugh scores were estimated before and at 1 year after B-RTO. The cumulative survival rate was calculated, and univariate and multivariate analyses were used to assess the prognostic factors. No major complications occurred in any of the patients following B-RTO and no recurrence or bleeding of gastric varices was noted. Of the 42 patients who were followed up for the progression of esophageal varices, 13 (31.0%) had worsened varices and of these, 6 (14.3%) showed bleeding. Prothrombin activity had significantly improved at 1 year after B-RTO, although there were no changes in other liver function parameters. The overall cumulative survival rates at 1, 3, and 5 years after B-RTO were 91.6%, 70.9%, and 53.6%, respectively. Multivariate analysis identified the occurrence of advanced hepatocellular carcinoma (HCC) during the observation period as a prognostic factor for survival (hazard ratio=4.1497, 95% CI=1.32314-13.0319, P=0.0148). B-RTO of gastric varices is an effective treatment ensuring lower recurrence and bleeding rates; however, these patients require careful observation for progression of esophageal varices. The management of HCC is crucial for achieving long-term survival after B-RTO. (author)

  12. Controlling Oesophageal Variceal Bleeding by Reloading ...

    African Journals Online (AJOL)

    A special reloading kit (produced by McGown; USA) was used to reload previously used and sterilized Opti-vu caps from Saeed six shooter variceal band ligators (North Carolina, USA). Subjects with oesophageal varices underwent banding of the varices down the lower 5cm of the oesophagus using this technique.

  13. Management of non variceal upper gastrointestinal bleeding: position statement of the Catalan Society of Gastroenterology.

    Science.gov (United States)

    García-Iglesias, Pilar; Botargues, Josep-Maria; Feu Caballé, Faust; Villanueva Sánchez, Càndid; Calvet Calvo, Xavier; Brullet Benedi, Enric; Cánovas Moreno, Gabriel; Fort Martorell, Esther; Gallach Montero, Marta; Gené Tous, Emili; Hidalgo Rosas, José-Manuel; Lago Macía, Amelia; Nieto Rodríguez, Ana; Papo Berger, Michel; Planella de Rubinat, Montserrat; Saló Rich, Joan; Campo Fernández de Los Ríos, Rafel

    2017-05-01

    In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  14. Transjugular Intrahepatic Porto-Systemic Stent-Shunt for Therapy of Bleeding Esophageal Varices Due to Extramedullary Hematopoiesis in Primary Myelofibrosis: A Case Report

    OpenAIRE

    Phillip, Veit;Berger, Hermann;Straub, Melanie;Saugel, Bernd;Treiber, Matthias;Einwächter, Henrik;Schmid, Roland M.;Huber, Wolfgang

    2016-01-01

    Background: Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. Patient and Methods: We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Results: Therapy of variceal bleeding ...

  15. 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...

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

    International Nuclear Information System (INIS)

    Cui Jinguo; Zhang Shutian; Feng Zitan; Zhou Guifen; Pan Xinyuan; Liang Zhihui

    2002-01-01

    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

  17. The role of collateral veins detected by endosonography in predicting the recurrence of esophageal varices after endoscopic treatment: a systematic review.

    Science.gov (United States)

    Masalaite, Laura; Valantinas, Jonas; Stanaitis, Juozas

    2014-07-01

    Endoscopic therapy is the principal method of treatment for esophageal varices. The recurrence of varices is still common following endoscopic treatment. The aim was to identify predictive factors for variceal recurrence detected by endosonography. We performed a systematic review of studies published prior to June 2013. Studies analyzing gastroesophageal collateral veins as risk factors for variceal recurrence after endoscopic treatment were included. The primary outcome was to identify predictive factors for variceal recurrence investigated by endosonography. After a full-text review, 13 studies were included in our analysis. Analysis of risk factors was not possible for all studies included. Perforating veins and periesophageal collateral veins were related to a higher risk of variceal recurrence (OR = 3.93; 95 % CI 1.06-14.51; I (2) = 96 %; OR = 2.29; 95 % CI 1.58-3.33; I (2) = 55 %). Analysis of cardiac intramural veins and paragastric/cardiac collateral veins showed the same trend, but without reaching statistical significance because of the small group size and wide CI (OR = 3.72; 95 % CI 0.14-101.53; I (2) = 91 %; OR = 1.85; 95 % CI 0.84-4.07; I (2) = 0 %). Analysis of other collateral veins as risk factors for variceal recurrence and analysis of risk factors with regard to the endoscopic treatment method was not possible because of the limited number of cases and different methodologies. A positive association between variceal recurrence and type and grade of collateral veins, investigated by endosonography, was demonstrated. Endosonography is a promising tool for predicting recurrence of esophageal varices following endoscopic treatment. These findings should be interpreted with caution because of the heterogeneity of the studies.

  18. Transjugular intrahepatic porto-systemic stent-shunt for therapy of bleeding esophageal varices due to extramedullary hematopoiesis in primary myelofibrosis: a case report.

    Science.gov (United States)

    Phillip, Veit; Berger, Hermann; Straub, Melanie; Saugel, Bernd; Treiber, Matthias; Einwächter, Henrik; Schmid, Roland M; Huber, Wolfgang

    2012-01-01

    Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Therapy of variceal bleeding by TIPS insertion was successful. During a 29-month follow-up, no hepatic failure, hepatic encephalopathy, or further variceal bleeding episode occurred. TIPS placement is a well-established procedure for the treatment of complications due to portal hypertension mainly due to liver cirrhosis. This report illustrates that TIPS placement can also be a promising treatment option in patients with primary myelofibrosis and portal hypertension due to extramedullary hematopoiesis. Copyright © 2012 S. Karger AG, Basel.

  19. Role of endoscopic ultrasonography in treatment and prognostic evaluation of esophageal and gastric varices

    Directory of Open Access Journals (Sweden)

    LI Shuang

    2016-12-01

    Full Text Available Through a comprehensive evaluation of collateral circulation establishment in portal hypertension, endoscopic ultrasonography (EUS not only helps to predict and evaluate the risks of first bleeding from esophageal and gastric varices and recurrence and rebleeding after treatment, but also guides and participates in the treatment of varices. This article introduces the unique advantages of EUS in the treatment and prognostic evaluation of esophageal and gastric varices and provides an important reference for individualized treatment of patients with liver cirrhosis complicated by esophageal and gastric varices. EUS also helps to improve treatment safety and response rate. EUS for the systematic treatment of portal hypertension has become a hot research topic in recent years.

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

    Science.gov (United States)

    Bai, Yu; Li, Zhao Shen

    2016-02-01

    Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common medical emergencies in China and worldwide. In 2009, we published the "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" for the patients in China; however, during the past years numerous studies on the diagnosis and treatment of ANVUGIB have been conducted, and the management of ANVUGIB needs to be updated. The guidelines were updated after the databases including PubMed, Embase and CNKI were searched to retrieve the clinical trials on the management of ANVUGIB. The clinical trials were evaluated for high-quality evidence, and the advances in definitions, diagnosis, etiology, severity evaluation, treatment and prognosis of ANVUGIB were carefully reviewed, the recommendations were then proposed. After several rounds of discussions and revisions among the national experts of digestive endoscopy, gastroenterology, radiology and intensive care, the 2015 version of "Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding" was successfully developed by the Chinese Journal of Internal Medicine, National Medical Journal of China, Chinese Journal of Digestion and Chinese Journal of Digestive Endoscopy. It shall be noted that although much progress has been made, the clinical management of ANVUGIB still needs further improvement and refinement, and high-quality randomized trials are required in the future. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  1. 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.

  2. 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.

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

    International Nuclear Information System (INIS)

    Choi, Young Ho; Yoon, Chang Jin; Park, Jae Hyung; Chung, Jin Wook; Kwon, Jong Won; Choi, Guk Myung

    2003-01-01

    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

  4. Oesophageal variceal band ligation using a Saeed Six-Shooter ...

    African Journals Online (AJOL)

    Background: Oesophageal varices are common sequelae of cirrhosis, which when they bleed can be difficult to control. Oesophageal variceal band ligation, being the best modality for controlling variceal bleeding has not been common practice in West Africa, a region recognized to have a high prevalence of liver diseases.

  5. Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Ari Garber

    2016-09-01

    Full Text Available Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical, EndoClot (EndoClot Plus Inc., and Ankaferd Blood Stopper (Ankaferd Health Products, in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

  6. INVASIVE AND NON-INVASIVE TECHNIQUES FOR DETECTING PORTAL HYPERTENSION AND PREDICTING VARICEAL BLEEDING IN CIRRHOSIS: A REVIEW

    Science.gov (United States)

    Zardi, Enrico Maria; Di Matteo, Francesco Maria; Pacella, Claudio Maurizio; Sanyal, Arun J

    2016-01-01

    Portal hypertension is a severe syndrome that may derive from pre-sinusoidal, sinusoidal and post-sinusoidal causes. As a consequence, several complications (i.e., ascites, oesophageal varices) may develop. In sinusoidal portal hypertension, hepatic venous pressure gradient (HVPG) is a reliable method for defining the grade of portal pressure, establishing the effectiveness of the treatment and predicting the occurrence of complications; however, some questions exist regarding its ability to discriminate bleeding from nonbleeding varices in cirrhotic patients. Other imaging techniques (transient elastography, endoscopy, endosonography and duplex Doppler sonography) for assessing causes and complications of portal hypertensive syndrome are available and may be valuable for the management of these patients. In this review, we evaluate invasive and non-invasive techniques currently employed to obtain a clinical prediction of deadly complications, such as variceal bleeding in patients affected by sinusoidal portal hypertension, in order to create a diagnostic algorithm to manage them. Again, HVPG appears to be the reference standard to evaluate portal hypertension and monitor the response to treatment, but its ability to predict several complications and support management decisions might be further improved through the diagnostic combination with other imaging techniques. PMID:24328372

  7. Outcomes of Propofol Sedation During Emergency Endoscopy Performed for Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Park, Chan Hyuk; Han, Dong Soo; Jeong, Jae Yoon; Eun, Chang Soo; Yoo, Kyo-Sang; Jeon, Yong Cheol; Sohn, Joo Hyun

    2016-03-01

    Although propofol-based sedation can be used during emergency endoscopy for upper gastrointestinal bleeding (UGIB), there is a potential risk of sedation-related adverse events, especially in patients with variceal bleeding. We compared adverse events related to propofol-based sedation during emergency endoscopy between patients with non-variceal and variceal bleeding. Clinical records of patients who underwent emergency endoscopy for UGIB under sedation were reviewed. Adverse events, including shock, hypoxia, and paradoxical reaction, were compared between the non-variceal and variceal bleeding groups. Of 703 endoscopies, 539 and 164 were performed for non-variceal and variceal bleeding, respectively. Shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding (12.2 vs. 3.5%, P bleeding (non-variceal bleeding vs. variceal bleeding: hypoxia, 3.5 vs. 1.8%, P = 0.275; paradoxical reaction interfering with the procedure, 4.1 vs. 5.5%, P = 0.442). Although shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding, most cases could be controlled without procedure interruption. Paradoxical reaction, rather than shock or hypoxia, was the most common cause of procedure interruption in patients with variceal bleeding, but the rate did not differ between patients with non-variceal and variceal bleeding.

  8. [Frequency and mortality by rebleeding in cirrhotic patients treated for bleeding esophagic varices in two hospitals in Lima Peru during years 2009 to 2011].

    Science.gov (United States)

    Pichilingue Reto, Catherina; Queirolo Rodriguez, Fiorella Sabrinna; Ruiz Llenque, José Jonathan; Bravo Paredes, Eduar; Guzmán Rojas, Patricia; Gallegos López, Roxana; Corzo Maldonado, Manuel Alejandro; Valdivia Roldán, Mario

    2013-01-01

    During the first 6 weeks after a variceal hemorrhage there is a 30-40% of probability of recurrence and those who rebleed 20- 30% die. Passed this period, the risk of rebleeding is of 60% and reaches a mortality of 60-70% in two years without treatment. Describe the frequency of rebleeding and mortality due to rebleeding in cirrhotic patients treated for variceal hemorrhage at Endoscopic Centers of Hospital Nacional Cayetano Heredia, Lima, Peru and Hospital Nacional Arzobispo Loayza, Lima, Peru during the years 2009-2011. The study type is a transversal, periodic and retrospective one in which were included 176 cirrhotic patients older than 14 years who have bleed for esophageal varices and that have received endoscopic therapy. The instruments used were a data sheet with all the information obtained from the clinical chart of each patient, the CHILD score to assess severity of hepatic disease, endoscopic informs and phone calls. The frequency of rebleeding before 6 weeks was 32.20% (56 patients). Also, the frequency of rebleeding after that time was 22.56% (37 patients). There was a mortality rate of 5.70% (10 patients) and a mortality rate due to rebleeding of 13.33% (6 patients). Variceal hemorrhage is an important cause of mobimortality in peruvian people. The frequency of rebleeding and mortality due to rebleeding resulted slightly lower than in other countries.

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

    International Nuclear Information System (INIS)

    Shin, Hyun Woong; Ryeom, Hun Kyu; Lee, Sang Kwon; Lee, Jong Min; Kim, Young Sun; Suh, Kyung Jin; Kim, Tae Hun; Kim, Yong Joo

    1997-01-01

    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

  10. [Hospital mortality associated with upper gastrointestinal hemorrhage due to ruptured esophageal varices at the Lomé Campus Hospital in Togo].

    Science.gov (United States)

    Bouglouga, O; Bagny, A; Lawson-Ananissoh, L; Djibril, M

    2014-01-01

    To study hospital mortality associated with upper gastrointestinal hemorrhages due to variceal bleeding in the department of hepatology and gastroenterology at the Lome Campus University Hospital. This retrospective cross-sectional and analytic study examined the 55 patients admitted for variceal bleeding on upper endoscopies during the 3-year period from January 1, 2008, through December 31, 2010. These patients accounted for 4.1% of all hospitalizations during the study period in the department. Their average age was 35 years, and their sex-ratio 4. A history of chronic liver disease was found in 65.5%. Liver cirrhosis was the principal cause of the esophageal varices, complicated by hepatocellular carcinoma in 30.9% of them. The mortality rate was 25.5% and was not related to the cause of portal hypertension. All the patients with a recurrence of bleeding died. Mortality was associated with jaundice. Blood transfusion did not significantly improve the prognosis. the mortality rate among patients with upper gastrointestinal hemorrhage linked to variceal bleeding is high in our unit. The prevention of hepatitis virus B is important because it is the main cause of chronic liver disease causing portal hypertension in our department.

  11. [Can Glasgow-Blatchford Score and Pre-endoscopic Rockall Score Predict the Occurrence of Hypotension in Initially Normotensive Patients with Non-variceal Upper Gastrointestinal Bleeding?].

    Science.gov (United States)

    Kim, June Sung; Ko, Byuk Sung; Son, Chang Hwan; Ahn, Shin; Seo, Dong Woo; Lee, Yoon Seon; Lee, Jae Ho; Oh, Bum Jin; Lim, Kyoung Soo; Kim, Won Young

    2016-01-25

    The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department. Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013. Study population was divided according to the development of hypotension, and demographics, comorbidities, and laboratory findings were compared. GBS and pre-E RS were estimated to predict the occurrence of hypotension. A total of 747 patients with non-variceal upper gastrointestinal bleeding were included during the study period, and 120 (16.1%) patients developed hypotension within 24 hours after ED admission. The median values GBS and pre-E RS were statistically different according to the occurrence of hypotension (8.0 vs. 10.0, 2.0 vs. 3.0, respectively; pupper gastrointestinal bleeding. Development of other scoring systems are needed.

  12. Ileal Varices Treated with Balloon-Occluded Retrograde Transvenous Obliteration.

    Science.gov (United States)

    Sato, Takahiro; Yamazaki, Katsu; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi; Akaike, Jun

    2009-04-01

    A 55-year-old man with hepatitis B virus antigen-positive liver cirrhosis was admitted to our hospital with anal bleeding. Colonoscopy revealed blood retention in the entire colon, but no bleeding lesion was found. Computed tomography images showed that vessels in the ileum were connected to the right testicular vein, and we suspected ileal varices to be the most probable cause of bleeding. We immediately performed double balloon enteroscopy, but failed to find any site of bleeding owing to the difficulty of fiberscope insertion with sever adhesion. Using a balloon catheter during retrograde transvenous venography, we found ileal varices communicating with the right testicular vein (efferent vein) with the superior mesenteric vein branch as the afferent vein of these varices. We performed balloon occluded retrograde transvenous obliteration by way of the efferent vein of the varices and have detected no further bleeding in this patient one year after treatment.

  13. Recurrent Bleeding After Perimesencephalic Hemorrhage.

    Science.gov (United States)

    Kauw, Frans; Velthuis, Birgitta K; Kizilates, Ufuk; van der Schaaf, Irene C; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-12-01

    Perimesencephalic hemorrhage (PMH) is a type of subarachnoid hemorrhage with excellent long-term outcomes. Only 1 well-documented case of in-hospital rebleeding after PMH is described in the literature, which occurred after initiating antithrombotic treatment because of myocardial ischemia. We describe a patient with PMH without antithrombotic treatment who had 2 episodes of recurrent bleeding on the day of ictus. To validate the radiologic findings, we conducted a case-control study. Six neuroradiologists and 2 neuroradiology fellows performed a blinded assessment of serial unenhanced head computed tomography (CT) scans of 8 patients with a perimesencephalic bleeding pattern (1 index patient, 6 patients with PMH, 1 patient with perimesencephalic bleeding pattern and basilar artery aneurysm) to investigate a potential increase in amount of subarachnoid blood. A 56-year-old woman with a perimesencephalic bleeding pattern and negative CT angiography had 2 episodes after the onset headache with a sudden increase of the headache. Blinded assessment of serial head CT scans of 8 patients with a perimesencephalic bleeding pattern identified the patient who was clinically suspected to have 2 episodes of recurrent bleeding to have an increased amount of subarachnoid blood on 2 subsequent CT scans. Recurrent bleeding after PMH may also occur in patients not treated with antithrombotics. Even after early rebleeding, the prognosis of PMH is excellent. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Profilaxis preprimaria de la hemorragia por varices Pre-primary prophylaxis of variceal bleeding

    Directory of Open Access Journals (Sweden)

    R. González-Alonso

    2007-12-01

    Full Text Available La formación de colaterales portosistémicas, en especial en la unión esofagogástrica, es una de las consecuencias más graves de la hipertensión portal. El aumento de la presión portal es la fuerza más importante que dirige la formación de varices esofagogástricas, siendo necesario para que esto ocurra que la presión portal (estimada por el gradiente de presión venosa hepática alcance un valor mínimo de 10 mmHg. Posteriormente, la hiperemia esplácnica también contribuye al desarrollo de las varices. Las colaterales portosistémicas se forman por repermeabilización de vasos preexistentes, remodelado vascular y angiogénesis. El objetivo de la profilaxis preprimaria es evitar o retrasar la formación de varices esofagogástricas. En modelos experimentales de hipertensión portal, la administración precoz de vasoconstrictores esplácnicos como los beta-bloqueantes, de inhibidores de la síntesis de óxido nítrico o de sustancias anti-angiogénicas, inhibe la formación de colaterales portosistémicas. Sin embargo, los ensayos clínicos con beta-bloqueantes realizados en pacientes con cirrosis sin varices con objeto de retrasar su formación no han alcanzado los resultados esperados.Portosystemic collateral formation, particularly at the gastroesophageal junction, is a most serious consequence of portal hypertension. Increased portal pressure is the most significant force underlying gastroesophageal variceal formation, to which end portal pressure (estimated from the hepatic venous pressure gradient must reach at least 10 mmHg. Subsequently, splanchnic hyperemia also contributes to variceal development. Portoystemic collaterals result from repermeabilization of pre-extant vessels, vascular remodeling, and angiogenesis. The goal of pre-primary prophylaxis is preventing or delaying the formation of gastroesophageal varices. In experimental models of portal hypertension, early administration of splanchnic vasoconstrictors such as beta

  15. The Significance of Variceal Haemorrhage in Ghana: A Retrospective Review.

    Science.gov (United States)

    Archampong, T N A; Tachi, K; Agyei, A A; Nkrumah, K N

    2015-09-01

    This study describes the burden of bleeding oesophageal varices at the main tertiary referral centre in Accra. Retrospective design to describe the endoscopic spectrum and review mortality data following acute upper gastro-intestinal bleeding at the Korle-Bu Teaching Hospital. Endoscopic data was reviewed in the Endoscopy Unit between 2007 and 2010. Mortality data was collated from the Department of Medicine between 2010 and 2013. The study questionnaire compiled clinical and demographic characteristics, endoscopic diagnoses, length of hospital admission and treatment regimens. Aetiology and time-trend analysis of mortality rates following acute upper gastro-intestinal bleeding; variceal bleeding treatment modalities. On review of the endoscopic diagnoses, gastro-oesophageal varices were identified in 21.9% of cases followed by gastritis 21.7%, duodenal ulcer, 17.0%, and gastric ulcer, 13.2%. Gastro-oesophageal varices were the predominant cause of death from acute upper gastro-intestinal haemorrhage from 46% in 2010 to 76% in 2013. Outcomes following acute upper gastro-intestinal bleeding were dismal with some 38% of fatalities occurring within the first 24 hours. Injection sclerotherapy was the dominant endoscopic modality for secondary prevention of variceal bleeding in comparison with band ligation, mainly as a result of cost and availability. At the tertiary centre in Accra, variceal bleeding is an increasingly common cause of acute upper gastro-intestinal haemorrhage in comparison with previous reviews in Ghana. Its significantly high in-hospital mortality reflects inadequate facilities to deal with this medical emergency. A strategic approach to care with endoscopic services equipped with all the necessary therapeutic interventions will be vital in improving the outcomes of variceal bleeding in Ghana.

  16. Prevalence of Oesophageal Varices in Newly Diagnosed Chronic ...

    African Journals Online (AJOL)

    Background: Variceal bleeding is an important complication of portal ... This study was carried out to document the occurrence of oesophageal varices and its ... They had upper gastrointestinal endoscopy to detect and characterize varices.

  17. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

    Science.gov (United States)

    Biecker, Erwin

    2013-01-01

    Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

  18. Successful Embolization of Bleeding Ileal Varices with N-butyl Cyanoacrylate via a Recanalized Paraumbilical Vein.

    Science.gov (United States)

    Onishi, Yasuyuki; Kimura, Hiroyuki; Kanagaki, Mitsunori; Oka, Shojiro; Fukumoto, Genki; Otani, Tomoaki; Matsubara, Naoko; Kawabata, Kazuna; Namikawa, Mio; Matsumura, Takeshi; Kimura, Toshiyuki

    2018-04-23

    A 48-year-old woman with alcoholic liver cirrhosis was admitted to our hospital because of hematochezia and severe anemia. She had been hospitalized many times over the past year for hematochezia of unknown etiology. Contrast-enhanced CT demonstrated ileal varices, which were fed by several ileal veins. These feeding veins were selectively embolized with N-butyl cyanoacrylate (NBCA) via a recanalized paraumbilical vein. The paraumbilical vein instead of the portal vein was punctured to decrease the risk of bleeding complications because she had coagulopathy and ascites. We consider antegrade embolization of ileal varices with NBCA to be a feasible and effective treatment. Access via a paraumbilical vein is an alternative to the transhepatic approach.Level of Evidence Level V, case report.

  19. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices.

    Science.gov (United States)

    Ryan, Barbara M; Stockbrugger, Reinhold W; Ryan, J Mark

    2004-04-01

    Gastric varices (GV) occur in 20% of patients with portal hypertension either in isolation or in combination with esophageal varices (EV). There is no consensus for optimum treatment of GV and because they comprise an inhomogeneous entity, accurate classification is vital to determine the appropriate management. Gastroesophageal varices (GOV) are classified as GOV1 (EV extending down to cardia or lesser curve) or GOV2 (esophageal and fundal varices). Isolated gastric varices (IGV) may be located in the fundus (IGV1) or elsewhere in the stomach (IGV2). GV possibly bleed less frequently than EV, but GV bleeding is typically difficult to control, associated with a high risk for rebleeding, and high mortality. Fundal varices, large GV (>5 mm), presence of a red spot, and Child's C liver status are associated with a high risk for bleeding. GOV1 have a much lower risk for bleeding. A portosystemic pressure gradient of > or =12 mm Hg is not necessary for GV bleeding, probably related to the high frequency of spontaneous gastrorenal shunts in these patients. GOV1 should be treated as for EV. First-line treatment of bleeding fundal varices is endoscopic variceal obturation. TIPS is currently second-line acute treatment and is used for prevention of rebleeding. The role of some newer interventional radiologic techniques requires further appraisal. This review describes the pathophysiology, diagnosis, natural history, endoscopic, and interventional radiologic treatment options for GV.

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

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    Sanjay Gupta

    2015-01-01

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

  1. [The causes of recurrent ulcerative gastroduodenal bleeding].

    Science.gov (United States)

    Lipnitsky, E M; Alekberzade, A V; Gasanov, M R

    To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

  2. Clinical effect of esophageal variceal ligation in treatment of esophageal variceal bleeding in patients with liver cirrhosis

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    ZHANG Dongxu

    2017-01-01

    Full Text Available Objective To investigate the clinical effect of endoscopic esophageal variceal ligation (EVL in the treatment of esophageal variceal bleeding (EVB in patients with liver cirrhosis. MethodsA total of 84 liver cirrhosis patients with EVB who were admitted to The Third People′s Hospital of Shenzhen, Guangdong Medical University, from December 2010 to July 2013 were divided into ligation group (group A, treated with EVL combined with somatostatin and esomeprazole and control group (group B, treated with somatostatin and esomeprazole, with 42 patients in each group. The hemostasis rate, rebleeding rate, incidence rate of complications, and mortality rate were observed in both groups, as well as the variceal eradication rate after EVL and risk factors for early rebleeding. The t-test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between multiple groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, the Wilcoxon signed-rank sum test was used for comparison within each group, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test or Fisher′s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used to compare survival rates between groups. The logistic regression method was used to investigate the influencing factors for dichotomous data. ResultsThere was a significant difference in the hemostasis rate between groups A and B (97.62% vs 80.95%, P=0.029. Compared with group B, group A had significantly lower rebleeding rates in 1-2 years (15.38% vs 38.89%, χ2=5.323, P=0.021 and 2-3 years (15.38% vs 48.48%, χ2=10.448, P=0.001. A total of 14 patients (33.33% in group A and 7 patients (16.67% in group B experienced adverse events, and 4 patients in

  3. Correlation of adjusted blood requirement index with treatment intervention and outcome in patients presenting with acute variceal bleeding

    International Nuclear Information System (INIS)

    Zaberi, B.F.; Riaz, M.F.; Sultan, B.A.; Gobindram, P.

    2007-01-01

    To determine the correlation of ABRI with treatment intervention and outcome as discharged or expired in patients of acute variceal bleed. Records of all the patients admitted in Medical Unit-IV, Civil Hospital Karachi with acute variceal bleeding during January 2004 to October 2006 were retrieved. Use of vasoactive agents (Terlipressin/Octreotide), endoscopic band ligation (EBL) and outcome (Discharged/Expired) were noted. ABRI was calculated by the following formula. ABRI= Blood Units Transfused/((Final Hematocrit-Initial Hematocrit)+0.01) Mean ABRI were compared by student's 't' test according to vasoactive therapy, EBL and outcome. Correlation of ABRI with the same variables was also studied by plotting Receiver Operative Curves (ROC). Seventy six patients fulfilling inclusion criteria were selected. No statistically significant difference was observed in the mean ABRI scores when compared according to vasoactive drug administration, EBL and outcome. Significant correlation with mortality was seen on ROC plot with significantly larger area under the curve. (author)

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

    International Nuclear Information System (INIS)

    Budruddin, A.H.; Rasool, G.; Chaudhry, M.A.

    2006-01-01

    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)

  5. Thirty-Day Readmission Among Patients With Non-variceal Upper Gastrointestinal Hemorrhage and Effects on Outcomes.

    Science.gov (United States)

    Abougergi, Marwan S; Peluso, Heather; Saltzman, John R

    2018-03-28

    We aimed to determine the rate of hospital readmission within 30 days of non-variceal upper gastrointestinal hemorrhage and its impact on mortality, morbidity, and health care use in the United States. We performed a retrospective study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (data on 14.9 million hospital stays at 2048 hospitals in 22 states). We collected data on hospital readmissions of 203,220 adults who were hospitalized for urgent non-variceal upper gastrointestinal hemorrhage and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. The 30-day rate of readmission was 13%. Only 18% of readmissions were due to recurrent non-variceal upper gastrointestinal bleeding. The rate of death among patients readmitted to the hospital (4.7%) was higher than that for index admissions (1.9%) (P upper endoscopy, and prolonged mechanical ventilation were associated with lower odds for readmission. In a retrospective study of patients hospitalized for non-variceal upper gastrointestinal hemorrhage, 13% are readmitted to the hospital within 30 days of discharge. Readmission is associated with higher mortality, morbidity, and resource use. Most readmissions are not for recurrent gastrointestinal bleeding. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  7. Hemothorax following Uncomplicated Endoscopic Variceal Sclerotherapy and Ligation for Esophageal Varices

    Directory of Open Access Journals (Sweden)

    Tomoko Ochiai

    2017-09-01

    Full Text Available Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures. An 86-year-old man diagnosed with liver cirrhosis due to chronic hepatitis type B and alcohol abuse underwent variceal sclerotherapy using ethanolamine oleate to treat his esophageal varices. Oozing from the esophageal varices continued even after the sclerotherapy procedure; therefore, we performed endoscopic variceal ligation. The patient developed left-sided hemothorax within 24 h after treatment of his varices, and an emergency thoracotomy was performed. A pulmonary ligament of the left lung was bulging and ripping because of mediastinal hematoma, and oozing was noted. Cessation of bleeding was noted after the laceration of the left pulmonary ligament had been sutured. Ours is the first case of hemothorax reported in a patient following an uncomplicated procedure of sclerotherapy and ligation.

  8. Prevention of Esophageal Variceal Rebleeding

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    Gin-Ho Lo

    2006-12-01

    Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

  9. Effect of endoscopic injection of cyanoacrylate in treatment of acute esophageal and gastric variceal bleeding in children

    Directory of Open Access Journals (Sweden)

    ZHANG Xiaoxing

    2016-05-01

    Full Text Available ObjectiveTo investigate the effect and safety of endoscopic injection of cyanoacrylate in the treatment of esophageal and gastric variceal bleeding (EGVB in children. MethodsThe clinical data of 35 children with acute EGVB who were treated with endoscopic injection of cyanoacrylate in Children′s Hospital of Baoji Maternal and Child Health Care Hospital from August 2010 to August 2015 were analyzed retrospectively. The emergency response rate, rebleeding rate, and incidence of complications after the treatment were analyzed statistically. ResultsThirty-five patients received 46 times of endoscopic injection of cyanoacrylate in total. The response rate to the initial injection was 95.6% (44/46. The volume of cyanoacrylate injected was 0.2-0.6 ml, with a mean volume of 0.4±0.2 ml. The emergency hemostasis rate was 93.4% (43/46, the rebleeding rate was 11.4% (4/35, and the cycle for 4 patients with the recurrence of bleeding to be cured was 1.2-23.0 months (mean 121±10.9 months. One patient experienced abdominal pain, and no patients experienced ectopic embolism. Two patients died after injection. ConclusionFrequent, small-volume endoscopic injection of cyanoacrylate is an effective and convenient therapeutic method for EGVB in children, has few complications, and holds promise for clinical application.

  10. Fifty-three years' experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in Cirrhosis: 1958-2011.

    Science.gov (United States)

    Orloff, Marshall J

    2014-02-01

    Emergency treatment of bleeding esophageal varices (BEV) consists mainly of endoscopic and pharmacologic measures, with transjugular intrahepatic portal-systemic shunt (TIPS) performed when bleeding is not controlled. Surgical shunt has been relegated to salvage. At the University of California, San Diego, Medical Center, our group has conducted 10 studies of emergency portacaval shunt (EPCS) during 46 years. To describe 2 randomized clinical trials (RCTs) conducted from 1988 to 2011 in unselected consecutive patients who received emergency treatment for BEV. In RCT No. 1, a total of 211 unselected consecutive patients with cirrhosis and acute BEV were randomized to emergency endoscopic sclerotherapy (EEST) (n=106) or EPCS (n=105). In RCT No. 2, a total of 154 unselected consecutive patients with cirrhosis and acute BEV were randomized to TIPS (n=78) or EPCS (n=76). Diagnostic workup was completed within 6 hours of initial contact, and primary treatment was initiated within 8 to 12 hours. Regular follow-up for up to 10 years was accomplished in 100% of the patients. In RCT No. 1, EEST or EPCS; in RCT No. 2, TIPS or EPCS. The 2 groups were compared with regard to survival, control of bleeding, portal-systemic encephalopathy, and direct cost of care. RESULTS Distribution in Child risk classes was almost identical. One-third of patients were in Child class C. Permanent control of bleeding was achieved by EEST in only 20% of the patients and by TIPS in only 22%. In contrast, EPCS permanently controlled bleeding in 97% and 100% of the patients in RCT No. 2 and RCT No. 1, respectively (Pcases. Recurrent portal-systemic encephalopathy developed in 35% of the patients who underwent EEST and 61% of those who received TIPS. In contrast, portal-systemic encephalopathy occurred in 15% of the patients who received EPCS in RCT No. 1 and 21% of those in RCT No. 2. Direct costs of care were 5 to 7 times greater in the EEST ($168100) and TIPS ($264800) groups than in the EPCS

  11. EVALUATION OF PRIMARY PROPHYLAXIS WITH PROPRANOLOL AND ELASTIC BAND LIGATION IN VARICEAL BLEEDING IN CIRRHOTIC CHILDREN AND ADOLESCENTS

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    Júlio Rocha PIMENTA

    Full Text Available ABSTRACT Background The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. Objective The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension. Methods This is a cohort study encompassing 26 cirrhotic patients. β-blocker prophylaxis was performed with propranolol. When contraindicated the use of β-blocker, or if side effects presents, the patients were referred to endoscopic therapy with band ligation. Patients were evaluated by endoscopy, and those who had varicose veins of medium and large caliber or reddish spots, regardless of the caliber of varices, received primary prophylaxis. Results Of the 26 patients evaluated, 9 (34.6% had contraindications to the use of propranolol and were referred for endoscopic prophylaxis. Six (35.3% of the 17 patients who received β-blocker (propranolol, had bled after a median follow-up time of 1.9 years. β-blockage dosage varied from 1 mg/kg/day to 3.1 mg/kg/day and seven (41.2% patients had the propranolol suspended due to fail of the β-blockage or adverse effects, such as drowsiness, bronchospasm and hypotension. Patients who received endoscopic prophylaxis (elastic bandage had no bleeding during the follow-up period. Conclusion All of the patients that had upper gastroinstestinal bleeding in this study were under propranolol prophylaxis. The use of propranolol showed a high number of contraindications and side effects, requiring referral to endoscopic prophylaxis. The endoscopic prophylaxis was effective in reducing episodes of bleeding.

  12. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from.......i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence. CONCLUSION: In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence....

  13. The difference of variceal distribution in the portal hypertension on CT between hemorrhagic and nonhemorrhagic groups

    International Nuclear Information System (INIS)

    Lee, Hwa Yeon; Yoo, Seung Min; Lim, Sang Joon; Lee, Jong Beum; Kim, Yang Soo; Choi, Young Hee; Choi, Yun Sun

    1997-01-01

    To determine whether there is any difference in variceal distribution between patients with and without a history of esophageal variceal bleeding. To compare the distribution of varices, abdominal CT scans of 24 patients with a history of esophageal variceal bleeding (hemorrhagic group) and 90 patients without a history of bleeding (non-hemorrhagic group) were retrospectively assessed. The most common varices in both the hemorrhagic (n=21, 87.5%) and nonhemorrhagic group (n=53, 58.9%) were coronary varices, with a statistically significant frequency (p<.01). Esophageal varices were also more common in the hemorrhagic than the nonhemorrhagic group (n=19, 79.2% vs n=36, 40.0% : P<.005). Splenorenal shunts were more common in the nonhemorrhagic (n=8, 8.9%) than in the hemorrhagic group (n=0, 0%)(P<.05). Other types of varice such as paraumbilical (n=10, 41.7% vs n=21, 23.3%), perisplenic (n=6, 25% vs n=15, 16.7%) and retroperitoneal-paravertebral (n=11, 45.8% vs n=24, 26.7%) were more common in the hemorrhagic group, but without a statistically significant frequency. The frequency of coronary and esophageal varices was significant in patients with a history of esophageal variceal bleeding. In patients without such a history, splenorenal shunts were seen

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

    International Nuclear Information System (INIS)

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

    2000-01-01

    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)

  15. Effectiveness of the polysaccharide hemostatic powder in non-variceal upper gastrointestinal bleeding: Using propensity score matching.

    Science.gov (United States)

    Park, Jun Chul; Kim, Yeong Jin; Kim, Eun Hye; Lee, Jinae; Yang, Hyun Su; Kim, Eun Hwa; Hahn, Kyu Yeon; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

    2018-02-07

    Recently, the application of hemostatic powder to the bleeding site has been used to treat active upper gastrointestinal bleeding (UGIB). We aimed to assess the effectiveness of the polysaccharide hemostatic powder (PHP) in patients with non-variceal UGIB. We reviewed prospectively collected 40 patients with UGIB treated with PHP therapy between April 2016 and January 2017 (PHP group) and 303 patients with UGIB treated with conventional therapy between April 2012 and October 2014 (conventional therapy group). We compared the rate of successful hemostasis and the rebleeding between the two groups after as well as before propensity score matching using the Glasgow-Blatchford score and Forrest classification. Thirty patients treated with the PHP and 60 patients treated with conventional therapy were included in the matched groups. Baseline patient characteristics including comorbidities, vital signs, and bleeding scores were similar in the matched groups. The rate of immediate hemostasis and 7-day and 30-day rebleeding were also similar in the two groups before and after matching. In the subgroup analysis, no significant differences in immediate hemostasis or rebleeding rate were noted between PHP in monotherapy and PHP combined with a conventional hemostatic method. At 30 days after the therapy, there were no significant PHP-related complications or mortality. Given its safety, the PHP proved feasible for endoscopic treatment of UGIB, having similar effectiveness as that of conventional therapy. The PHP may become a promising hemostatic method for non-variceal UGIB. © 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  16. 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...... 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...... enrolled, one in a community hospital comprising 66 patients and one in a specialized unit comprising 111 patients. Data on treatment, rebleeding and mortality were collected from medical records according to the Baveno III/IV Criteria. RESULTS: Treatments in the specialized unit versus the community...

  17. The clinical value of 3D dynamic contrast enhanced MR angiography on haemorrhage of esophageal and gastric varices compared with endoscopy

    International Nuclear Information System (INIS)

    Wu Zhou; Liang Biling; Li Yong; Zhong Jinglian; Ye Ruixin; Wang Dongye; Li Chuqiang; Yuan Yuhong

    2010-01-01

    Objective: To investigate the clinical value of three dimensional dynamic contrast enhanced MRA (3D DCE MRA) on esophageal and gastric varices compared with endoscopy. Methods: From April 2003 to June 2008, 153 patients with portal hypertension who underwent both 3D DCE MRA and endoscopy were reviewed retrospectively. All the patients were divided into bleeding group and non-bleeding group according to the clinical symptoms. The location and degree of the esophagogastric varices on 3D DCE MRA were assessed with postprocessing images, including subtraction, MIP and thin-slab masimum intensity projection (tin-MIP), and were compared with the results of endoscopy. The maximum, minimum and mean diameters of esophagogastric varices inside and outside of the wall were measured on the reformed images. The correlation between the findings of 3D DCE MRA and endoscopy were analyzed with Spearman rank correlation coefficient test. The rates of esophagogastric varices outside of the wall in bleeding and non-bleeding group were compared by means of Chi-square test. Results: In bleeding group, severe esophageal varices were documented in 59 patients, moderate in 6 patients, mild in 5 patients; in non-bleeding group, severe esophageal varices were documented in 32 patients, moderate in 4 patients, mild in 5 patients. Severe, moderate, and mild gastric varices were documented in 28, 34 and 16 in bleeding group, while they were 7, 12 and 9 in non-bleeding group. Esophageal and gastric varices can be wholly pressnted on MIP images after subtraction, while the esophagogastric varices inside and outside of the wall can be differentiated on thin-MIP images. The location and degree of esophagogastric varices on 3D DCE MRA were correlated with the findings of the endoscopy. The range of r was from 0.544 to 0.878 (P 2 =7.199, P<0.01). In 35 patients with severe gastric varices, 22 patients showed adventitial gastric varices in bleeding group (n=28) and 4 patients showed adventitial

  18. 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.

  19. [Application of degree of portal systemic shunting in assessing upper gastrointestinal bleeding in patients with schistosomiasis cirrhosis].

    Science.gov (United States)

    Shuai, Ju; Ying, Li; Chang-Xue, Ji; Biao, Zhang

    2017-03-27

    To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointestinal bleeding in patients with hepatic schistosomiasis. Thirty-three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis (a bleeding group) and 29 schistosomiasis cirrhosis patients without bleeding (a non-bleeding group) were enrolled as investigation subjects in Jinshan Hospital. The subjects were scanned by the 128 abdominal slice spiral CT. The portal systemic shunting vessels were reconstructed by using thin slab maximum intensity projection (TSMIP) and multiplanar reconstruction (MPR). The degrees of the shunting vessels of the subjects were evaluated and compared, and the relationship between upper gastrointestinal bleeding and the degree of the shunting was analyzed. In the bleeding group, the occurrence rates of the shunting vessels were found as follows: 86.4% in left gastric varices, 68.2% in short gastric varices, 50.0% in esophageal varices, 50.0% in para-esophageal varices, 37.9% in gastric varices, 69.7% in gastric-renal varices, 51.5% in spleen-renal varices, 25.8% in abdominal wall varices, 15.2% in omentum varices, 63.6% in para-splenic varices, 34.8% in umbilical varices, 40.9% in retroperitoneal-paravertebral varices, and 36.4% in mesenteric varices. In the bleeding group, the occurrence rates and the degree of shunt were significantly higher than those in the non-bleeding group in esophageal varices, esophageal vein, left gastric vein and gastric varices (all P upper gastrointestinal bleeding in patients with hepatic schistosomiasis. The patents with higher degree of the shunting vessels have a higher risk of gastrointestinal bleeding.

  20. Application of Balloon-Occluded Retrograde Transvenous Obliteration to Gastric Varices Complicating Refractory Ascites

    International Nuclear Information System (INIS)

    Fukuda, Tetsuya; Hirota, Shozo; Matsumoto, Shinichi; Sugimoto, Koji; Fujii, Masahiko; Tsurusaki, Masakatsu; Izaki, Kenta; Sugimura, Kazuro

    2004-01-01

    We report two cases of gastric varices complicated by massive ascites that disappeared after balloon-occluded retrograde transvenous obliteration (B-RTO). The first patient had progressive gastric varices that continued to enlarge even after three episodes of esophagogastric variceal bleeding, and the second patient was admitted to our hospital because of the bleeding from gastric varices. After B-RTO procedures in both patients, significant improvement of the ascites, hepatic function reserve, and hypoalbuminemia was observed. Although further experience is needed, our experience points to the likelihood of the amelioration of ascites after B-RTO

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-08-15

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

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

    International Nuclear Information System (INIS)

    Yoon, Min Jae; Hwang, Cheol Mog; Kim, Ho Jun; Cho, Young Jun; Bae, Seok Hwan; Shin, Byung Seok; Ohm, Joon Young; Kang, Chae Hoon

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Moon Han Choi

    2013-09-01

    Full Text Available Background/AimsThe 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.MethodsNinety-three patients at Soonchunhyang University Hospital with acute GVB who received GVO using Histoacryl® were enrolled between June 2001 and March 2010. Among these, 42 patients underwent GVO alone (GVO group and 51 patients underwent GVO with adjuvant BB therapy (GVO+BB group. This study was intended for patients in whom a desired heart rate was reached. The rates of rebleeding-free survival and overall survival were calculated for the two study groups using Kaplan-Meyer analysis and Cox's proportional-hazards model.ResultsThe follow-up period after the initial eradication of gastric varices was 18.14±25.22 months (mean±SD. During the follow-up period, rebleeding occurred in 10 (23.8% and 21 (41.2% GVO and GVO+BB patients, respectively, and 39 patients died [23 (54.8% in the GVO group and 16 (31.4% in the GVO+BB group]. The mean rebleeding-free survival time did not differ significantly between the GVO and GVO+BB groups (65.40 and 37.40 months, respectively; P=0.774, whereas the mean overall survival time did differ (52.54 and 72.65 months, respectively; P=0.036.Conclusions Adjuvant BB therapy after GVO using Histoacryl® for the first acute episode of GVB could decrease the mortality rate relative to GVO alone. However, adjuvant BB therapy afforded no benefit for the secondary prevention of rebleeding in GV.

  4. Customization of laparoscopic gastric devascularization and splenectomy for gastric varices based on CT vascular anatomy.

    Science.gov (United States)

    Kawanaka, Hirofumi; Akahoshi, Tomohiko; Nagao, Yoshihiro; Kinjo, Nao; Yoshida, Daisuke; Matsumoto, Yoshihiro; Harimoto, Norifumi; Itoh, Shinji; Yoshizumi, Tomoharu; Maehara, Yoshihiko

    2018-01-01

    Laparoscopic gastric devascularization(Lap GDS) and splenectomy (SPL) for gastric varices is technically challenging because of highly developed collateral vessels and bleeding tendency. We investigated the feasibility of customization of Lap GDS and SPL based on CT vascular anatomy. We analyzed 61 cirrhotic patients with gastric varices who underwent Lap GDS and SPL between 2006 and 2014. Lap GDS was customized according to the afferent feeding veins (left gastric vein (LGV) and/or posterior gastric vein (PGV)/short gastric vein (SGV)) and efferent drainage veins (gastrorenal shunt and/or gastrophrenic shunt, or numerous retroperitoneal veins) based on CT imaging. Thirty-four patients with efferent drainage veins suitable for balloon-occluded retrograde transvenous obliteration (B-RTO) underwent B-RTO instead of surgical GDS, with subsequent Lap SPL. Among 27 patients with gastric varices unsuitable for B-RTO, 15 patients with PGV/SGV underwent Lap GDS of the greater curvature and SPL, and 12 patients with LGV or LGV/PGV/SGV underwent Lap GDS of the greater and lesser curvature and SPL. The mean operation time was 294 min and mean blood loss was 198 g. There was no mortality or severe morbidity. Gastric varices were eradicated in all 61 patients, with no bleeding or recurrence during a mean follow-up of 55.9 months. The cumulative 3-, 5-, and 7-year survival rates were 92, 82, and 64%, respectively. Lap GDS and SPL customized based on CT vascular anatomy is a safe and effective procedure for treating gastric varices.

  5. Outcomes of pregnancies complicated by liver cirrhosis, portal hypertension, or esophageal varices.

    Science.gov (United States)

    Puljic, Anela; Salati, Jennifer; Doss, Amy; Caughey, Aaron B

    2016-01-01

    To evaluate pregnancy outcomes in women with liver cirrhosis, portal hypertension, or esophageal varices. We analyzed a retrospective cohort of 2,284,218 pregnancies in 2005-2009 recorded in the California Birth Registry database. Utilizing ICD-9 codes we analyzed the following outcomes for liver cirrhosis, portal hypertension, or esophageal varices in pregnancy: preeclampsia (PET), preterm delivery (PTD; Portal hypertension in pregnancy was associated with PTD, LBW, NND, and PPH. Non-bleeding esophageal varices in pregnancy were not associated with the outcomes assessed in a statistically significant manner. One case of bleeding esophageal varices was observed, resulting in PTD with a LBW infant. There were three cases of concomitant portal hypertension or concomitant esophageal varices with cirrhosis in pregnancy. Pregnancy in women with concomitant liver cirrhosis, portal hypertension, or esophageal varices can be successful. However, pregnancy outcomes are worse and may warrant closer antenatal monitoring and patient counseling. Cirrhosis in pregnancy with concomitant portal hypertension or esophageal varices is rare.

  6. Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension.

    Science.gov (United States)

    Bass, Lee M; Kim, Stanley; Superina, Riccardo; Mohammad, Saeed

    2017-02-01

    Portal hypertension secondary to portal vein obstruction following liver transplant occurs in 5%-10% of children. Jejunal varices are uncommon in this group. We present a case series of children with significant GI blood loss, negative upper endoscopy, and jejunal varices detected by CE. Case series of patients who had CE for chronic GI blood loss following liver transplantation. Three patients who had their initial transplants at a median age of 7 months were identified at our institution presenting at a median age of 8 years (range 7-16 years) with a median Hgb of 2.8 g/dL (range 1.8-6.8 g/dL). Upper endoscopy was negative for significant esophageal varices, gastric varices, and bleeding portal gastropathy in all three children. All three patients had significant jejunal varices noted on CE in mid-jejunum. Jejunal varices were described as large prominent bluish vessels underneath visualized mucosa, one with evidence of recent bleeding. The results led to venoplasty of the portal vein in two patients and a decompressive shunt in one patient with resolution of GI bleed and anemia. CE is useful to diagnose intestinal varices in children with portal hypertension and GI bleeding following liver transplant. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

    Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.

  8. Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency

    Energy Technology Data Exchange (ETDEWEB)

    Calame, Paul [Department of Radiology, University Hospitals of Besançon (France); Ronot, Maxime, E-mail: maxime.ronot@aphp.fr [Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine (France); University Paris Diderot, Sorbonne Paris Cité, Paris (France); INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris (France); Bouveresse, Sébastien [Department of Radiology, University Hospitals of Besançon (France); Cervoni, Jean-Paul [Department of Hepatology, University Hospitals of Besançon (France); Vilgrain, Valérie [Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine (France); University Paris Diderot, Sorbonne Paris Cité, Paris (France); INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris (France); Delabrousse, Éric [Department of Radiology, University Hospitals of Besançon (France)

    2017-02-15

    Highlights: • Large PUV are more frequent in patients without variceal bleeding and in those low-risk esophageal varices. • The PUV diameter is smaller in patients who experience variceal bleeding. • The imaging score could help to identify cirrhotic patients at high-risk for EVH. • Cirrhotic patients with high imaging score should be referred for treatment. - Abstract: Purpose: To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH. Materials and methods: From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV >5 mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients. Results: 172 patients (113 men, mean 60 ± 12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p = 0.005). At multivariate analysis, factors associated with a first EVH were spleen size > 135 mm (Odd Ratio [OR] = 1.32 [95% confident interval [CI] 1.16–1.51], p < 0.001), ascites (OR = 4.07 [95%CI-1.84–9.01], p = 0.001) and small/absent PUV (OR = 3.06 [95%CI-1.86–5.05], p < 0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0–1, 2–3, and 4–5, respectively). Conclusions: A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.

  9. Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency

    International Nuclear Information System (INIS)

    Calame, Paul; Ronot, Maxime; Bouveresse, Sébastien; Cervoni, Jean-Paul; Vilgrain, Valérie; Delabrousse, Éric

    2017-01-01

    Highlights: • Large PUV are more frequent in patients without variceal bleeding and in those low-risk esophageal varices. • The PUV diameter is smaller in patients who experience variceal bleeding. • The imaging score could help to identify cirrhotic patients at high-risk for EVH. • Cirrhotic patients with high imaging score should be referred for treatment. - Abstract: Purpose: To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH. Materials and methods: From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV >5 mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients. Results: 172 patients (113 men, mean 60 ± 12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p = 0.005). At multivariate analysis, factors associated with a first EVH were spleen size > 135 mm (Odd Ratio [OR] = 1.32 [95% confident interval [CI] 1.16–1.51], p < 0.001), ascites (OR = 4.07 [95%CI-1.84–9.01], p = 0.001) and small/absent PUV (OR = 3.06 [95%CI-1.86–5.05], p < 0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0–1, 2–3, and 4–5, respectively). Conclusions: A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.

  10. Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding

    International Nuclear Information System (INIS)

    Akasaka, Thai; Shibata, Toshiya; Isoda, Hiroyoshi; Taura, Kojiro; Arizono, Shigeki; Shimada, Kotaro; Togashi, Kaori

    2010-01-01

    We report a 64-year-old woman with duodenal varices who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) complicated by intraprocedural variceal rupture. The patient developed shivering and a fever higher than 40 o C 3 days after the B-RTO procedure. A blood culture grew Entereobacter cloacoe. This case represents a rare septic complication of B-RTO for duodenal varices.

  11. Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate.

    Science.gov (United States)

    Grassia, Roberto; Capone, Pietro; Iiritano, Elena; Vjero, Katerina; Cereatti, Fabrizio; Martinotti, Mario; Rozzi, Gabriele; Buffoli, Federico

    2016-12-28

    To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane (NBCA + MS)] to treat non-variceal upper gastrointestinal bleeding (NV-UGIB). In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy's lesions, and 1 had duodenal diverticular bleeding. Of the 45 patients treated endoscopically without initial hemostasis or with early rebleeding, 33 (76.7%) were treated with modified cyanoacrylate glue, 16 (37.2%) underwent surgery, and 3 (7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS (23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients (78.8%): 19 out of 24 (79.2%) during the first endoscopy and in 7 out of 9 (77.8%) among early rebleeders. Two patients (22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded. Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.

  12. Evaluation of percutaneous transhepatic gastroesophageal varices embolization

    International Nuclear Information System (INIS)

    Yao Hongxiang; Chen Gensheng; Sun Huiling; Zeng Yun; Yan Zhiping

    2008-01-01

    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)

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

    Directory of Open Access Journals (Sweden)

    Petre Cotoras Viedma

    2016-12-01

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

  14. Endoscopic findings of upper gastrointestinal bleeding in patients with liver cirrhosis

    International Nuclear Information System (INIS)

    Hadayat, R.; Rehman, A.U.; Gandapur, A.

    2015-01-01

    Acute upper gastrointestinal (GI) bleeding is a common medical emergency. A common risk factor of upper GI bleeding is cirrhosis of liver, which can lead to variceal haemorrhage. 30-40% of cirrhotic patients who bleed may have non-variceal upper GI bleeding and it is frequently caused by peptic ulcers, portal gastropathy, Mallory-Weiss tear, and gastro-duodenal erosions. The objective of this study was to determine the frequency of upper gastrointestinal endoscopic findings among patients presenting with upper gastrointestinal bleeding with liver cirrhosis. Methods: This descriptive cross-sectional study was carried out in Gastroenterology and Hepatology Department of Ayub Teaching Hospital, Abbottabad from February 2012 to June 2013. 252 patients diagnosed with cirrhosis, presenting with upper GI bleed, age ?50 years of either gender, and were included in the study. Non-probability consecutive sampling was used. Endoscopy was performed on each patient and the findings documented. Results: The mean age was 57.84 ± 6.29 years. There were 158 (62.7%) males and 94 (37.3%) females. The most common endoscopic finding was oesophageal varices (92.9%, n=234) followed by portal hypertensive gastropathy (38.9%, n=98) with almost equal distribution among males and females. Gastric varices were found in 33.3% of patients (n=84). Among other non-variceal lesions, peptic ulcer disease was seen in 26 patients (10.3%) while gastric erosions were found in 8 patients (3.2%). Conclusion: In patients with acute upper GI bleeding and liver cirrhosis, the most common endoscopic finding is oesophageal varices, with a substantially higher value in our part of the country, apart from other non-variceal causes. (author)

  15. ENDOSCOPIC FINDINGS OF UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH LIVER CIRROSIS.

    Science.gov (United States)

    Hadayat, Rania; Jehangiri, Attique-ur-Rehman; Gul, Rahid; Khan, Adil Naseer; Said, Khalid; Gandapur, Asadullah

    2015-01-01

    Acute upper gastrointestinal (GI) bleeding is a common medical emergency. A common risk factor of upper GI bleeding is cirrhosis of liver, which can lead to variceal haemorrhage. 30-40% of cirrhotic patients who bleed may have non-variceal upper GI bleeding and it is frequently caused by peptic ulcers, portal gastropathy, Mallory-Weiss tear, and gastroduodenal erosions. The objective of this study was to determine the frequency of upper gastrointestinal endoscopic findings among patients presenting with upper gastrointestinal bleeding with liver cirrhosis. This descriptive cross-sectional study was carried out in Gastroenterology & Hepatology Department of Ayub Teaching Hospital, Abbottabad from February 2012 to June 2013. 252 patients diagnosed with cirrhosis, presenting with upper GI bleed, age 50 years of either gender, and were included in the study. Non-probability consecutive sampling was used, Endoscopy was performed on each patient and the findings documented. The mean age was 57.84 +/- 6.29 years. There were 158 (62.7%) males and 94 (37.3%) females. The most common endoscopic finding was oesophageal varices (92.9%, n=234) followed by portal hypertensive gastropathy (38.9%, n=98) with almost equal distribution among males and females. Gastric varices were found in 33.3% of patients (n=84). Among other non-variceal lesions, peptic ulcer disease was seen in 26 patients (10.3%) while gastric erosions were found in 8 patients (3.2%). In patients with acute upper GI bleeding and liver cirrhosis, the most common endoscopic finding is oesophageal varices, with a substantially higher value in our part of the country, apart from other non-variceal causes.

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

    International Nuclear Information System (INIS)

    Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A.; Sugimura, Kazuro

    2006-01-01

    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

  17. 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.

  18. Greek results of the “ENERGIB” European study on non-variceal upper gastrointestinal bleeding

    Science.gov (United States)

    Papatheodoridis, George; Akriviadis, Evangelos; Evgenidis, Nikolaos; Kapetanakis, Anargyros; Karamanolis, Demetrios; Kountouras, Jannis; Mantzaris, Gerassimos; Potamianos, Spyros; Triantafyllou, Konstantinos; Tzathas, Charalambos

    2012-01-01

    Background Non-variceal upper gastro-intestinal bleeding (NVUGIB) is a common and challenging emergency situation. We aimed to describe the characteristics and clinical outcomes of patients with NVUGIB in Greece. Methods ENERGIB (NCT00797641) was an epidemiological survey conducted in 7 European countries including Greece. It included adult patients with overt NVUGIB from 10 tertiary hospitals across Greece. Data for each patient were collected on admission and up to 30 days thereafter. Results 201 patients were enrolled. A previous history of NVUGIB was reported by 14% of patients, while 61% had ≥ 1 co-morbidities. At presentation, 59% were on therapy that could harm the gastrointestinal mucosa, 14% on anticoagulant(s) and 42% had sign(s) of hemodynamic instability. 54% of patients showed stigmata of recent hemorrhage. Therapeutic endoscopy was performed in 25% and blood product(s) transfusions were required in 86% of cases. Proton pump inhibitors were administered before and after endoscopy in 70% and 95% of patients, respectively. Uncontrolled bleeding or rebleeding was observed in 11% being more common in elderly, hospitalized patients and patients with ≥1 co-morbidities. Second-look endoscopy was performed in 20%, angiographic intervention in 1.5% and surgical intervention in 4% of patients. Only 5/201 (2.5%) patients died during hospitalization and none died during the 30-day post-hospitalization period. Conclusions The majority of patients with NVUGIB in tertiary Greek hospitals are elderly, with co-morbidities, hemodynamic instability and required transfusion(s), while one fourth undergoes therapeutic endoscopic interventions. However, NVUGIB is associated with moderate degrees of continued bleeding/re-bleeding, low surgical rates and, most importantly, low mortality. PMID:24714268

  19. Relationship between recurrence of esophageal varices and changes of portal circulation after endoscopic injection sclerotherapy

    International Nuclear Information System (INIS)

    Azuma, Masayoshi; Kashiwagi, Toru; Ohata, Hiroyuki

    1992-01-01

    The relationship between recurrence of esophageal varices after endoscopic injection sclerotherapy (EIS) and changes of the blood pool of portosystemic collaterals was studied in 36 patients with liver cirrhosis. Examination of the blood pool of portosystemic collaterals was performed by single photon emission CT (SPECT). Seven hundreds and forty MBq of 99m Tc-RBCs, labeled by an in vivo technique, were given intra-venously, and tomographic imaging of the intraabdominal vascular blood pool was performed. Before EIS, the blood pool images of the coronary vein was demonstrated in 34 cases (94.4%). According to changes of SPECT images, the patients were divided into 3 groups, that is, the groups showing a disappearance, decrease, and no changes of the blood pool images of the coronary vein. The recurrence rates of esophageal varices after EIS were 11.1% (1 of 9 patients), 40.0% (6 of 15 patients), and 90.0% (9 of 10 patients) in the disappeared, decreased and unchanged groups respectively. These values were significantly different between the disappeared group and the unchanged group (P<0.01), and between the decreased group and the unchanged group (P<0.05). These results indicate that the abdominal blood pool SPECT is useful for evaluating the therapeutic effectiveness of EIS. (author)

  20. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from...

  1. Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic.

    Science.gov (United States)

    Opio, Christopher Kenneth; Kazibwe, Francis; Ocama, Ponsiano; Rejani, Lalitha; Belousova, Elena Nikolaevna; Ajal, Paul

    2016-01-01

    Severe chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). However, there is paucity of data on clinical epidemiology of episodes of UGIB from rural Africa despite on going public health interventions to control and eliminate schistosomiasis. Through a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. The main outcome was number of lifetime episodes of UGIB analyzed as count data. From 107 enrolled participants, 323 lifetime episodes of UGIB were reported. Fifty-seven percent experienced ≥ 2 lifetime episodes of UGIB. Ninety-four percent had severe chronic hepatic schistosomiasis and 80% esophageal varices. Alcohol use and viral hepatitis was infrequent. Eighty-eight percent were previously treated with praziquantel and 70% had a history of blood transfusion. No patient had ever had an endoscopy or treatment for prevention of recurrent variceal bleeding. Multivariable analysis identified a cluster of eight clinical factor variables (age ≥ 40, female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated (P-value Upper gastrointestinal bleeding is a common health problem in this part of rural SSA where schistosomiasis is endemic. The clinical profile described is unique and is important for improved case management, and for future research.

  2. Endoscopic management of bleeding peptic ulcers

    International Nuclear Information System (INIS)

    Farooqi, J.I.; Farooqi, R.J.

    2001-01-01

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  3. Characteristics of patients with non-variceal upper gastrointestinal bleeding taking antithrombotic agents.

    Science.gov (United States)

    Yamaguchi, Daisuke; Sakata, Yasuhisa; Tsuruoka, Nanae; Shimoda, Ryo; Higuchi, Toru; Sakata, Hiroyuki; Fujimoto, Kazuma; Iwakiri, Ryuichi

    2015-01-01

    The present study aimed to clarify the features and management of non-variceal upper gastrointestinal bleeding (UGIB) in Japanese patients taking antithrombotic agents. We retrospectively investigated the medical records of 560 patients who underwent emergency endoscopy for UGIB from 2002 to 2013. The patients were divided into two groups: group A, antithrombotic agent use; and group NA, no antithrombotic agent use. We compared clinical characteristics, comorbidities, and causes of UGIB between the groups. We also investigated management with antithrombotics. Of 560 patients with UGIB, 27.5% were taking antithrombotics, and this proportion gradually increased during the study period. Mean hemoglobin levels on admission were significantly lower in group A (8.0 ± 1.7 g/dL) than in group NA (8.9 ± 2.9 g/dL) (P bleeding was lower in group A than in group NA (P < 0.001), and the rate of endoscopic hemostasis was significantly higher in group A (98.7%) than in group NA (94.3%) (P = 0.022). After the release of the 2012 Japan Gastroenterological Endoscopy Society guidelines, the antithrombotic agent cessation periods were significantly shortened (P < 0.001). Among patients with UGIB, those taking antithrombotics exhibited more severe clinical signs. However spurting hemorrhage was rare. Antithrombotics may be resumed early after endoscopic hemostasis. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

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

    Science.gov (United States)

    Gubler, Christoph; Bauerfeind, Peter

    2014-09-01

    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. We present a large single-center cohort over 7 years with a standardized EUS-guided sclerotherapy of all patients with gastric varices. Application was controlled by fluoroscopy to immediately detect any glue embolization. Only perforating veins located within the gastric wall were treated. In the follow up, we repeated this treatment until varices were eradicated. Utmost patients (36 of 40) were treated during or within 24 h of active bleeding. About 32.5% of patients were treated while visible bleeding. Histoacryl injection was always technically successful and only two patients suffered a minor complication. Acute bleeding was stopped in all patients. About 15% (6 of 40) of patients needed an alternative rescue treatment in the longer course. Three patients got a transjugular portosystemic shunt and another three underwent an orthotopic liver transplantation. Mean long-term survival of 60 months was excellent. Active bleeding of gastric varices can be treated successfully without the necessity of gastric rinsing with EUS-guided injection of Histoacryl.

  5. Splenomegaly and its Relation to Esophageal Varices in Patient with liver Cirrhosis

    International Nuclear Information System (INIS)

    Rasheid, S.A.; Hafez, E.N.; Al Kady, M.M.

    2013-01-01

    Liver cirrhosis has been associated with portal hypertension as a common complication with subsequent development of esophageal varices (EV).Bleeding due to rupture of esophageal varices (EV) is one of main cause of death in liver cirrhosis, that endoscopy screening is recommended. The aim of work was to determin the of the degree esophageal varices endoscopically in in 60 cirrhotic patients,(32 in Child-Pugh's class A, 16 in Child-Pugh's class B, and 12 in Child-Pugh's class C) who were examined clinically, laboratory , ultrasonography to and comparing them with the determines of the spleen ultrasonography and some biochemical data . Correlation analysis was done to assess this study. Of 60 patients, 20 were admitted to hospital because of acute gastro-intestinal bleeding and 40 without history of gastro-intestinal bleeding. The range age of patients was 30-65 years (average 48.4 ± 8.6 years), 6 (10%) patients with EV grade I, 14(23.4%) patients with grade II and 10 (16.6%) patients with grade III. Twinty patients having esophageal varices of different degrees, had no splenomegaly. A negative correlation was found between spleen diameter and the degree of EV (p < 0.05). The percentage of patients with varices increased with the severty of Liver cirrhosis: 6(18.8) of 32 patients in Child-Pugh class A,14 (87.5%) of 16 in Child-Pugh class B, and 10(83.3%) of 12 in Child-Pugh class C had varices.The degree of EV significantly correlated with Child-Puph score. Patients with varices had lower platelet counts comparison to those without varices (237.259 ± 100.305, 298.424 ± 103.09 respectively; p<0.001), and lower serum albumin comparison to those without varices (1.8 ± 0.92, 2.8 ± 0.83 respectively; p<0.001). The platelet count to spleen diameter ratio (PC/SD) in patients with EV were significantly Rasheid et. al., J. Rad. Res. Appl. Sci., 266 Vol. 6, No. 1B (2013) different from patients without EV (945.84±778.59, 686.26± 546.39 respectively; p<0.001).

  6. 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

  7. Outcome of band ligation in oesophageal varices

    International Nuclear Information System (INIS)

    Abbasi, A.; Bhutto, A.R.; Bhatti, K.I.; Mahmood, K.; Lal, K.

    2013-01-01

    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)

  8. Alcohol Abuse Increases Rebleeding Risk and Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Kärkkäinen, Jussi M; Miilunpohja, Sami; Rantanen, Tuomo; Koskela, Jenni M; Jyrkkä, Johanna; Hartikainen, Juha; Paajanen, Hannu

    2015-12-01

    No current data are available on rebleeding and mortality risk in patients who use alcohol excessively and are admitted for non-variceal upper gastrointestinal bleeding (NVUGIB). This information could help in planning interventions and follow-up protocols for these patients. This study provides contemporary data on the long-term outcome after first-time NVUGIB in alcohol abusers (AAs) compared to non-abusers (NAs). Consecutive patients hospitalized for their first acute gastrointestinal bleeding from 2009 through 2011 were retrospectively recorded and categorized as AA or NA. Risk factors for one-year mortality and rebleeding were identified, and patients were further monitored for long-term mortality until 2015. Alcohol abuse was identified in 19.7% of patients with NVUGIB (n = 518). The one-year rebleeding rate was 16.7% in AAs versus 9.1% in NAs (P = 0.027). Alcohol abuse was associated with a twofold increase in rebleeding risk (P = 0.025); the risk especially increased 6 months after the initial bleeding. The study groups did not differ significantly in 30-day (6.0%) or one-year mortality rates (20.5%). However, there was a tendency for higher overall mortality in AAs than NAs after adjustment of comorbidities. AAs with NVUGIB are at high risk of rebleeding, and mortality is increased in AA patients. A close follow-up strategy and long-term proton pump inhibitor therapy are recommended for AA patients with peptic ulcer or esophagitis.

  9. Therapeutic effects of percutaneous transhepatic variceal embolization combined with partial splenic embolization for portal hypertention

    International Nuclear Information System (INIS)

    Hua Yingxue; Yan Zhiping; Cheng Yongde; Qiao Delin; Zhou Bing; Chen Shiwei; Li Yong

    2007-01-01

    Objective: To evaluate the efficiency of percutaneous transhepatic variceal embolization (PTVE) combined with patial splenic embolization (PES)for portal hypertension. Methods: 30 patients with critical portal hypertension were divided randomly into two groups, 15 patients of A group underwent PSE PTVE combined with PSE and 15 of B group underwent PES only. The changes of collateral circulation of the two groups were compared via color Doppler ultrasonography pre-and postoperatively. Results: The hypersplenism was well controlled in both groups after PTVE and PSE. The varices of A group were embolized completely, the flow rate and velocity of portal blood stream were significantly reduced (P<0.05). In addition, the flow rate and velocity together with inner diameter of the azygous vein decreased (P<0.01), but no change shown on portal vein diameter, only with decrease of blood flow and velocity postoperatively were shown in the two groups (P<0.05). During 13-16 months follow-up, gastroesophageal variceal bleeding appeared in 2 patients and formation of portal thrombi in 1 patients of B group. There was no gastroesophageal variceal bleeding in A group but 2 patients appeared portal hypertensive gastroenteropathy (PHG)under endoscopic confirmations. Conclusion: PTVE combined PSE is very efficient for gastroesophageal variceal bleeding and hypersplenism due to portal hypertension, especially for patients with poor hepatic function, possessing simple, economic, less invasive properties and deserving to be recommended. (authors)

  10. Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma.

    Science.gov (United States)

    Pang, Chang Hwan; Lee, Soo Eon; Kim, Chang Hyeun; Kim, Jeong Eun; Kang, Hyun-Seung; Park, Chul-Kee; Paek, Sun Ha; Kim, Chi Heon; Jahng, Tae-Ahn; Kim, Jin Wook; Kim, Yong Hwy; Kim, Dong Gyu; Chung, Chun Kee; Jung, Hee-Won; Yoo, Heon

    2015-07-01

    There is inconsistency among the perioperative management strategies currently used for chronic subdural hematoma (cSDH). Moreover, postoperative complications such as acute intracranial bleeding and cSDH recurrence affect clinical outcome of cSDH surgery. This study evaluated the risk factors associated with acute intracranial bleeding and cSDH recurrence and identified an effective perioperative strategy for cSDH patients. A retrospective study of patients who underwent bur hole craniostomy for cSDH between 2008 and 2012 was performed. A consecutive series of 303 cSDH patients (234 males and 69 females; mean age 67.17 years) was analyzed. Postoperative acute intracranial bleeding developed in 14 patients (4.57%) within a mean of 3.07 days and recurrence was observed in 37 patients (12.21%) within a mean of 31.69 days (range 10-104 days) after initial bur hole craniostomy. The comorbidities of hematological disease and prior shunt surgery were clinical factors associated with acute bleeding. There was a significant risk of recurrence in patients with diabetes mellitus, but recurrence did not affect the final neurological outcome (p = 0.776). Surgical details, including the number of operative bur holes, saline irrigation of the hematoma cavity, use of a drain, and type of postoperative ambulation, were not significantly associated with outcome. However, a large amount of drainage was associated with postoperative acute bleeding. Bur hole craniostomy is an effective surgical procedure for initial and recurrent cSDH. Patients with hematological disease or a history of prior shunt surgery are at risk for postoperative acute bleeding; therefore, these patients should be carefully monitored to avoid overdrainage. Surgeons should consider informing patients with diabetes mellitus that this comorbidity is associated with an increased likelihood of recurrence.

  11. Portal vein stenting for delayed jejunal varix bleeding associated with portal venous occlusion after hepatoiliary and pancreatic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Dong Ho; Park, Kwang Bo; Cho, Sung Ki; Park, Hong Suk; Shin, Sung Wook; Choo, Sung Wook; Do, Young Soo; Choo, In Wook; Choi, Dong Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2017-09-15

    The study aimed to describe portal stenting for postoperative portal occlusion with delayed (≥ 3 months) variceal bleeding in the afferent jejunal loop. Eleven consecutive patients (age range, 2–79 years; eight men and three women) who underwent portal stenting between April 2009 and December 2015 were included in the study. Preoperative medical history and the postoperative clinical course were reviewed. Characteristics of portal occlusion and details of procedures were also investigated. Technical success, treatment efficacy (defined as disappearance of jejunal varix on follow-up CT), and clinical success were analyzed. Primary stent patency rate was plotted using the Kaplan-Meier method. All patients underwent hepatobiliary-pancreatic cancer surgery except two children with liver transplantation for biliary atresia. Portal occlusion was caused by benign postoperative change (n = 6) and local tumor recurrence (n = 5). Variceal bleeding occurred at 27 months (4 to 72 months) and portal stenting was performed at 37 months (4 to 121 months), on average, postoperatively. Technical success, treatment efficacy, and clinical success rates were 90.9, 100, and 81.8%, respectively. The primary patency rate of portal stent was 88.9% during the mean follow-up period of 9 months. Neither procedure-related complication nor mortality occurred. Interventional portal stenting is an effective treatment for delayed jejunal variceal bleeding due to portal occlusion after hepatobiliary-pancreatic surgery.

  12. Portal vein stenting for delayed jejunal varix bleeding associated with portal venous occlusion after hepatoiliary and pancreatic surgery

    International Nuclear Information System (INIS)

    Hyun, Dong Ho; Park, Kwang Bo; Cho, Sung Ki; Park, Hong Suk; Shin, Sung Wook; Choo, Sung Wook; Do, Young Soo; Choo, In Wook; Choi, Dong Wook

    2017-01-01

    The study aimed to describe portal stenting for postoperative portal occlusion with delayed (≥ 3 months) variceal bleeding in the afferent jejunal loop. Eleven consecutive patients (age range, 2–79 years; eight men and three women) who underwent portal stenting between April 2009 and December 2015 were included in the study. Preoperative medical history and the postoperative clinical course were reviewed. Characteristics of portal occlusion and details of procedures were also investigated. Technical success, treatment efficacy (defined as disappearance of jejunal varix on follow-up CT), and clinical success were analyzed. Primary stent patency rate was plotted using the Kaplan-Meier method. All patients underwent hepatobiliary-pancreatic cancer surgery except two children with liver transplantation for biliary atresia. Portal occlusion was caused by benign postoperative change (n = 6) and local tumor recurrence (n = 5). Variceal bleeding occurred at 27 months (4 to 72 months) and portal stenting was performed at 37 months (4 to 121 months), on average, postoperatively. Technical success, treatment efficacy, and clinical success rates were 90.9, 100, and 81.8%, respectively. The primary patency rate of portal stent was 88.9% during the mean follow-up period of 9 months. Neither procedure-related complication nor mortality occurred. Interventional portal stenting is an effective treatment for delayed jejunal variceal bleeding due to portal occlusion after hepatobiliary-pancreatic surgery

  13. Hemodynamic evaluation of portal blood flow with transrectal scintigraphy using sup 123 I-iodoamphetamine with special reference to esophageal varices and bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Shirasaki, Keiji; Ishii, Kohdoh; Kokubu, Shigehiro; Shibata, Hisao; Ishii, Katsumi (Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine)

    1990-12-01

    Portosystemic shunting was evaluated by portal scintigraphy with transrectally admininistered {sup 123}I-iodoamphetamine (IMP) in 21 patients with liver diseases. IMP was injected in an amount of 111 MBq (3 mCi) into the upper part of the rectum through the catheter. Images of the liver and lungs were monitores for up to 60 minutes with scintillation camera. The subjects were divided into three groups according to the images of the organs: the tracer was accumulated predominantly in the lungs (group A); almost equally accumulated in the both organs (group B); accumulated predominantly in the liver (group C). Advanced liver cirrhosis and IPH with esophageal varices were almost exclusively seen in group A, whereas early stage of liver cirrhosis and other mild hepatic lesions without esophageal varix remainded in group C. Patients of group A showed worse laboratory data than those of group C, including platelet count, serum levels of ch-E and {gamma}-globulin. It is noteworthy that in patients with esophageal bleeding, clear lung images appeared shortly after IMP administration in contrast with extremely delayed visualization of the liver. On the contrary, liver images was demonstrated early in cirrhotic patients without esophageal bleeding. It was coucluded that portal scintigraphy with IMP is useful for the evaluation of portosystemic shunting, especially in esophageal varices. (author).

  14. Treatment and follow-up of a case of bleeding duodenal varix

    Directory of Open Access Journals (Sweden)

    Viveksandeep Thoguluva Chandrasekar

    2013-01-01

    Full Text Available Duodenal varices (DV are rare in patients with portal hypertension secondary to liver disease. Their tendency to bleed is less common than in gastroesophageal varices, but can sometimes produce a life-threatening bleed. They are often difficult to diagnose and treat. We present a case of a 35-year-old man with parenchymal liver disease admitted with complaints of hematemesis and melena. Upper gastrointestinal endoscopy was performed and a duodenal varix, with stigmata of a recent bleed, was noted in the second part of the duodenum. Five milliliters of N-butyl-2-cyanoacrylate glue was injected into the varix leading to obliteration. A follow-up study with an endoscopic ultrasound and repeat endoscopy showed near total obturation of the varix and success of the therapy. This report concludes that glue injection can effectively be used as a first-line treatment for bleeding duodenal varices.

  15. Comparison of computed tomography and endoscopy in the diagnosis and grading of esophageal varices; value of computed tomography for predict prognosis of chronic liver disease

    International Nuclear Information System (INIS)

    Ko, Gi Young; Park, Cheol Min; Lee, Jin Seong; Hyun, Chang Dong; Lee, Moon Gyu; Auh, Yong Ho; Kim, Hae Ryun

    1996-01-01

    To evaluate the sensitivity and specificity of conventional CT of abdomen in the detection of esophageal varices, and to correlate CT grade of esophageal varices with prognosis and risk for bleeding. Both CT and endoscopy were performed in 100 patients. Endoscopy revealed that while 54 patients had varices, 46 did not. CT criteria of variceal grading were follows;(1) wallthickening of more than 5 mm or irregular wall contour(grade 1):(2) intraluminal protruding tubular structures with contrast enhancement(grade II);(3) confluent varices in the wall of esophagus or multiplied paraesophageal collaterals(gradeIII). CT were reviewed by three radiologists without reference to clinical and endoscopic data. Sensitivity and specificity of CT in the detection of esophageal varices were 80%, retrospectively. CT and endoscopic grades agreed with each other in 68% of patients, and there was high correlation between CT and endoscopy. (Gamma statistics, p=0.828). No history or endoscopic evidence of variceal bleeding was present on grade I, but there was a high incidence on grade II(35%) and on grade III(50%)(MH Chi-Square, Ridit scores=50.561, p=0.000). Abdominal CT is useful in the detection of esophageal varices, and can predict the risk factors of bleeding in patients with chronic liver diseases

  16. Acute Variceal Bleeding: Does Octreotide Improve Outcomes in Patients with Different Functional Hepatic Reserve?

    Science.gov (United States)

    Monreal-Robles, Roberto; Cortez-Hernández, Carlos A; González-González, José A; Abraldes, Juan G; Bosques-Padilla, Francisco J; Silva-Ramos, Héctor N; García-Flores, Jorge A; Maldonado-Garza, Héctor J

    2018-01-01

    Current guidelines do not differentiate in the utilization of vasoactive drugs in patients with cirrhosis and acute variceal bleeding (AVB) depending on liver disease severity. In this retrospective study, clinical outcomes in 100 patients receiving octreotide plus endoscopic therapy (ET) and 216 patients with ET alone were compared in terms of failure to control bleeding, in-hospital mortality, and transfusion requirements stratifying the results according to liver disease severity by Child-Pugh (CP) score and MELD. In patients with CP-A or those with MELD < 10 octreotide was not associated with a better outcome compared to ET alone in terms of hospital mortality (CP-A: 0.0 vs. 0.0%; MELD < 10: 0.0 vs. 2.9%, p = 1.00), failure to control bleeding (CP-A: 8.7 vs. 3.7%, p = 0.58; MELD < 10: 5.3 vs. 4.3%, p = 1.00) and need for transfusion (CP-A: 39.1 vs. 61.1%, p = 0.09; MELD < 10: 63.2 vs. 62.9%, p = 1.00). Those with severe liver dysfunction in the octreotide group showed better outcomes compared to the non-octreotide group in terms of hospital mortality (CP-B/C: 3.9 vs. 13.0%, p = 0.04; MELD ≥ 10: 3.9 vs. 13.3%, p = 0.03) and need for transfusion (CP-B/C: 58.4 vs. 71.6%, p = 0.05; MELD ≥ 10: 50.6 vs. 72.7%, p < 0.01). In multivariate analysis, octreotide was independently associated with in-hospital mortality (p = 0.028) and need for transfusion (p = 0.008) only in patients with severe liver dysfunction (CP-B/C or MELD ≥ 10). Patients with cirrhosis and AVB categorized as CP-A or MELD < 10 had similar clinical outcomes during hospitalization whether or not they received octreotide.

  17. Combined embolization with multiple materials for the treatment of esophagogastric varices: an analysis of clinical therapeutic effect

    International Nuclear Information System (INIS)

    Lu Yanping; Qin Haopu; Zhang Mengzeng

    2011-01-01

    Objective: To evaluate the clinical efficacy of percutaneous transhepatic combined embolization with multiple materials in treating esophagogastric varices. Methods: A total of 48 patients with esophagogastric varices complicated by bleeding due to ruptured varices were enrolled in this study. Percutaneous transhepatic combined embolization with Gelfoam, ethanol and stainless steel coils was carried out in all patients. The clinical results were analyzed. Results: Superselective catheterization and subsequent combined embolization procedure were successfully completed in all patients. In 17 patients with acute upper gastrointestinal bleeding, one died seven days after the treatment because of general failure. Postoperative gastroscopic examination was performed in 33 patients, which showed that esophagogastric varices were completely obliterated in 27 patients and markedly improved in six patients. A total of 35 patients were followed up for 4-36 months. During the follow-up period rebleeding occurred in 5 and death in 2 patients. Conclusion: For the treatment of esophagogastric varices, combined embolization with multiple materials is mini-invasive, safe and effective. It is of value to popularize this technique in clinical practice. (authors)

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

    Directory of Open Access Journals (Sweden)

    Salla Surya Prakasa Rao

    2016-10-01

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

  19. Prediction of esophageal variceal bleeding in B-viral liver cirrhosis using the P2/MS noninvasive index based on complete blood counts.

    Science.gov (United States)

    Kim, Beom Kyung; Ahn, Sang Hoon; Han, Kwang-Hyub; Park, Jun Yong; Han, Min Seok; Jo, Jung Hyun; Kim, Ja Kyung; Lee, Kwan Sik; Chon, Chae Yoon; Kim, Do Young

    2012-01-01

    Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e., medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count)2/[monocyte fraction (%) × segmented neutrophil fraction (%)]. We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS <9. Copyright © 2012 S. Karger AG, Basel.

  20. 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...

  1. Risk factors associated with recurrent hemorrhage after the initial improvement of colonic diverticular bleeding.

    Science.gov (United States)

    Nishikawa, Hiroki; Maruo, Takanori; Tsumura, Takehiko; Sekikawa, Akira; Kanesaka, Takashi; Osaki, Yukio

    2013-03-01

    We elucidated risk factors contributing to recurrent hemorrhage after initial improvement of colonic diverticular bleeding. 172 consecutive hospitalized patients diagnosed with colonic diverticular bleeding were analyzed. Recurrent hemorrhage after initial improvement of colonic diverticular bleeding is main outcome measure. We analyzed factors contributing to recurrent hemorrhage risk in univariate and multivariate analyses. The length of the observation period after improvement of colonic diverticular bleeding was 26.4 +/- 14.6 months (range, 1-79 months). The cumulative recurrent hemorrhage rate in all patients at 1 and 2 years was 34.8% and 41.8%, respectively. By univariate analysis, age > 70 years (P = 0.021), BMI > 25 kg/m2 (P = 0.013), the use of anticoagulant drugs (P = 0.034), the use of NSAIDs (P = 0.040), history of hypertension (P = 0.011), history of smoking (P = 0.030) and serum creatinine level > 1.5 mg/dL (P bleeding. By multivariate analysis, age > 70 years (Hazard ratio (HR), 1.905, 95% confidence interval (CI), 1.067-3.403, P = 0.029), history of hypertension (HR, 0.493, 95% CI, 0.245-0.993, P = 0.048) and serum creatinine level > 1.5 mg/dL (HR, 95% CI, 0.288-0.964, P = 0.044) were shown to be significant independent risk factors. Close observation after the initial improvement of colonic diverticular bleeding is needed, especially in elderly patients or patients with history of hypertension or renal deficiency.

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

    Science.gov (United States)

    Saad, Wael E; Lippert, Allison; Schwaner, Sandra; Al-Osaimi, Abdullah; Sabri, Saher; Saad, Nael

    2014-01-01

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

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

    International Nuclear Information System (INIS)

    Maruyama, Hitoshi; Ishihara, Takeshi; Ishii, Hiroshi; Tsuyuguchi, Toshio; Yoshikawa, Masaharu; Matsutani, Shoichi; Yokosuka, Osamu

    2010-01-01

    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.

  4. Pseudoaneurysm embolization and vasopressin infusion for lower gastrointestinal bleeding due to recurrence of urinary bladder carcinoma.

    Science.gov (United States)

    Kakizawa, Hideaki; Toyota, Naoyuki; Mita, Koji; Fujimura, Yoshio; Hieda, Masashi; Hirai, Nobuhiko; Tachikake, Toshihiro; Ito, Katsuhide

    2006-05-01

    We report a case that was successfully treated for massive lower gastrointestinal (LGI) bleeding due to a recurrent urinary bladder carcinoma. Treatment consisted of combination therapy including embolization of an inferior gluteal artery (IGA) pseudoaneurysm and low-dose arterial vasopressin infusion via a sigmoid artery (SA). A 57-year-old man presented with life-threatening sudden, massive LGI bleeding due to an obturator lymph node (LN) metastasis from a urinary bladder carcinoma. Computed tomography showed that the LN recurrence had invaded all the way to the sigmoid colon, and there was a pseudoaneurysm with extravasation inside the recurrence. An angiogram revealed a left IGA pseudoaneurysm. We therefore excluded the pseudoaneurysm by embolization with microcoils. Following this treatment the bleeding decreased, but intermittent LGI bleeding continued. Endoscopic examination showed the tumor with a huge ulcer inside the colonic lumen, and continuous oozing was confirmed. A second angiogram showed no recurrence of the IGA pseudoaneurysm and no apparent findings of bleeding. Then a 3F microcatheter was placed in the SA selectively using a coaxial catheter system, and vasopressin was infused at a rate 0.05 U/min for 12 h. Bleeding completely ceased 2 days later. There were no signs of ischemic gastrointestinal complications. Massive LGI bleeding has not recurred in 5 months.

  5. The Short-Term Effects of Balloon-Occluded Retrograde Transvenous Obliteration, for Treating Gastric Variceal Bleeding, on Portal Hypertensive Changes: a CT Evaluation

    International Nuclear Information System (INIS)

    Cho, Sung Ki; Shin, Sung Wook; Yoo, Eun Young; Do, Young Soo; Park, Kwang Bo; Choo, Sung Wook; Choo, In Wook; Han, Heon

    2007-01-01

    We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans. We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test. Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm 3 to 580.8 cm 3 , and based on a 15% volume change cutoff value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively). Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO

  6. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use.

    Science.gov (United States)

    Martinelli, Ida; Lensing, Anthonie W A; Middeldorp, Saskia; Levi, Marcel; Beyer-Westendorf, Jan; van Bellen, Bonno; Bounameaux, Henri; Brighton, Timothy A; Cohen, Alexander T; Trajanovic, Mila; Gebel, Martin; Lam, Phuong; Wells, Philip S; Prins, Martin H

    2016-03-17

    Women receiving vitamin K antagonists (VKAs) require adequate contraception because of the potential for fetal complications. It is unknown whether the use of hormonal therapy, especially those containing estrogens, is associated with recurrent venous thromboembolism (VTE) during anticoagulation. Despite the absence of data, World Health Organization guidelines state that use of estrogen-containing contraceptives confers an "unacceptable health risk" during established anticoagulation for VTE. We compared the incidences of recurrent VTE and abnormal uterine bleeding with and without concomitant hormonal therapy in women aged abnormal uterine bleeding. In total, 1888 women were included. VTE incidence densities on and off hormonal therapy were 3.7%/year and 4.7%/year (adjusted HR, 0.56; 95% confidence interval [CI], 0.23-1.39), respectively, and were 3.7%/year and 3.8%/year, respectively, for estrogen-containing and progestin-only therapy. The adjusted HR for all abnormal uterine bleeding (on vs off hormonal therapy) was 1.02 (95% CI, 0.66-1.57). Abnormal uterine bleeding occurred more frequently with rivaroxaban than with enoxaparin/VKA (HR, 2.13; 95% CI, 1.57-2.89). Hormonal therapy was not associated with an increased risk of recurrent VTE in women receiving therapeutic anticoagulation. The observed increased risk of abnormal uterine bleeding with rivaroxaban needs further exploration. © 2016 by The American Society of Hematology.

  7. An Unusual Reason for Gastric Variceal Hemorrhage: Wandering Spleen.

    Science.gov (United States)

    Köseoğlu, Hüseyin; Atalay, Roni; Büyükaşık, Naciye Şemnur; Canyiğit, Murat; Özer, Mehmet; Solakoğlu, Tevfik; Akın, Fatma Ebru; Bolat, Aylin Demirezer; Yürekli, Öykü Tayfur; Ersoy, Osman

    2015-12-01

    Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5 %. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22-year-old woman with wandering spleen presenting with life-threatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now.

  8. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Lip, Gregory Y.H.; Olesen, Jonas B.

    2015-01-01

    Study question What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? Methods This Danish cohort study (1996...... to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models. Study answer and limitations 4602...... gastrointestinal bleeding. 27.1% (n=924) of patients did not resume antithrombotic treatment. Compared with non-resumption of treatment, a reduced risk of all cause mortality was found in association with restart of oral anticoagulation (hazard ratio 0.39, 95% confidence interval 0.34 to 0.46), an antiplatelet...

  9. 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.

  10. Perivesical varices and portal hypertension: imaging study; Varices perivesiculares e hipertension postal. Estudio por imagen

    Energy Technology Data Exchange (ETDEWEB)

    Mallorquin Jimenez, F; Medina Benitez, A; Lopez Machado, E; Pardo Moreno, M D; Garrido Moreno, C; Pastor Rull, J [Servicio de Radiodiagnostico, Hospital General de Especialidades Virgen de la Nieve, Granada (Spain)

    1995-07-01

    Nine patients with portal hypertension syndrome and Perivesical varices are studied retrospectively by means of imaging techniques including ultrasound, duplex Doppler, color Doppler, CT and angiography. All the patients presented portal thrombosis and thickening of the bladder wall. These collaterals either represent a shunting of hepato pedal flow or correspond to blood stasis associated with said syndrome. Ultrasound, whether involving duplex Doppler or color Doppler techniques, is highly useful to detect the presence of Perivesical varices which appear as tubular or rounded hypo echogenic areas in the bladder wall. Given the association of this entity with bladder wall thickening, it should be taken into account in any clinical situation involving said change, especially in patients with portal hypertension; moreover knowledge of its presence is of great importance when the possibility of creating shunts by means of interventional or surgical vascular procedures or other types of abdominal procedures are being considered because of the risk of bleeding. (Author)

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

    Directory of Open Access Journals (Sweden)

    A. Amorós

    2008-07-01

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

  12. What is the recurrence rate of postmenopausal bleeding in women who have a thin endometrium during a first episode of postmenopausal bleeding?

    NARCIS (Netherlands)

    van Doorn, H. C.; Timmermans, A.; Opmeer, B. C.; Kruitwagen, R. F. M. P.; Dijkhuizen, F. P. H. L. J.; Kooi, G. S.; van de Weijer, P. H. M.; Mol, B. W. J.

    2008-01-01

    Objective. To determine the incidence and significance of recurrent postmenopausal bleeding among women diagnosed with an endometrial thickness <= 4 mm after a first episode of postmenopausal bleeding. Methods. Consecutive patients not using hormone replacement therapy (HRT) presenting with a first

  13. A Modified APACHE II Score for Predicting Mortality of Variceal ...

    African Journals Online (AJOL)

    Conclusion: Modified APACHE II score is effective in predicting outcome of patients with variceal bleeding. Score of L 15 points and long ICU stay are associated with high mortality. Keywords: liver cirrhosis, periportal fibrosis, portal hypertension, schistosomiasis udan Journal of Medical Sciences Vol. 2 (2) 2007: pp. 105- ...

  14. Treatment of Non variceal Gastrointestinal Hemorrhage by Transcatheter Embolization

    International Nuclear Information System (INIS)

    Ali, M.; Ul Haq, T.; Salam, B.; Beg, M.; Sayani, R.; Azeemuddin, M.

    2013-01-01

    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.

  15. Value of Glasgow-Blatchford score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding

    Directory of Open Access Journals (Sweden)

    CUI Shu

    2017-10-01

    Full Text Available ObjectiveTo investigate the value of Glasgow-Blatchford score (GBS, Child-Turcotte-Pugh (CTP score, and Model for End-Stage Liver Disease (MELD score in predicting the 1- and 6-week prognosis of cirrhotic patients with esophagogastric variceal bleeding via a comparative analysis. MethodsA retrospective analysis was performed for the clinical data of 202 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31, 2014. According to the endpoint of death at 6 weeks after admission, the patients were divided into 1-week death group (10 patients, 6-week death group (23 patients, and survival group (179 patients. The Glasgow-Blatchford score, MELD score, CTP score, and CTP score and classification were calculated on admission, and these scores were compared between the three groups. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher′s exact test was used for comparison of categorical data between groups. The Z test was used for comparison of the area under the receiver operating characteristic curve (AUC of these three scoring systems. ResultsThere were significant differences between the 1-week death group and the survival group in the incidence rates of liver cancer with vascular invasion or metastasis (χ2=4.559, P=0.033, hepatic encephalopathy (χ2=25.568, P<0.01, melena (χ2=0.842, P=0.04, and heart failure (P=0.003, pulse rate (Z=-2.943, P=0.003, CTP classification (χ2=12.22, P=0.002, CTP score (Z=-2.505, P=0.012, MELD score (t=-2.395, P=0.018, and GBS score (Z=-2545, P=0.011. There were significant differences between the 6-week death group and the survival group in the incidence rates of liver cancer (χ2=9.374, P=0.002, liver

  16. 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

    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...... rebleeding were not statistically different. CONCLUSION: Our study shows that patients with BOV are more likely to receive therapy according to guidelines when hospitalized in a specialized unit compared with a community hospital. This however did not affect mortality.......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...

  17. Bleeding Duodenal Varices Successfully Treated with Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO) Assisted by CT During Arterial Portography

    International Nuclear Information System (INIS)

    Tsurusaki, Masakatsu; Sugimoto, Koji; Matsumoto, Shinichi; Izaki, Kenta; Fukuda, Tetsuya; Akasaka, Yoshinobu; Fujii, Masahiko; Hirota, Shozo; Sugimura, Kazuro

    2006-01-01

    A 60-year-old woman with massive hemorrhage from duodenal varices was transferred to our hospital for the purpose of transcatheter intervention. Although digital subtraction arterial portography could not depict the entire pathway of collateral circulation, the efferent route of the duodenal varices was clearly demonstrated on subsequent CT during arterial portography. Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed via the efferent vein and achieved complete thrombosis of the varices

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

    Directory of Open Access Journals (Sweden)

    Wael E Saad

    2014-01-01

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

  19. Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation.

    Science.gov (United States)

    Buechter, Matthias; Kahraman, Alisan; Manka, Paul; Gerken, Guido; Dechêne, Alexander; Canbay, Ali; Wetter, Axel; Umutlu, Lale; Theysohn, Jens M

    2017-01-01

    Upper gastrointestinal bleeding (UGIB) is a severe and life-threatening complication among patients with portal hypertension (PH). Covered transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization (SE) may be a promising alternative in this setting. We retrospectively analyzed 9 patients with PH-induced UGIB who underwent partial SE between 2012 and 2016. All patients met the following criteria: (i) upper gastrointestinal hemorrhage with primary or secondary failure of endoscopic interventions and (ii) TIPS implantation not possible. Each patient was followed for at least 6 months after embolization. Five patients (56%) suffered from cirrhotic PH, 4 patients (44%) from non-cirrhotic PH. UGIB occured in terms of refractory hemorrhage from gastric varices (3/9; 33%), hemorrhage from esophageal varices (3/9; 33%), and finally, hemorrhage from portal-hypertensive gastropathy (3/9; 33%). None of the patients treated with partial SE experienced re-bleeding episodes or required blood transfusions during a total follow-up time of 159 months, including both patients with cirrhotic- and non-cirrhotic PH. Partial SE, as a minimally invasive intervention with low procedure-associated complications, may be a valuable alternative for patients with recurrent PH-induced UGIB refractory to standard therapy.

  20. 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

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    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

  1. Monitoring of gastric secretion and early diagnostics of gastroduodenal ulcerative bleeding recurrences

    Directory of Open Access Journals (Sweden)

    Belikov A.V.

    2011-12-01

    Full Text Available The research goal is to develop a universal method of monitoring of intragastric medium dynamics. It allows diagnosing of bleeding recurrences and monitoring the effectiveness of gastric secretion suppression. In Saratov clinic of General Surgery use of probe-detector, dynamic endoscopy, laser Doppler flowmetry and methods of endoscopic hemostasis has reduced mortality: postoperative mortality has been decreased from 7,4 to 1,6%, while the general mortality — from 3,5 to 1,5%. The proposed devices can be used separately, and do not allow parallel assessment of pH of gastric juice, the microcirculation in the stomach wall and bleeding recurrences. 47 patients have been under the study. The changes in electroconductivity of intragastric medium have been proved in the suppression of intragastric secretion and the appearance of blood in gastric lumen. The received data have considered impedancemetry as the method of monitoring of intragastric medium in gastroduodenal bleedings

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

    International Nuclear Information System (INIS)

    Kim, Ji Chang; Yang, Po Sang; Lee, Yeon Soo; Kim, Hyun Jeong; Park, Gun

    2015-01-01

    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.

  3. 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.

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

    Science.gov (United States)

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. 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...

  6. Hand-assisted laparoscopic Hassab's procedure for esophagogastric varices with portal hypertension.

    Science.gov (United States)

    Kobayashi, Takashi; Miura, Kohei; Ishikawa, Hirosuke; Soma, Daiki; Zhang, Zhengkun; Ando, Takuya; Yuza, Kizuki; Hirose, Yuki; Katada, Tomohiro; Takizawa, Kazuyasu; Nagahashi, Masayuki; Sakata, Jun; Kameyama, Hitoshi; Wakai, Toshifumi

    2017-10-23

    Laparoscopic surgery for patients with portal hypertension is considered to be contraindicated because of the high risk of massive intraoperative hemorrhaging. However, recent reports have shown hand-assisted laparoscopic surgery for devascularization and splenectomy to be a safe and effective method of treating esophagogastric varices with portal hypertension. The aim of this study is to evaluate the efficacy of hand-assisted laparoscopic devascularization and splenectomy (HALS Hassab's procedure) for the treatment of esophagogastric varices with portal hypertension. From 2009 to 2016, seven patients with esophagogastric varices with portal hypertension were treated with hand-assisted laparoscopic devascularization and splenectomy in our institute. Four men and three women with a median age of 61 years (range 35-71) were enrolled in this series. We retrospectively reviewed the medical records for the perioperative variables, postoperative mortality and morbidity, and postoperative outcomes of esophagogastric varices. The median operative time was 455 (range 310-671) min. The median intraoperative blood loss was 695 (range 15-2395) ml. The median weight of removed spleen was 507 (range 242-1835) g. The conversion rate to open surgery was 0%. The median postoperative hospital stay was 21 (range 13-81) days. During a median 21 (range 3-43) months of follow-up, the mortality rate was 0%. Four postoperative complications (massive ascites, enteritis, intra-abdominal abscess, and intestinal ulcer) were observed in two patients. Those complications were treated successfully without re-operation. Esophagogastric varices in all patients disappeared or improved. Bleeding from esophagogastric varices was not observed during the follow-up period. Although our data are preliminary, hand-assisted laparoscopic devascularization and splenectomy proved an effective procedure for treating esophagogastric varices in patients with portal hypertension.

  7. Recurrent Bleeding Within 24 Hours After Uterine Artery Embolization for Severe Postpartum Hemorrhage: Are There Predictive Factors?

    International Nuclear Information System (INIS)

    Bros, Sébastien; Chabrot, Pascal; Kastler, Adrian; Ouchchane, Lemlih; Cassagnes, Lucie; Gallot, Denis; Boyer, Louis

    2012-01-01

    Purpose: To retrospectively identify predictive factors of recurrent bleeding within 24 h after uterine artery embolization (UAE) for postpartum hemorrhage (PPH). Materials and Methods: A total of 194 patients underwent UAE for PPH between August 1999 and April 2009 at our institution. Twelve patients experienced recurrent bleeding within the next 24 h; a second attempt at UAE was thus necessary, which was successful in 10 cases. In two cases, hemostatic hysterectomy was performed. Epidemiological, gynecological-obstetrical, anatomic, and biological data were analyzed. Results: Complete data were available for 148 of the 194 (76%) included patients. Sixty-four (43%) were primiparous, 18 (12.2%) had a placenta accreta, 21 (14%) had a coagulopathy, and 28 (18.9%) had an anatomic variant of the uterine arterial vasculature. Mean age and pregnancy term were similar in both recurring and nonrecurrent bleeding groups. After multivariate analysis, three criteria emerged as risk factors of recurrent bleeding: primiparity (10 patients, 83%; odds ratio [OR] = 18.84; P = 0.014), coagulation disorders (6 patients, 50%; OR = 12.08; P = 0.006), and anatomic variant of the uterine arterial vasculature (28 patients; OR = 9.83; P = 0.003). Conclusions: earch for uterine collaterals must be performed before UAE for PPH. Primiparity and coagulation disorders increase the risk of recurrent bleeding after UAE for PPH.

  8. Perivesical varices and portal hypertension: imaging study

    International Nuclear Information System (INIS)

    Mallorquin Jimenez, F.; Medina Benitez, A.; Lopez Machado, E.; Pardo Moreno, M.D.; Garrido Moreno, C.; Pastor Rull, J.

    1995-01-01

    Nine patients with portal hypertension syndrome and Perivesical varices are studied retrospectively by means of imaging techniques including ultrasound, duplex Doppler, color Doppler, CT and angiography. All the patients presented portal thrombosis and thickening of the bladder wall. These collaterals either represent a shunting of hepato pedal flow or correspond to blood stasis associated with said syndrome. Ultrasound, whether involving duplex Doppler or color Doppler techniques, is highly useful to detect the presence of Perivesical varices which appear as tubular or rounded hypo echogenic areas in the bladder wall. Given the association of this entity with bladder wall thickening, it should be taken into account in any clinical situation involving said change, especially in patients with portal hypertension; moreover knowledge of its presence is of great importance when the possibility of creating shunts by means of interventional or surgical vascular procedures or other types of abdominal procedures are being considered because of the risk of bleeding. (Author)

  9. Evaluation of technetium-99m DTPA for localization of site of acute upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Abdel-Dayem, H.M.; Mahajan, K.K.; Ericsson, S.; Nawaz, K.; Owunwanne, A.; Kouris, K.; Higazy, E.; Awdeh, M.

    1986-01-01

    Intravenous Tc-99m DTPA was evaluated in 34 patients with active upper gastrointestinal bleeding. Active bleeding was detected in 25 patients: nine in the stomach, 12 in the duodenum, and four from esophageal varices. No active bleeding was seen in nine patients (two gastric ulcers and seven duodenal ulcers). Results were correlated with endoscopic and/or surgical findings. All completely correlated except: 1) one case of esophageal varices in which there was disagreement on the site, 2) three cases of duodenal ulcers that were not bleeding on endoscopy but showed mild oozing on delayed images and 3) one case of gastric ulcer, in which no bleeding was detected in the Tc-99m DTPA study, but was found to be bleeding at surgery 24 hours later. The Tc-99m DTPA study is a reliable method for localization of upper gastrointestinal bleeding with an agreement ratio of 85%. This method also can be used safely for follow-up of patients with intermittent bleeding. It is less invasive than endoscopy, is easily repeatable, and has the same accuracy

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

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    Iqbal Sungkar

    2016-09-01

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

  11. Profiling lifetime episodes of upper gastrointestinal bleeding among ...

    African Journals Online (AJOL)

    Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic. ... female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated ...

  12. Hepatocellular carcinoma directly invading the duodenum

    International Nuclear Information System (INIS)

    Mohamed, Abdelrehman O.; Joshi, Sandhya; Czechowski, Janusz; Branicki, Frank

    2005-01-01

    Recurrent gastrointestinal bleeding from hepatocellular carcinoma (HCC) invading the duodenum is very rare. We present a case of 50-year-old male who was admitted with a history of recurrent upper gastrointestinal tract (UGIT) bleeding, weight loss and anemia. The patient was known to have a chronic hepatitis C. Endoscopic examination showed grade-2 non-bleeding esophageal varices, and a large ulcerated duodenal mass partially obstructing the duodenal bulb outlet and causing recurrent UGIT bleeding. Pathological evaluation of the mass revealed HCC. (author)

  13. Tratamento da recidiva hemorrágica por varizes do esôfago em doentes esquistossomóticos operados Treatment of recurrent hemorrhage esophageal varices in schistosomotic patients after surgery

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    José Cesar Assef

    2003-01-01

    ástrica esquerda ocluída e veia gástrica esquerda não-opacificada.OBJECTIVE: To standardize the treatment recurrent hemorrhage esophageal varices in schistosomotic patients after non decompressive surgery. METHODS: We treated 45 patients with schistosomotic portal hypertension who presented recurrent hemorrhage esophageal varices. Performance of abdominal ultra-sonography and arteriographic studies and two groups were defined: Group A: Nineteen patients (42,2% with absence of spleen, occluded splenic artery and patency of left gastric artery and vein, thus characterizing splenectomy at prior operation. Group B: Twenty six patients (57,8% with absence of spleen image, occluded splenic and left gastric artery and non-opacified left gastric vein, showing splenectomy and some type of gastroesophageal devascularization performed before. Patients of Group A were reoperated to carry out the gastroesophageal devascularization and patients of Group B were submitted to a sclerotherapy program. RESULTS: In Group A, one patient (5.3% presented recurrent hemorrhage on the late postoperative period. The esophageal varices decreased in number or diameter in 14 patients (73.7%, disappeared in three (15.8% and remained unchanged in two (10.5%, under final endoscopic evaluation. In Group B, six patients (23.1% presented recurrent bleeding. In four patients the acute hemorrhagic event were controlled. Two patients who underwent mesocaval shunt owing to unsuccess of these methods died postoperatively. Esophageal varices disappeared in 17 patients (65.4%, decreased in number or diameter in seven (26.9% and remained unchanged in two (7.7% after the last endoscopic evaluation. CONCLUSIONS: 1 The gastroesophageal devascularization is appropriated to splenectomized patients, with patency of left gastric artery and vein. 2 A long term of esophageal varices endoscopic sclerotherapy may be an option to splenectomized patients, with occluded left gastric artery and non-opacified left gastric ven.

  14. Flouroscopically–guided transhepatic puncture for difficult TIPS re-do procedures utilizing the En Snare retrieval device: A new approach to occluded TIPS in patients with recurrent ascites

    International Nuclear Information System (INIS)

    Stambo, Glenn W.; Berlet, Matthew H.

    2012-01-01

    Portal hypertension and variceal bleeding are complications due to cirrhosis. Transjugular Intraphepatic Portosystemic shunt (TIPS) procedure is a well-established treatment for recurrent ascites and variceal bleeding related to portal hypertension. After a TIPS has been placed, the potential of TIPS occlusion or stenosis is high. A TIPS re-do procedure has been used in treatment of progressive clinical symptoms. The standard approach is via the jugular route to recannulate the TIPS shunt. Rarely, it cannot be performed from the jugular approach. Therefore, a fluoroscopically -guided transhepatic approach has been devised for these difficult situations. This case describes the use of the transhepatic route through an indwelling Viatorr covered stent utilizing an En-Snare device to help complete the TIPS re-do procedure. With this newer approach to TIPS re-do procedures, endovascular specialists can achieve TIPS patency despite difficult venous anatomical challenges and the various types of available TIPS stents presently on the market.

  15. Recurrent Obscure Gastrointestinal Bleeding: Dilemmas and Success with Pharmacological Therapies. Case Series and Review

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    Majid Almadi

    2009-01-01

    Full Text Available The present article describes three difficult cases of recurrent bleeding from obscure causes, followed by a review of the pitfalls and pharmacological management of obscure gastrointestinal bleeding. All three patients underwent multiple investigations. An intervening complicating diagnosis or antiplatelet drugs may have compounded long-term bleeding in two of the cases. A bleeding angiodysplasia was confirmed in one case but was aggravated by the need for anticoagulation. After multiple transfusions and several attempts at endoscopic management in some cases, long-acting octreotide was associated with decreased transfusion requirements and increased hemoglobin levels in all three cases, although other factors may have contributed in some. In the third case, however, the addition of low-dose thalidomide stopped bleeding for a period of at least 23 months.

  16. South African Gastroenterology Review - Vol 2, No 2 (2004)

    African Journals Online (AJOL)

    Variceal recurrence, rebleeding and survival after injection sclerotherapy in 306 alcoholic cirrhotic patients with bleeding oesophageal varices: original · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. JEJ Krige, UK Kotze, PC Bornman, W Ddamulira, M Klipin, 8-13.

  17. The Novel Scoring System for 30-Day Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Hwang, Sejin; Jeon, Seong Woo; Kwon, Joong Goo; Lee, Dong Wook; Ha, Chang Yoon; Cho, Kwang Bum; Jang, ByungIk; Park, Jung Bae; Park, Youn Sun

    2016-07-01

    Although the mortality rates for non-variceal upper gastrointestinal bleeding (NVUGIB) have recently decreased, it remains a significant medical problem. The main aim of this prospective multicenter database study was to construct a clinically useful predictive scoring system by using our predictors and compare its prognostic accuracy with that of the Rockall scoring system. Data were collected from consecutive patients with NVUGIB. Logistic regression analysis was performed to identify the independent predictors of 30-day mortality. Each independent predictor was assigned an integral point proportional to the odds ratio (OR) and we used the area under the curve to compare the discrimination ability between the new predictive model and the Rockall score. The independent predictors of mortality included age >65 years [OR 2.627; 95 % confidence interval (CI) 1.298-5.318], hemodynamic instability (OR 2.217; 95 % CI 1.069-4.597), serum blood urea nitrogen level >40 mg/dL (OR 1.895; 95 % CI 1.029-3.490), active bleeding at endoscopy (OR 2.434; 95 % CI 1.283-4.616), transfusions (OR 3.811; 95 % CI 1.640-8.857), comorbidities (OR 3.481; 95 % CI 1.405-8.624), and rebleeding (OR 10.581; 95 % CI 5.590-20.030). The new predictive model showed a high discrimination capability and was significantly superior to the Rockall score in predicting the risk of death (OR 0.837;95 % CI 0.818-0.855 vs. 0.761; 0.739-0.782; P = 0.0123). The new predictive score was significantly more accurate than the Rockall score in predicting death in NVUGIB patients. We need to prospectively validate the accuracy of this score for predicting mortality in NVUGIB patients.

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

    Directory of Open Access Journals (Sweden)

    Fabienne C. Fierz

    2013-03-01

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

  19. Psuedotumoral gastric varices

    International Nuclear Information System (INIS)

    Yoon, Yong Kyu; Kim, Choon Won

    1974-01-01

    The roentgenographic recognition of gastric varices often is difficult, even when there is a history of liver disease or splenomegaly without demonstrable esophageal varices. An apparant polypoid filling defect with exaggerated mucosal folds in proximal portion of the gastric body and funds on upper GI series, accompanied by hematemesis and splenomegly should suggest the presence of pseudotumoral gastric varices. We have an experience a case of polypoid filling defects in gastric fundus of psudotumoral gastric varices of 49 years old Korean woman, which was diagnosed by surgical and histopathological findings

  20. [Comparison on Endoscopic Hemoclip and Hemoclip Combination Therapy in Non-variceal Upper Gastrointestinal Bleeding Patients Based on Clinical Practice Data: Is There Difference between Prospective Cohort Study and Randomized Study?].

    Science.gov (United States)

    Lee, Su Hyun; Jung, Jin Tae; Lee, Dong Wook; Ha, Chang Yoon; Park, Kyung Sik; Lee, Si Hyung; Yang, Chang Heon; Park, Youn Sun; Jeon, Seong Woo

    2015-08-01

    Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n = 62), hemoclipping only; group 2 (n = 88), hemoclipping plus epinephrine injection; and group 3 (n = 36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p bleeding associated mortality and total mortality) were not different among groups. Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.

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

    Science.gov (United States)

    Bonilha, Danielle Queiroz; Correia, Lucianna Motta; Monaghan, Marie; Lenz, Luciano; Santos, Marcus; Libera, Ermelindo Della

    2011-01-01

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

  2. Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    González-González, J A; Vázquez-Elizondo, G; Monreal-Robles, R; García-Compean, D; Borjas-Almaguer, O D; Hernández-Velázquez, B; Maldonado-Garza, H J

    The role of serum albumin level in patients with non-variceal upper gastrointestinal bleeding (NVUGB) has not been extensively studied. Our aim was to evaluate the role of serum albumin on admission in terms of in-hospital mortality in patients with NVUGB. Patients admitted with NVUGB during a 4-year period were prospectively included. Demographic, clinical, and laboratory data were collected. ROC curve analysis was used to determine the cutoff value for serum albumin on admission that made a distinction between deceased patients and survivors with respect to serum albumin on admission, as well as its overall performance compared with the Rockall score. 185 patients with NVUGB were evaluated. Men predominated (56.7%) and a mean age of 59.1±19.9 years was found. Mean serum albumin on admission was 2.9±0.9g/dl with hypoalbuminemia (< 3.5g/dl) detected on admission in 71.4% of cases. The ROC curve found that the best value for predicting hospital mortality was an albumin level of 3.1g/dl (AUROC 0.738). Mortality in patients with albumin ≥ 3.2g/dl was 1.2% compared with 11.2% in patients with albumin<3.2g/dl (P=.009; OR 9.7, 95%CI 1.2-76.5). There was no difference in overall performance between the albumin level (AUORC 0.738) and the Rockall score (AUROC 0.715) for identifying mortality. Patients with hypoalbuminemia presenting with NVUGB have a greater in-hospital mortality rate. The serum albumin level and the Rockall score perform equally in regard to identifying the mortality rate. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

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

    International Nuclear Information System (INIS)

    Liu Lingyun; Li Xiaohui; Qiu Xuanying; Lai Lisha; Zhong Qiuying; Zhu Kangshun

    2009-01-01

    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)

  4. Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report.

    Science.gov (United States)

    Mohd Rizal, M Y; Kosai, N R; Sutton, P A; Rozman, Z; Razman, J; Harunarashid, H; Das, S

    2013-01-01

    Dieulafoy's lesion is one of an unusual cause of upper gastrointestinal bleeding (U GIB). Endoscopic intervention has always been a preferred non-surgical method in treating UGIB including bleeding from Dieulafoy's lesion. Owing to recent advances in angiography, arterial embolization has become a popular alternative in non- variceal UGIB especially in cases with failed endoscopic treatment. However, managing bleeding Dieulafoy's with selective arterial embolization as the first line of treatment has not been exclusively practiced. We hereby, report a case of bleeding Dieulafoy lesion which had been primarily treated with arterial embolization.

  5. [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.

  6. Relevance of surgery in patients with non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Dango, S; Beißbarth, T; Weiss, E; Seif Amir Hosseini, A; Raddatz, D; Ellenrieder, V; Lotz, J; Ghadimi, B M; Beham, A

    2017-05-01

    %). Patients taking steroids presented with a risk of death of 26%, once taken to surgery the risk increased to 80%. Patients with liver cirrhosis had a risk of death of 42%; we observed a better outcome for these patients once taken to theater. Clinically, once scored with Blatchford score, statistical correlation was found for initial need for blood transfusion and surgical intervention. Clinical as well as complete Rockall score revealed a correlation between need for blood transfusion as well as surgical intervention in addition with a decreased outcome with increasing Rockall scores. Risk factor analysis including comorbidity, drug administration, and anticoagulation therapy introduced the combination of tumor and non-steroidal antirheumatic medication as independent risk factors for increased disease-related mortality. UGIB remains challenging and endoscopy is the first choice of intervention. Care must be taken once a patient is taking antirheumatic non-steroidal pain medication and suffers from cancer. In patients with presence of liver cirrhosis, an earlier surgical intervention may be considered, in particular for patients with recurrent bleeding. Embolization is not widely available and carries the risk of necrosis of the affected organ and should be restricted to a subgroup of patients not primarily eligible for surgery once endoscopy has failed. Taken together, an interdisciplinary approach including gastroenterologists as well as surgeons should be used once the patient is admitted to the hospital to define the best treatment option.

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

    Directory of Open Access Journals (Sweden)

    Paulo Lisboa Bittencourt

    2010-06-01

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

  8. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Elsebaey, Mohamed A; Elashry, Heba; Elbedewy, Tamer A; Elhadidy, Ahmed A; Esheba, Noha E; Ezat, Sherif; Negm, Manal Saad; Abo-Amer, Yousry Esam-Eldin; Abgeegy, Mohamed El; Elsergany, Heba Fadl; Mansour, Loai; Abd-Elsalam, Sherief

    2018-04-01

    Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly.Variceal bleeding was the most common cause of acute UGIB in elderly Egyptian patients. In-hospital mortality rate was 8.74%. Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding were the predictors of in-hospital mortality.Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding should be considered when triaging those patients for immediate resuscitation, close observation, and early treatment.

  9. Outcomes in variceal hemorrhage following the use of a balloon tamponade device

    Science.gov (United States)

    Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J.; Sanchez, Leon D.; Wolfe, Richard E.; Chase, Maureen; Donnino, Michael W.; Cocchi, Michael N.

    2017-01-01

    Background Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. Methods In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. Results 34 patients with a BTD were identified. Median age was 57.5 (IQR 47–63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p < 0.01). One complication, an esophageal perforation, was identified and managed conservatively. Conclusion In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. PMID:28460805

  10. Outcomes in variceal hemorrhage following the use of a balloon tamponade device.

    Science.gov (United States)

    Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J; Sanchez, Leon D; Wolfe, Richard E; Chase, Maureen; Donnino, Michael W; Cocchi, Michael N

    2017-10-01

    Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. 34 patients with a BTD were identified. Median age was 57.5 (IQR 47-63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p<0.01). One complication, an esophageal perforation, was identified and managed conservatively. In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. [Late complications of liver cirrhosis - management of gastrointestinal bleeding in the presence of portal hypertension].

    Science.gov (United States)

    Hejda, Václav

    Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality. A major progress was reached during the past 10-20 years in diagnosing liver cirrhosis (including non-invasive methods), in primary prevention of the initial episode of upper gastrointestinal bleeding and in the therapy of acute bleeding due to modern pharmacotherapy, with regard to expanding possibilities of therapeutic endoscopy and relatively new options for management of acute bleeding (esophageal stents, TIPS and suchlike). However acute upper gastrointestinal bleeding associated with portal hypertension still presents a considerable risk of premature death (15-20 %). Early diagnosing and causal treatment of numerous liver diseases may lead to slowing or regression of fibrosis and cirrhosis and possibly even of the degree of portal hypertension and thereby also the risk of bleeding.Key words: cirrhosis - esophageal varices - treatment of bleeding - portal hypertension.

  12. New placement of TIPS during pregnancy for recurring esophageal variceal bleeding: Estimation of fetal radiation exposure; TIPS-Neuanlage in der Schwangerschaft bei rezidivierender Oesophagusvarizenblutung - Abschaetzung der fetalen Strahlenexposition

    Energy Technology Data Exchange (ETDEWEB)

    Wildberger, J.E.; Vorwerk, D.; Stargardt, A.; Guenther, R.W. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Winograd, R.; Busch, N. [Technische Hochschule Aachen (Germany). Medizinische Klinik 3

    1998-10-01

    Recurrent variceal bleeding due to liver cirrhosis led to treatment with a transjugular intrahepatic portosystemic shunt (TIPS) in a pregnant woman at 20 weeks` gestation. Fetal radiation exposure was estimated to be less than 10 mSv. The use of a graduated catheter allowed measurement of field size and reliable determination of the patient`s entrance dose. Radiation exposure of an approximated fetal dosage of 5.2 mSv did not justify abortion for medical reasons. Therefore, TIPS procedure is not generally contraindicated during pregnancy itself. TIPS placement may be a therapeutic option related to the severity of the underlying maternal disease, after radiation exposure of the fetus has been estimated. (orig.) [Deutsch] Bei rezidivierender Oesophagusvarizenblutung auf dem Boden einer Leberzirrhose wurde bei bestehender Schwangerschaft der 20. Woche ein transjugulaerer portosystemischer Stent-Shunt (TIPS) neu angelegt. Praeinterventionell wurde die zu erwartende Strahlenexposition fuer den Feten kleiner 10 mSv abgeschaetzt. Der Einsatz eines Messkatheters waehrend des Eingriffs ermoeglichte die genaue Bestimmung der Feldgroesse und somit eine verlaessliche Berechnung der Einfallsdosis. Die applizierte Strahlendosis lag mit 5,2 mSv unter der praeinterventionellen Abschaetzung. Eine Strahlenexposition in diesem Dosisbereich stellt keine Indikation fuer einen medizinisch induzierten Schwangerschaftsabbruch dar. Eine intakte Graviditaet ist keine absolute Kontraindikation zur TIPS-Neuanlage. Diese muss unter Beruecksichtigung der Schwere des muetterlichen Krankheitsbildes und unter Vorausabschaetzung der zu erwartenden Strahlenexposition fuer den Feten als moegliche Therapieoption geprueft werden. (orig.)

  13. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators.

    Science.gov (United States)

    D'Amico, Gennaro; De Franchis, Roberto

    2003-09-01

    Several treatments have been proven to be effective for variceal bleeding in patients with cirrhosis. The aim of this multicenter, prospective, cohort study was to assess how these treatments are used in clinical practice and what are the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis. A training set of 291 and a test set of 174 bleeding cirrhotic patients were included. Treatment was according to the preferences of each center and the follow-up period was 6 weeks. Predictive rules for 5-day failure (uncontrolled bleeding, rebleeding, or death) and 6-week mortality were developed by the logistic model in the training set and validated in the test set. Initial treatment controlled bleeding in 90% of patients, including vasoactive drugs in 27%, endoscopic therapy in 10%, combined (endoscopic and vasoactive) in 45%, balloon tamponade alone in 1%, and none in 17%. The 5-day failure rate was 13%, 6-week rebleeding was 17%, and mortality was 20%. Corresponding findings for variceal versus nonvariceal bleeding were 15% versus 7% (P =.034), 19% versus 10% (P =.019), and 20% versus 15% (P =.22). Active bleeding on endoscopy, hematocrit levels, aminotransferase levels, Child-Pugh class, and portal vein thrombosis were significant predictors of 5-day failure; alcohol-induced etiology, bilirubin, albumin, encephalopathy, and hepatocarcinoma were predictors of 6-week mortality. Prognostic reassessment including blood transfusions improved the predictive accuracy. All the developed prognostic models were superior to the Child-Pugh score. In conclusion, prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades. Initial treatment stops bleeding in 90% of patients. Accurate predictive rules are provided for early recognition of high-risk patients.

  14. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit.

    Science.gov (United States)

    Jairath, Vipul; Rehal, Sunita; Logan, Richard; Kahan, Brennan; Hearnshaw, Sarah; Stanworth, Simon; Travis, Simon; Murphy, Michael; Palmer, Kelvin; Burroughs, Andrew

    2014-05-01

    Despite advances in treatment, acute variceal haemorrhage remains life-threatening. To describe contemporary characteristics, management and outcomes of patients with cirrhosis and acute variceal haemorrhage and risk factors for rebleeding and mortality. Multi-centre clinical audit conducted in 212 UK hospitals. In 526 cases of acute variceal haemorrhage, 66% underwent endoscopy within 24h with 64% (n=339) receiving endoscopic therapy. Prior to endoscopy, 57% (n=299) received proton pump inhibitors, 44% (n=232) vasopressors and 27% (n=144) antibiotics. 73% (n=386) received red cell transfusion, 35% (n=184) fresh frozen plasma and 14% (n=76) platelets, with widely varying transfusion thresholds. 26% (n=135) experienced further bleeding and 15% (n=80) died by day 30. The Model for End Stage Liver Disease score was the best predictor of mortality (area under the receiver operating curve=0.74, Prisk stratification tools are required to identify patients needing more intensive support. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  15. 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

    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...

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

    International Nuclear Information System (INIS)

    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.

    2008-01-01

    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 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

  17. Upper gastrointestinal bleeding in irbid, jordan

    International Nuclear Information System (INIS)

    Banisalamah, A.A.; Mraiat, Z.M.

    2007-01-01

    To define the various causes of nonvariceal upper gastrointestinal bleeding, to outline management modalities and to determine the final outcome of patients. A retrospective analysis of patients presenting with upper gastrointestinal (UGI) bleeding from January 2003 to December 2006 (4 years) was conducted. Patients with endoscopically proven variceal bleeding were excluded. Out of the 120 patients, most of the patients belonged to an age group of more than 50 years (mean 48.5 years). Haematemesis was the most common presentation and Acute Gastric Mucosal Lesion (AGML) was the most frequently encountered lesion. The cause of bleeding was not identified in 10 patients (undetermined group). Twenty-two (18.3%) underwent surgery and we had an overall mortality of 15.8%. AGML being the leading cause can be managed conservatively most of the time. There is a male preponderance and the incidence and mortality increases with advancing age. The undetermined group remains a diagnostic problem. (author)

  18. Narrow-band imaging can increase the visibility of fibrin caps after bleeding of esophageal varices: a case with extensive esophageal candidiasis.

    Science.gov (United States)

    Furuichi, Yoshihiro; Kasai, Yoshitaka; Takeuchi, Hirohito; Yoshimasu, Yuu; Kawai, Takashi; Sugimoto, Katsutoshi; Kobayashi, Yoshiyuki; Nakamura, Ikuo; Itoi, Takao

    2017-08-01

    A 58-year-old man with hepatitis B cirrhosis noticed black stools and underwent an endoscopy at a community hospital. The presence of esophageal varices (EVs) was confirmed, but the bleeding point was not found. He was referred to our institution and underwent a second endoscopy. Extensive white patches of esophageal candidiasis were visible on endoscopy by white-light imaging (WLI), but it was difficult to find the fibrin cap of the EVs. This was easier under narrow-band imaging (NBI), however, as the color turned red from absorption by hemoglobin adhered to it. We retrospectively measured the color differences (CD) between the fibrin cap and the surrounding mucosa 10 times using the CIE (L*a*b*) color space method. The median value of CD increased after NBI (13.9 → 43.0, p candidiasis, but the increased visibility of the fibrin cap by NBI enabled it to be found more easily. This is the first report of a case in which NBI was helpful in locating a fibrin cap of EVs.

  19. Bleeding ectopic duodenal varix: use of a new microvascular plug (MVP) device along with transjugular intrahepatic portosystemic shunt (TIPSS).

    Science.gov (United States)

    Bhardwaj, Richa; Bhardwaj, Gaurav; Bee, Erik; Karagozian, Raffi

    2017-08-16

    Ectopic varices (ECV) occur along the gastrointestinal (GI) tract outside the common variceal sites and represent 2%-5% of all GI variceal bleeds with mortality rates up to 40%. Management is challenging because of inaccessibility and increased risk of rebleeding. We report what is to our knowledge the first clinical use of a new microvascular plug (MVP) with transjugular intrahepatic portosystemic shunt (TIPSS) for a bleeding duodenal varix (DV). A 68-year-old man presented with melena. Endoscopy demonstrated a grade II varix in the second part of the duodenum with red wale sign. TIPSS was performed and portogram revealed a single DV. Poststent placement venogram revealed a persistent varix and hence a 5-7 mm MVP was deployed. Subsequent imaging showed cessation of blood through the DV. The patient had no further bleeding. TIPSS with embolisation is an effective treatment for ECV. This MVP offers advantages due to its size and compatibility and can be redeployed in case of suboptimal placement. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Partial splenic embolization in patients with idiopathic portal hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Maurizio E-mail: maurizio.romano@ibb.cnr.it; Giojelli, Angela; Capuano, Gaetano; Pomponi, Domenico; Salvatore, Marco

    2004-03-01

    Purpose: To evaluate the effectiveness of partial splenic embolization (PSE) in patients with idiopathic portal hypertension (IPH) in reducing variceal bleeding episodes, splenomegaly and thrombocytopenia. Materials and methods: Six patients (2M, 4F, mean age 30.3 years) with IPH presenting with splenomegaly, thrombocytopenia and recurrent variceal bleeding were treated with PSE using gelatin sponge (four patients) or Contour particles (two patients) as embolization material. Results: PSE was performed successfully in all cases; 3F coaxial microcatheters were necessary in two patients due to extreme splenic artery tortuosity. The average amount of devascularized parenchyma at CT 1 week after PSE was 71%. Splenomegaly and thrombocytopenia improved in all cases, with a mean platelet count increase of 120000/mm{sup 3} and an average 68% reduction of spleen volume at follow up. Variceal bleeding did not recur after PSE. Esophageal or gastroesophageal varices disappeared (one patient) or significantly reduced (five patients) at endoscopic controls. No significant complications were noted. The follow up was of at least 18 months in all patients; mean follow up was 28.2 months. Conclusion: In patients with IPH PSE can be effective in preventing variceal bleedings, in reducing spleen volume and in significantly increasing platelet count; therapeutic results were durable in our population.

  1. Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding: Left gastric artery pseudoaneurysm compressing the splenic vein treated by embolization of the pseudoaneurysm.

    Science.gov (United States)

    Hakim, Seifeldin; Bortman, Jared; Orosey, Molly; Cappell, Mitchell S

    2017-03-01

    A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA) compressing the splenic vein (SV) that was successfully treated with PA embolization. A 41-year-old man with previous medical history of recurrent, alcoholic pancreatitis presented with several episodes of hematemesis and abdominal pain for 48 hours. Physical examination revealed a soft abdomen, with no abdominal bruit, no pulsatile abdominal mass, and no stigmata of chronic liver disease. The hemoglobin declined acutely from 12.3 to 9.3 g/dL. Biochemical parameters of liver function and routine coagulation profile were entirely within normal limits. Abdominal CT revealed a 5-cm-wide peripancreatic mass compressing the stomach and constricting the SV. Esophagogastroduodenoscopy showed blood oozing from portal hypertensive gastropathy, small nonbleeding gastric cardial and fundal varices, gastric compression from the extrinsic mass, and no esophageal varices. MRCP and angiography showed that the mass was vascular, arose from the LGA, compressed the mid SV without SV thrombosis, and caused sinistral portal hypertension. At angiography, the PA was angioembolized and occluded. The patient has been asymptomatic with no further bleeding and a stable hemoglobin level during 8 weeks of follow-up. Literature review of the 14 reported cases of LGA PA revealed that this report of acute UGI bleeding from sinistral portal hypertension from a LGA PA constricting the SV is novel; one previously reported patient had severe anemia without acute UGI bleeding associated with sinistral portal hypertension from a LGA PA. A patient presented with UGI bleeding from sinistral portal hypertension from a LGA PA compressing the SV that was treated by angiographic obliteration of the PA which relieved the SV compression and arrested the UGI bleeding. Primary therapy for this syndrome should be addressed to obliterate the PA and not

  2. 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.

  3. Peroral endoscopic myotomy for the treatment of achalasia in a patient with esophageal varices. A case report.

    Science.gov (United States)

    Shen, Naning; Wang, Xin; Zhang, Xiaoyin; Yao, Liping; Xie, Huahong; Zhang, Hongbo

    2017-06-01

    Achalasia is very uncommon, and rarely does achalasia co-exist with esophageal varices. We present a 62-year-old woman who was diagnosed with both achalasia and esophageal varices in December 2014 and had a past history of hematemesis. The patient's achalasia symptoms' Eckardt score was 9, and her hepatic function was Child-Pugh grade A6. After comprehensive assessment of the patient's health and discussion of the pros and cons of various therapies for achalasia, the patient underwent a peroral endoscopic myotomy. She was symptom-free after the operation and had no recurrence of achalasia symptoms at 20-month follow-up. No adverse events were reported. Peroral endoscopic myotomy for achalasia with esophageal varices has not been previously reported in the English literature.

  4. High-Dose Barium Impaction Therapy Is Useful for the Initial Hemostasis and for Preventing the Recurrence of Colonic Diverticular Bleeding Unresponsive to Endoscopic Clipping

    Directory of Open Access Journals (Sweden)

    Ryota Niikura

    2013-01-01

    Full Text Available Most cases of colonic diverticular bleeding stop spontaneously, but some patients experience massive bleeding that requires emergency treatment. Endoscopy can be useful when the bleeding source is identified. However, bleeding sometimes recurs within a short period despite the successful endoscopic treatment. Under such conditions, more invasive therapy such as interventional angiography or surgery is required and can prolong hospitalization and involve frequent blood transfusions. We report the case of a 68-year-old woman who presented with massive hematochezia. The patient was in hemorrhagic shock and required 16 units of blood transfusion to recover to general condition. We performed multidetector row computed tomography, but it showed no sites of bleeding. We conducted colonoscopy and identified the source of bleeding as colonic diverticula. We treated the bleeding with endoscopic hemoclips and achieved hemostasis, but bleeding recurred the next day. Four units of blood transfusion were required. We tried high-dose barium impaction therapy to avoid further blood transfusion and surgery. No complications or recurrent bleeding was observed for an 18-month period. Therapeutic barium enema is an option for colonic diverticular bleeding unresponsive to endoscopic clipping and may be effective for preventing recurrent bleeding.

  5. Retrospective Study to Compare Selective Decongestive Devascularization and Gastrosplenic Shunt versus Splenectomy with Pericardial Devascularization for the Treatment of Patients with Esophagogastric Varices Due to Cirrhotic Portal Hypertension.

    Science.gov (United States)

    Bao, Haili; He, Qikuan; Dai, Ninggao; Ye, Ruifan; Zhang, Qiyu

    2017-06-08

    BACKGROUND For patients with esophagogastric varices secondary to portal hypertension due to liver cirrhosis, portosystemic shunts and devascularization have become the most commonly used treatment methods. We have developed a novel surgical approach for the treatment of patients with cirrhotic portal hypertension, selective decongestive devascularization, and shunt of the gastrosplenic region (SDDS-GSR). This aim of this study was to compare the efficacy and safety of SDDS-GSR with splenectomy with pericardial devascularization (SPD). MATERIAL AND METHODS A retrospective study was undertaken between 2006 and 2013 and included 110 patients with cirrhotic portal hypertension, 34 of whom underwent SDDS-GSR; 76 patients underwent SPD. Kaplan-Meier analysis was used to evaluate clinical outcomes, mortality, the incidence of re-bleeding, encephalopathy, and portal venous system thrombosis (PVST). RESULTS Postoperatively portal venous pressure decreased by 20% in both groups. The long-term incidence of re-bleeding and PVST was significantly lower in the SDDS-GSR group compared with the SPD group (P=0.018 and P=0.039, respectively). CONCLUSIONS This preliminary retrospective study has shown that SDDS-GSR was an effective treatment for patients with esophagogastric varices secondary to portal hypertension that may be used as a first-line treatment to prevent variceal bleeding and lower the incidence of PVST.

  6. Pharmacologic influence on esophageal varices

    International Nuclear Information System (INIS)

    Lunderquist, A.; Owman, T.

    1983-01-01

    Selective catherization of the left gastric vein was performed after percutaneous transhepatic portography (PTP) in patients with portal hypertension and esophageal varices. Following the hypothesis that drugs increasing the lower esophageal sphincter (LES) pressure may obstruct the variceal blood flow throught the lower esophagus, the effect of different drugs (i.e., intravenous injection of vasopressin, pentagastrin, domperidone and somatostatin and subcutaneous injection of metacholine) on the variceal blood flow was examined. Vasopressin did not change the variceal blood flow; pentagastrine, with its known effect of increasing the LES pressure produced a total interruption of the flow in four of eight patients; domperiodone, also known to increase the LES pressure obstructed the variceal blood flow in the only patient examined with this drug; somatostatin has no reported action on the LES but blocked the flow in one of two patients; and metacholine, reported to increase the LES pressure did not produce any change in the flow in the three patients examined. LES pressure was recorded before and during vasopressin infusion in seven patients with portal hypertension and esophageal varices. No reaction on the pressure was found. The patient number in the study is small and the results are nonuniform but still they suggest that drugs increasing the LES tonus might be useful to control variceal blood flow. (orig.)

  7. 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.

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

    Science.gov (United States)

    Owensby, Susan; Taylor, Kellee; Wilkins, Thad

    2015-01-01

    Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. © Copyright 2015 by the American Board of Family Medicine.

  9. Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

    Science.gov (United States)

    Kim, Young-Il

    2015-01-01

    Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

  10. Identifying Emergency Department Patients at Low Risk for a Variceal Source of Upper Gastrointestinal Hemorrhage.

    Science.gov (United States)

    Klein, Lauren R; Money, Joel; Maharaj, Kaveesh; Robinson, Aaron; Lai, Tarissa; Driver, Brian E

    2017-11-01

    Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage. This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization. Clinical and laboratory data were abstracted from the medical record. The source of the UGIB was defined as variceal or nonvariceal based on endoscopic reports. Binary recursive partitioning was utilized to create a clinical decision rule. The rule was internally validated and test characteristics were calculated with 1,000 bootstrap replications. A total of 719 patients were identified; mean age was 55 years and 61% were male. There were 71 (10%) patients with a variceal UGIB identified on endoscopy. Binary recursive partitioning yielded a two-step decision rule (platelet count > 200 × 10 9 /L and an international normalized ratio [INR] study must be externally validated before widespread use, patients presenting to the ED with an acute UGIB with platelet count of >200 × 10 9 /L and an INR of upper gastrointestinal hemorrhage. © 2017 by the Society for Academic Emergency Medicine.

  11. Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study.

    Science.gov (United States)

    Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrissoula; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D'Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Acciarresi, Monica; D'Amore, Cataldo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario Maimone; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria Giulia; Bubba, Valentina; Silvestri, Ilenia; Lees, Kennedy R

    2015-08-01

    The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered

  12. 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.

  13. Comparison of transjugular intrahepatic portosystemic shunt with covered stent and ballon-occluded retrograde transvenous obliteration in managing isolated gastric varices

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Kwon; Lee, Kristen A.; Sauk, Steven; Korenblat, Kevin [Washington University St. Louis School of Medicine, St. Louis (United States)

    2017-04-15

    Although a transjugular intrahepatic portosystemic shunt (TIPS) is commonly placed to manage isolated gastric varices, balloon-occluded retrograde transvenous obliteration (BRTO) has also been used. We compare the long-term outcomes from these procedures based on our institutional experience. We conducted a retrospective review of patients with isolated gastric varices who underwent either TIPS with a covered stent or BRTO between January 2000 and July 2013. We identified 52 consecutive patients, 27 who had received TIPS with a covered stent and 25 who had received BRTO. We compared procedural complications, re-bleeding rates, and clinical outcomes between the two groups. There were no significant differences in procedural complications between patients who underwent TIPS (7%) and those who underwent BRTO (12%) (p = 0.57). There were also no statistically significant differences in re-bleeding rates from gastric varices between the two groups (TIPS, 7% [2/27]; BRTO, 8% [2/25]; p = 0.94) or in developing new ascites following either procedure (TIPS, 4%; BRTO, 4%; p = 0.96); significantly more patients who underwent TIPS developed hepatic encephalopathy (22%) than did those who underwent BRTO (0%, p = 0.01). There was no statistically significant difference in mean survival between the two groups (TIPS, 30 months; BRTO, 24 months; p = 0.16); median survival for the patients who received TIPS was 16.6 months, and for those who underwent BRTO, it was 26.6 months. BRTO is an effective method of treating isolated gastric varices with similar outcomes and complication rates to those of TIPS with a covered stent but with a lower rate of hepatic encephalopathy.

  14. Role of enhanced multi-detector-row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Miyaoka, Youichi; Amano, Yuji; Ueno, Sayaka; Izumi, Daisuke; Mikami, Hironobu; Yazaki, Tomotaka; Okimoto, Eiko; Sonoyama, Takayuki; Ito, Satoko; Fujishiro, Hirofumi; Kohge, Naruaki; Imaoka, Tomonori

    2014-04-01

    Multi-detector-row computed tomography (MDCT) has been reported to be a potentially useful modality for detection of the bleeding origin in patients with acute upper massive gastrointestinal (GI) bleeding. The purpose of this study is to investigate the efficacy of MDCT as a routine method for detecting the origin of acute upper GI bleeding prior to urgent endoscopy. Five hundred seventy-seven patients with acute upper GI bleeding (514 nonvariceal patients, 63 variceal patients) who underwent urgent upper GI endoscopy were retrospectively analyzed. Patients were divided into three groups: enhanced MDCT, unenhanced MDCT, and no MDCT before endoscopy. The diagnostic accuracy of MDCT for detection of the bleeding origin was evaluated, and the average procedure times needed to endoscopically identify the bleeding origin were compared between groups. Diagnostic accuracy among endoscopists was 55.3% and 14.7% for the enhanced MDCT and unenhanced MDCT groups, respectively. Among nonvariceal patients, accuracy was 50.2% in the enhanced MDCT group, which was significantly better than that in the unenhanced MDCT group (16.5%). In variceal patients, accuracy was significantly better in the enhanced MDCT group (96.4%) than in the unenhanced MDCT group (0.0%). These accuracies were similar to those achieved by expert radiologists. The average procedure time to endoscopic detection of the bleeding origin in the enhanced MDCT group was significantly faster than that in the unenhanced MDCT and no-MDCT groups. Enhanced MDCT preceding urgent endoscopy may be an effective modality for the detection of bleeding origin in patients with acute upper GI bleeding. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  15. Portal Hypertension Secondary to Spontaneous Arterio-Portal Venous Fistulas: Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate and Microcoils

    International Nuclear Information System (INIS)

    Yamagami, Takuji; Nakamura, Toshiyuki; Nishimura, Tsunehiko

    2000-01-01

    We report a 73-year-old man with recurrent variceal bleeding due to portal hypertension caused by multiple intrahepatic arterio-portal venous fistulas, which were successfully occluded by embolization with n-butyl cyanoacrylate and micro-coils

  16. 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

  17. Radionuclide transit in esophageal varices

    International Nuclear Information System (INIS)

    Yeh, S.H.; Wang, S.J.; Wu, L.C.; Liu, R.S.; Tsai, Y.T.; Chiang, T.T.

    1985-01-01

    This study assessed esophageal motility in patients with esophageal varices by radionuclide transit studies. Data were acquired in list mode after an oral dose of 0.5 mCi Tc-99m sulfur colloid in 10 ml of water in the supine position above a low-energy all-purpose collimator of a gamma camera. The condensed image (CI) superimposed with a centroid curve was also produced in each case. Twenty-five normal subjects (N) and 32 patients (pts) with esophageal varices by endoscopy (large varices in Grades IV and V in 8 and small varices in Grade III or less in 24) were studied. TMTT, RTT, RF, and RI were all significantly increased in pts as compared to N. Especially, the transit time for the middle third (6.7 +- 2.6 sec vs 3.5 +- 0.9 sec in N, rho < 0.005) had the optimal sensitivy and specificity of 88% each at the cutoff value of 4.2 sec as determined by ROC analysis. In summary, radionuclide transit disorders occur in the majority of pts with esopageal varices. The middle RTT and CI are both optimal in sensitivity and specificity for detecting the abnormalities

  18. An observational study on oesophageal variceal endoscopic ...

    African Journals Online (AJOL)

    An observational study on oesophageal variceal endoscopic injection sclerotherapy in patients with portal hypertension seen at the Centre for Clinical Research, ... The report concludes that variceal injection sclerotherapy is a useful method of treating oesophageal varices and can be performed on an out patient basis.

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

    International Nuclear Information System (INIS)

    Lee, Ji Hyun; Jo, Jeong Hyun; Park, Jae Hyung; Park, Byeong Ho; Jung, Gyoo Sik

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-08-15

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

  1. Novel Application of Percutaneous Cryotherapy for the Treatment of Recurrent Oral Bleeding From a Noninvoluting Congenital Hemangioma Involving the Right Buccal Space and Maxillary Tuberosity

    International Nuclear Information System (INIS)

    Salehian, Sepand; Gemmete, Joseph J.; Kasten, Steven; Edwards, Sean P.

    2011-01-01

    Cryotherapy is the application of varying extremes of cold temperatures to destroy abnormal tissue. The intent of this article is to describe a novel technique using percutaneous cryotherapy for treating a noninvoluting congenital craniofacial hemangioma (NICH). An 18-year-old woman with type 1 von Willebrand’s disease, as well as a qualitative platelet aggregation disorder, presented with multiple recurrent episodes of oral bleeding from a NICH involving the right buccal space and maxillary tuberosity. The patient was initially treated with a combination of endovascular particulate embolization, percutaneous sclerotherapy, tissue cauterization, and laser therapy between the ages of 4 and 8 years of age. At 18 years of age, the patient presented with recurrent episodes of oral bleeding related to the NICH. Endovascular embolization was performed using particulate and a liquid embolic agent with limited success. Due to the refractory nature of this bleeding, the patient underwent successful lesion ablation using percutaneous cryotherapy. At 9-month follow-up, the patient is asymptomatic with no episodes of recurrent bleeding.

  2. Use of non-steroidal anti-inflammatory drugs and proton pump inhibitors in correlation with incidence, recurrence and death of peptic ulcer bleeding: an ecological study

    Science.gov (United States)

    Lu, Yunxia; Sverdén, Emma; Ljung, Rickard; Söderlund, Claes; Lagergren, Jesper

    2013-01-01

    Background Non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) are regarded as two types of drugs that respectively increase and decrease the risk of peptic ulcer bleeding. However, their relation to occurrence, recurrence and death of bleeding in the population level is not clear. Study objective To clarify recent calendar-time correlations between sales of NSAIDs and PPIs and the occurrence of peptic ulcer bleeding, re-bleeding and death. Design Ecological study. Results The time trend of peptic ulcer bleeding did not correlate with PPI sales but did correlate with NSAIDs in mem (Rmale=0.6571, Pmale=0.05). Sales of PPIs (inverse) and NSAIDs correlated with re-bleeding in women (Rmale=−0.8754, Pmale=0.002 and Rfemale=0.7161, Pfemale=0.03, respectively), but not in men. An inverse correlation between PPI sales and 30-day death after bleeding was found (Rmale=−0.9392, Pmale=0.0002 and Rfemale=−0.8561, Pfemale=0.003), and NSAID sales were found to correlate with increased death after bleeding ((Rmale=0.7278, Pmale=0.03, Rfemale=0.7858, Pfemale=0.01). Conclusions The sales of NSAIDs and PPIs correlate with recurrence of peptic ulcer bleeding in women and death after peptic ulcer bleeding in both genders in the population level. PMID:23293249

  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

    serum bilirubin (p 10 (p associated with a higher risk. In conclusion, the results support the prognostic value of metabolic variables as described earlier...... a significant relation with an increased risk of bleeding or death: high plasma volume (p 10 (p .... The prognostic significance of central circulation time stresses the importance of the hyperdynamic systemic circulation in assessing the increased risk of bleeding or death.(ABSTRACT TRUNCATED AT 250 WORDS)...

  4. Esophageal varices in cirrhotics on dynamic computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Miyazaki, Masaru; Takahashi, Osamu; Shimura, Tadanori

    1985-07-01

    Dynamic CT was performed on fifteen cirrhotics. The cirrhotics with esophageal varices were compared with those without esophageal varices in regard to the enhanced capacity of the liver and the spleen and the declining ratio of the spleen following the enhancement. Both the liver and the spleen in cirrhotics were enhanced less than non-cirrhotics, especially in those with esophageal varices (p<0.01). Splenic declining ratio following splenic enhancement clearly distinguish cirrhotics with esophageal varices from those without esophageal varices (p<0.01). These parameters on dynamic CT could be useful for the diagnosis of portal hypertension in cirrhotics.

  5. Valoración del pronóstico a corto y largo plazo de pacientes con cirrosis y hemorragia digestiva por hipertensión portal Assessing the short- and long-term prognosis of patients with cirrhosis and acute variceal bleeding

    Directory of Open Access Journals (Sweden)

    L. Sempere

    2009-04-01

    -term survival in patients with cirrhosis and acute variceal bleeding. Material and methods: prognostic indicators were calculated for a cohort of 201 cirrhotic patients with acute variceal bleeding hospitalized in our center, a third-level teaching hospital. The studied variables were: age, sex, etiology of cirrhosis, endoscopic findings, previous variceal bleeding episodes, human immunodeficiency virus (HIV infection, hepatocellular carcinoma (HCC, infection during episode, and Child-Turcotte-Pugh (CTP and Model for End-stage Liver Disease (MELD scores within 24 hours of bleeding onset. Patients were followed up for at least 6 months until death, liver transplantation, or end of observation. Results: median follow-up was 66.85 weeks (range 0-432.4. The 6-week, 3-month, 12-month and 36-month mortality rates were 22.9, 24.9, 34.3, and 39.8%, respectively. Age ≥ 65 years, presence of HCC, CTP score ≥ 10, and MELD score ≥ 18 were the variables associated with mortality in the multivariate analysis. The accuracy of MELD scores as predictors of 6-week, 3-month, 12-month, and 36-month mortality was better than that of CTP scores (c-statistics: 6 week MELD 0.804, CTP 0.762; 3-month MELD 0.794, CTP 0.760; 12-month MELD 0.766, CTP 0.741; 36 month MELD 0.737, CTP 0.717. Conclusion: MELD and CTP scores together with age and a diagnosis of hepatocellular carcinoma are useful indicators to assess the short- and long-term prognosis of patients with acute variceal bleeding.

  6. [Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

    Science.gov (United States)

    Belanová, Veronika; Gřiva, Martin

    2015-12-01

    The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even

  7. Effect of Ramadan fasting on acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Amine, El Mekkaoui; Kaoutar, Saâda; Ihssane, Mellouki; Adil, Ibrahimi; Dafr-Allah, Benajah

    2013-03-01

    Prolonged fasting may precipitate or exacerbate gastrointestinal complaints. The aim of this study was to evaluate the relation between Ramadan fasting and acute upper gastrointestinal bleeding (AUGIB), and to assess characteristics of those occurred in the holly month. Retrospective analysis was conducted for all patients, who underwent endoscopy for AUGIB in Ramadan (R) and the month before Ramadan (BR). Epidemiological, clinical and etiological characteristics and outcome of patients having AUGIB were compared between the two periods from 2001 to 2010. Two hundred and ninety-one patients had endoscopy for AUGIB during the two periods study. There was an increasing trend in the overall number of patients in Ramadan period (n = 132, 45.4% versus n = 159, 54.6%), especially with duodenal ulcer (n = 48, 37.2% versus n = 81, 62.8%). The most frequent etiology was peptic ulcer but it was more observed in group R than in group BR (46.2% versus 57.9%, P = 0.04), especially duodenal ulcer (36.4% versus 50.3%, P = 0.01); this finding persisted in multivariable modeling (adjusted odds ratio: 1.67; 95% confidence interval, 1.03-2.69, P = 0.03). In contrast, there was a decreasing trend in rate of variceal bleeding from BR period (26.5%) to R period (18.9%; P = 0.11). Regarding the outcome, there were no significant differences between the two periods of the study: Recurrent bleeding (10.6% versus 7.5%, P = 0.36) and mortality rate (5.3% versus 4.4%, P = 0.7). The most frequent etiology of AUGIB was peptic ulcer during Ramadan. However, Ramadan fasting did not influence the outcome of the patients. Prophylactic measures should be taken for people with risk factors for peptic ulcer disease.

  8. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    International Nuclear Information System (INIS)

    Ingraham, Christopher R.; Padia, Siddharth A.; Johnson, Guy E.; Easterling, Thomas R.; Liou, Iris W.; Kanal, Kalpana M.; Valji, Karim

    2015-01-01

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus

  9. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ingraham, Christopher R., E-mail: cringra@uw.edu; Padia, Siddharth A., E-mail: spadia@uw.edu; Johnson, Guy E., E-mail: gej@uw.edu [University of Washington, Department of Interventional Radiology (United States); Easterling, Thomas R., E-mail: easter@uw.edu [University of Washington, Department of Obstetrics and Gynecology (United States); Liou, Iris W., E-mail: irisl@medicine.washington.edu [University of Washington, Department of Medicine (United States); Kanal, Kalpana M., E-mail: kkanal@uw.edu [University of Washington, Physics Section, Department of Radiology (United States); Valji, Karim, E-mail: kvalji@uw.edu [University of Washington, Department of Interventional Radiology (United States)

    2015-10-15

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.

  10. Weekend effect in upper gastrointestinal bleeding: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Pei-Ching Shih

    2018-01-01

    Full Text Available Aim To perform a systematic review and meta-analysis of the weekend effect on the mortality of patients with upper gastrointestinal bleeding(UGIB. Methods The review protocol has been registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42017073313 and was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement. We conducted a search of the PUBMED, COCHRANE, EMBASE and CINAHL databases from inception to August 2017. All observational studies comparing mortality between UGIB patients with weekend versus weekday admissions were included. Articles that were published only in abstract form or not published in a peer-reviewed journal were excluded. The quality of articles was assessed using the Newcastle-Ottawa Scale. We pooled results from the articles using random-effect models. Heterogeneity was evaluated by the chi-square-based Q-test and I2test. To address heterogeneity, we performed sensitivity and subgroup analyses. Potential publication bias was assessed via funnel plot. Results Eighteen observational cohort studies involving 1,232,083 study patients were included. Weekend admission was associated with significantly higher 30-day or in-hospital mortality in all studies (OR = 1.12, 95% CI [1.07–1.17], P < 0.00001. Increased in-hospital mortality was also associated with weekend admission (OR = 1.12, 95% CI [1.08–1.17], P < 0.00001. No significant difference in in-hospital mortality was observed between patients admitted with variceal bleeding during the weekend or on weekdays (OR = 0.99, 95% CI [0.91–1.08], P = 0.82; however, weekend admission was associated with a 15% increase in in-hospital mortality for patients with non-variceal bleeding (OR = 1.15, 95% CI [1.09–1.21], P < 0.00001. The time to endoscopy for weekday admission was significantly less than that obtained for weekend admission (MD = −2.50, 95% CI [−4

  11. Esophageal variceal ligation in the secondary prevention of variceal ...

    African Journals Online (AJOL)

    Pan African Medical Journal ... Introduction: Long-term outcome of patients after band ligation have been poorly defined. ... endoscopic band ligation, liver cirrhosis, complication of band ligation, esophageal varices, secondary prevention ...

  12. Clinical and endoscopic profile of patients with upper gastrointestinal bleeding at tertiary care center of North India

    Directory of Open Access Journals (Sweden)

    Deep Anand

    2014-01-01

    Full Text Available Background: Upper gastrointestinal bleeding (UGIB is a common medical emergency associated with significant morbidity and mortality. The presentation of bleeding depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. Despite advancements in medical intervention UGIB still carries considerable morbidity, mortality and economic burden on health care system. At present, there is limited epidemiological data on UGIB and associated mortality from India. Aims: The aim was to study clinical, endoscopic profile, and associated mortality in patients presenting with UGIB. Materials and Methods: One hundred and fourteen patients came to Emergency Department with UGIB during the study period and were subjected to endoscopy to identify the etiology. The clinical and endoscopic profile was analyzed and mortality pattern was studied. Results: The mean age of patients was 49 ± 14.26. Majority of them were males (83.33% and male to female ratio was 5:1. The most common cause of UGIB was portal hypertension related (Esophageal and gastric varices seen in 56.14% of patients, peptic ulcer-related bleed was seen in 14.91% patients, gastric erosions were responsible for bleed in 12.28% patients, Mallory-Weiss tear was seen in 8.77% cases, gastric malignancy accounted for 4.38% of cases, Dieulafoy′s lesion was responsible for bleed in 1.75% cases and 1.75% had Duodenal polyp. The mortality rate because of UGIB in our cohort of patients was 21.05%. Conclusions: In the present study, variceal bleed was the most common cause of UGIB, followed by peptic ulcer bleed. Overall mortality was seen in 21.05% of cases; however, majority of mortality was seen in portal hypertension related bleeding.

  13. PROPHYLACTIC ENDOSCOPIC INJECTION SCLEROTHERAPY FOR GASTRIC VARICES : 1. DEVELOPMENT OF A NEW SCLEROTHERAPY TECHNIQUE AND ITS APPLICATION

    OpenAIRE

    Matsumura, Masahiko

    1994-01-01

    The author designed a direct injection method of endoscopic injection sclerotherapy (EIS) for gastric varices with a newly developed technique for controlling bleeding from the punctured site, and subsequently used it for prophylactic treatment in 10 cases. EIS was performed under X-ray monitoring in the absence of a balloon, and 5% ethanolamine oleate containing 49% Iopamidol was used as the sclerosant. A twenty-five gauge needle wearing an outer tube was used for the puncture. After injecti...

  14. Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule Endoscopy—A Case Report and Literature Review

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    Jie Ling

    2013-01-01

    Full Text Available Introduction. Gastrointestinal stromal tumor (GIST in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB. Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0 g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST.

  15. Transjugular intrahepatic portosystemic shunt in a patient with cavernomatous portal vein occlusion

    International Nuclear Information System (INIS)

    Kawamata, Hiroshi; Kumazaki, Tatsuo; Kanazawa, Hidenori; Takahashi, Shuji; Tajima, Hiroyuki; Hayashi, Hiromitsu

    2000-01-01

    A 23-year-old woman with liver cirrhosis secondary to primary sclerosing cholangitis was referred to us for the treatment of recurrent bleeding from esophageal varices that had been refractory to endoscopic sclerotherapy. Her portal vein was occluded, associated with cavernous transformation. A transjugular intrahepatic portosystemic shunt (TIPS) was performed after a preprocedural three-dimensional computed tomographic angiography evaluation to determine feasibility. The portal vein system was recanalized and portal blood flow increased markedly after TIPS. Esophageal varices disappeared 3 weeks after TIPS. Re-bleeding and hepatic encephalopathy were absent for 3 years after the procedure. We conclude that with adequate preprocedural evaluation, TIPS can be performed safely even in patients with portal vein occlusion associated with cavernous transformation.

  16. A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease

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    Yang Won Min

    2012-06-01

    Full Text Available Background/AimsThe aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG in patients with chronic liver disease (CLD, and to determine the accuracy of those parameters.MethodsWe retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography.ResultsThe multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP scoring system (=[platelet count (/mm3×albumin (g/dL]/[M-Index (cm3]. The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confidence interval, 0.801-0.899. The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%.ConclusionsThe VAP score can predict the presence of varices and PHG in patients with CLD and may increase the cost-benefit of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.

  17. Small-Diameter PTFE Portosystemic Shunts: Portocaval vs Mesocaval

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    Robert Shields

    1998-01-01

    Full Text Available Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh gradeA disease and 26 grade B; all had a liver volume of 1000– 2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.

  18. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    International Nuclear Information System (INIS)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao

    2014-01-01

    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

  19. 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.

  20. Antibiotic prophylaxis using third generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study.

    Science.gov (United States)

    Jun, Chung-Hwan; Park, Chang-Hwan; Lee, Wan-Sik; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun; Kim, Sei-Jong; Kim, Young-Dae

    2006-10-01

    Bacterial infection may be a critical trigger for variceal bleeding. Antibiotic prophylaxis can prevent rebleeding in patients with acute gastroesophageal variceal bleeding (GEVB). The aim of the study was to compare prophylactic third generation cephalosporins with on-demand antibiotics for the prevention of gastroesophageal variceal rebleeding. In a prospective trial, patients with the first acute GEVB were randomly assigned to receive prophylactic antibiotics (intravenous cefotaxime 2 g q 8 hr for 7 days, prophylactic antibiotics group) or to receive the same antibiotics only when infection became evident (on-demand group). Sixty-two patients in the prophylactic group and 58 patients in the on-demand group were included for analysis. Antibiotic prophylaxis decreased infection (3.2% vs. 15.5%, p=0.026). The actuarial rebleeding rate in the prophylactic group was significantly lower than that in the on-demand group (33.9% vs. 62.1%, p=0.004). The difference of rebleeding rate was mostly due to early rebleeding within 6 weeks (4.8% vs. 20.7%, p=0.012). On multivariate analysis, antibiotic prophylaxis (relative hazard: 0.248, 95% confidence interval (CI): 0.067-0.919, p=0.037) and bacterial infection (relative hazard: 3.901, 95% CI: 1.053-14.448, p=0.042) were two independent determinants of early rebleeding. In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.

  1. Frequency of rectal varices in patients with cirrhosis

    International Nuclear Information System (INIS)

    Zuberi, F.F; Khan, M.A.; Zuberi, B.F.; Khan, M.H.

    2004-01-01

    Objective: To document the frequency of rectal varices in patients with cirrhosis of liver and compare it with that of oesophageal varices in liver and to compare the frequency of rectal varices with non-cirrhotic controls. Patients and Methods: All patients of confirmed cirrhosis of liver, presenting during the study period, were selected for initial workup. On the basis of upper gastrointestinal (GI) endoscopy, patients were segregated into those with oesophageal varices group-A) and those without them (Group-B). A matched control group (Group-C) was added, which consisted of patients of irritable bowel syndrome (IBS) who underwent sigmoidoscopic/colonoscopic examination during the study period. Fiberoptic sigmoidoscopy was done in all selected patients. Statistical analysis for continuous variables was done by student's 't' test while non-continuous variables were analyzed by Mann-Whitney-U test. Results: A total of 104 patients (males 61; females 43) were included. Hepatic encephalopathy grade was significantly lower in group-B (p < 0.0001). Grade-I varices were seen in 13 patients, Grade-II in 38 and Grade-III in 33 patients of Group-A. Rectal varices were present in 59.9% of patients in Group-A as compared to Group-B in which no one had them (p < 0.0001). Conclusion: Rectal varices are common in patients of portal hypertension. (author)

  2. Double blind, placebo-controlled trial of Tranexamic acid on recent internal hemorrhoid bleeding

    Directory of Open Access Journals (Sweden)

    Abdul A. Rani

    2002-12-01

    Full Text Available Double blind randomized placebo controlled trial was conducted to evaluate the efficacy of Tranexamic acid in 54 patients with recent hemorrhoid bleeding. Age, gender, body weight, height, grade of hemorrhoid, time of onset of recent bleeding were comparable between two groups. Analysis of haemostatic effect or stop bleeding as an immediate outcome of this study revealed that in the grade 2 patients, 23/23 (100% of tranexamic group and 18/23(78.26% of placebo group the bleeding stop. After 3 days of observation, there was statistically significant different for the rate of stop bleeding as well as at the end of observation. Bleeding stop earlier in the Tranexamic group with median 4 days (3-5 days, compare to placebo, median 11(9.55-12.45. Analysis of recurrent bleeding as an outcome of this study revealed that in the placebo group 9/18(50% of grade 2 patients and all grade 3 (100%patients suffered from recurrent bleeding. Since the days 4, both group have significant different time for recurrent bleeding and at the end of observation, cumulative probability of free of bleeding between two groups significantly different. Median still stop bleeding in the placebo group was 36 days, and the tranexamic group never reaches the median until the end of observation. Conclusion: tranexamic acid was an effective drug to stop recent hemorrhoid bleeding and prevent further recurrent bleeding, significantly better than placebo. (Med J Indones 2002;11: 215-21Keywords: Tranexamic acid, hemorrhoid bleeding, haemostatic effect, recurrent bleeding.

  3. Development of optimal management of upper gastrointestinal bleeding secondary to pancreatic sinistral portal hypertension

    Directory of Open Access Journals (Sweden)

    SONG Yang

    2014-08-01

    Full Text Available The pathogenesis of pancreatic sinistral portal hypertension (PSPH is quite different from that of cirrhotic portal hypertension, and PSPH is the only curable type of portal hypertension. Gastric variceal bleeding is a less common manifestation of PSPH; however, it probably exacerbates the patient’s condition and leads to critical illness, and inappropriate management would result in death. Therefore, it is necessary to develop the optimal management of upper gastrointestinal bleeding in PSPH patients. Splenectomy is considered as a definitive procedure, together with surgical procedures to treat underlying pancreatic diseases. For patients in poor conditions or ineligible for surgery, splenic artery coil embolization is a preferable and effective method to stop bleeding before second-stage operation. The therapeutic decision should be made individually, and the further multi-center study to optimize the management of upper gastrointestinal bleeding from PSPH is warranted.

  4. Vocal fold varices and risk of hemorrhage.

    Science.gov (United States)

    Tang, Christopher Guan-Zhong; Askin, Gülce; Christos, Paul J; Sulica, Lucian

    2016-05-01

    To establish risk of hemorrhage in patients with varices compared to those without, determine additional risk factors, and make evidence-based treatment recommendations. Retrospective cohort study. Patients who were vocal performers presenting for care during a 24-month period were analyzed to determine incidence of hemorrhage. Patients with varices were compared to those without. Demographic information and examination findings (presence, location, character, and size of varices; presence of mucosal lesions or paresis) were analyzed to determine predictors of hemorrhage. A total of 513 patients (60.4% female, mean age 36.6 years ± 13.95 years) were evaluated; 14 patients presenting with hemorrhage were excluded. One hundred and twelve (22.4%) patients had varices; 387 (77.6%) did not. The rate of hemorrhage in patients with varices was 2.68% at 12 months compared to 0.8% in patients without. Cox proportional hazard regression analysis revealed a hazard ratio of 10.1 for patients with varix developing hemorrhage compared to nonvarix patients (P hemorrhage was 3.3 cases per 1,000 person-months for varix patients compared to 0.5 cases per 1,000 person-months in the nonvarix group. There was no significant difference in the incidence of paresis, mucosal lesions, location of varix (left or right side; medial or lateral), or varix morphology (pinpoint, linear, lake) between patients who hemorrhaged and those that did not. The presence of varices increases the risk of hemorrhage. Varix patients had 10 times the rate of hemorrhage compared to nonvarix patients, although the overall incidence is low. This data may be used to inform treatment of patients with varices. 4. Laryngoscope, 126:1163-1168, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Treatment of symptomatic pelvic varices by ovarian vein embolization

    International Nuclear Information System (INIS)

    Capasso, Patrizio; Simons, Christine; Trotteur, Genevieve; Dondelinger, Robert F.; Henroteaux, Denis; Gaspard, Ulysse

    1997-01-01

    Purpose. Pelvic congestion syndrome is a common cause of chronic pelvic pain in women and its association with venous congestion has been described in the literature. We evaluated the potential benefits of lumboovarian vein embolization in the treatment of lower abdominal pain in patients presenting with pelvic varicosities. Methods. Nineteen patients were treated. There were 13 unilateral embolizations, 6 initial bilateral treatments and 5 treated recurrences (a total of 30 procedures). All embolizations were performed with either enbucrilate and/or macrocoils, and there was an average clinical and Doppler duplex follow-up of 15.4 months. Results. The initial technical success rate was 96.7%. There were no immediate or long-term complications. Variable symptomatic relief was observed in 73.7% of cases with complete responses in 57.9%. All 8 patients who had partial or no pain relief complained of dyspareunia. The direct relationship between varices and chronic pelvic pain was difficult to ascertain in a significant number of clinical failures. Conclusion. Transcatheter embolization of lumboovarian varices is a safe technique offering symptomatic relief of pelvic pain in the majority of cases. The presence of dyspareunia seemed to be a poor prognostic factor, indicating that other causes of pelvic pain may coexist with pelvic varicosities

  6. A Rare Case of Retrogastric Abscess Occurring Six Months after N-Butyl-2-Cyanoacrylate Injection into Gastric Varices

    Directory of Open Access Journals (Sweden)

    Ikram Hussain

    2018-01-01

    Full Text Available Background. Injection with N-butyl-2-cyanoacrylate is a proven and successful therapeutic modality for treatment of patients with bleeding gastric varices. However, a variety of complications have also been associated with its use. Here, we report a rare case of retrogastric abscess which occurred almost six months after this therapy. This abscess was attributed to the hampered microbial clearance caused by the venous obliterations from N-butyl-2-cyanoacrylate. The abscess was successfully treated with 3 months of antibiotics.

  7. 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)

  8. Thrombosis of orbital varices

    International Nuclear Information System (INIS)

    Boschi Oyhenart, J.; Tenyi, A.; Boschi Pau, J.

    2002-01-01

    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

  9. Management of Patients with Acute Lower Gastrointestinal Bleeding

    Science.gov (United States)

    Strate, Lisa L.; Gralnek, Ian M.

    2016-01-01

    This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

  10. [Clinical epidemiological characteristics and change trend of upper gastrointestinal bleeding over the past 15 years].

    Science.gov (United States)

    Wang, Jinping; Cui, Yi; Wang, Jinhui; Chen, Baili; He, Yao; Chen, Minhu

    2017-04-25

    To investigate the clinical epidemiology change trend of upper gastrointestinal bleeding (UGIB) over the past 15 years. Consecutive patients who was diagnosed as continuous UGIB in the endoscopy center of The First Affiliated Hospital of Sun-Yat University during the period from 1 January 1997 to 31 December 1998 and the period from 1 January 2012 to 31 December 2013 were enrolled in this study. Their gender, age, etiology, ulcer classification, endoscopic treatment and hospitalization mortality were compared between two periods. In periods from 1997 to 1998 and 2012 to 2013, the detection rate of UGIB was 9.99%(928/9 287) and 4.49%(1 092/24 318)(χ 2 =360.089, P=0.000); the percentage of male patients was 73.28%(680/928) and 72.44% (791/1 092) (χ 2 =0.179, P=0.672), and the onset age was (47.3±16.4) years and (51.4±18.2) years (t=9.214, P=0.002) respectively. From 1997 to 1998, the first etiology of UGIB was peptic ulcer bleeding, accounting for 65.2%(605/928)[duodenal ulcer 47.8%(444/928), gastric ulcer 8.3%(77/928), stomal ulcer 2.3%(21/928), compound ulcer 6.8%(63/928)],the second was cancer bleeding(7.0%,65/928), and the third was esophageal and gastric varices bleeding (6.4%,59/928). From 2012 to 2013, peptic ulcer still was the first cause of UGIB, but the ratio obviously decreased to 52.7%(575/1092)(χ 2 =32.467, P=0.000)[duodenal ulcer 31.9%(348/1092), gastric ulcer 9.4%(103/1092), stomal ulcer 2.8%(30/1092), compound ulcer 8.6%(94/1092)]. The decreased ratio of duodenal ulcer bleeding was the main reason (χ 2 =53.724, P=0.000). Esophageal and gastric varices bleeding became the second cause (15.1%,165/1 092, χ 2 =38.976, P=0.000), and cancer was the third cause (9.2%,101/1 092, χ 2 =3.352, P=0.067). The largest increasing amplitude of the onset age was peptic ulcer bleeding [(46.2±16.7) years vs. (51.9±18.9) years, t=-5.548, P=0.000), and the greatest contribution to the amplitude was duodenal ulcer bleeding [(43.4±15.9) years vs. (48.4±19

  11. Management of overt upper gastrointestinal bleeding in a low resource setting: a real world report from Nigeria.

    Science.gov (United States)

    Alatise, Olusegun I; Aderibigbe, Adeniyi S; Adisa, Adewale O; Adekanle, Olusegun; Agbakwuru, Augustine E; Arigbabu, Anthony O

    2014-12-10

    Upper gastrointestinal bleeding (UGIB) remains a common medical problem worldwide that has significant associated morbidity, mortality, and health care resource use. This study outlines the aetiology, clinical presentation, and treatment outcomes of patients with UGIB in a Nigerian low resource health facility. This was a descriptive study of consecutive patients who underwent upper gastrointestinal (GI) endoscopy for upper GI bleeding in the endoscopy unit of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria from January 2007 to December 2013. During the study period, 287 (12.4%) of 2,320 patients who underwent upper GI endoscopies had UGIB. Of these, 206 (72.0%) patients were males and their ages ranged from 3 to 100 years with a median age of 49 years. The main clinical presentation included passage of melaena stool in 268 (93.4%) of individuals, 173 (60.3%) had haematemesis, 110 (38.3%) had haematochezia, and 161 (56.1%) were dizzy at presentation. Observed in 88 (30.6%) of UGIB patients, duodenal ulcer was the most common cause, followed by varices [52 (18.1%)] and gastritis [51 (17.1%)]. For variceal bleeding, 15 (28.8%) and 21 (40.4%) of patients had injection sclerotherapy and variceal band ligation, respectively. The overall rebleeding rate for endoscopic therapy for varices was 16.7%. For patients with ulcers, only 42 of 55 who had Forrest grade Ia to IIb ulcers were offered endoscopic therapy. Endoscopic therapy was áin 90.5% of the cases. No rebleeding followed endoscopic therapy for the ulcers. The obtained Rockall scores ranged from 2 to 10 and the median was 5.0. Of all patients, 92.7% had medium or high risk scores. An increase in Rockall score was significantly associated with length of hospital stay and mortality (p < 0.001). The overall mortality rate was 5.9% (17 patients). Endoscopic therapy for UGIB in a resource-poor setting such as Nigeria is feasible, significantly reduces morbidity and mortality

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

    Directory of Open Access Journals (Sweden)

    Mahesh Kumar Goenka

    2017-01-01

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

  13. Frequecy of different causes of upper gastrointestinal bleeding using endoscopic procedure at a tertiary care hospital

    International Nuclear Information System (INIS)

    Sher, F.; Ullah, R.S.; Khan, J.

    2014-01-01

    To assess the outcome of early endoscopy in terms of frequency of different causes of upper Gastrointestinal bleeding at a tertiary care hospital.Study Design: Cross sectional descriptive study. Place and Duration of Study: Outpatients / indoor patients, Department of Medicine Military Hospital Rawalpindi from 1st Jan 2010 to 30th June 2010. Patients and Methods: Study was carried out in department of medicine Military Hospital Rawalpindi. Two hundred and forty four after cosen. Patients of upper gastrointestinal bleeding fulfilling the inclusion criteria were included in the study. Haemodynamically stable patients were kept empty stomach for at least 6 -8 hours before procedure. A detailed history and thorough physical examination was carried out. Protocols for endoscopic examination were followed. Mandatory baseline investigations were obtained. Endoscopic findings were documented on a proforma. pvalue of less than 0.05 was considered statistically significant. Results: There were 174 males (71.3%) and 70 females (28.7%). The age of the patients ranged from 15 years to 75 years, mean age was 52.23 years (SD = 14.78). The most common cause of upper GI bleed was varices in 176 (72.1%) patients; followed by gastric ulcer in 24 (9.8%) patients. Other causes in order of decreasing frequency included gastritis 16(6.55%), duodenal ulcer 14(5.73%), esophagitis 6(2.45%), Mallory Weiss tear 2(0.81%) and miscellaneous 6(2.45%). Conclusion: Esophageal varices is the most common cause of upper GI bleed in our set up reflecting high prevalence of liver cirrhosis secondary to chronic HBV and HCV infection. (author)

  14. An upper gastrointestinal ulcer still bleeding after endoscopy : what comes next?

    NARCIS (Netherlands)

    Craenen, E. M. E.; Hofker, Hendrik; Peters, Frans; Kater, G. M.; Glatman, K. R.; Zijlstra, J. G.

    Introduction: Recurrent bleeding from an upper gastrointestinal ulcer when endoscopy fails is a reason for radiological or surgical treatment, both of which have their advantages and disadvantages. Case: Based on a patient with recurrent gastrointestinal bleeding, we reviewed the available evidence

  15. [Varices of the vocal cord: report of 21 cases].

    Science.gov (United States)

    Li, Jin-rang; Sun, Jian-jun

    2006-04-01

    To study the diagnosis and treatment of varices of the vocal cord. The clinical data of 21 cases with varix of vocal cord were analyzed. All the patients presented hoarseness. There were 15 female and 6 male cases with their ages ranged from 23 to 68 years (median 44 years old). The varix was found on the right vocal cord in 12 cases, on the left vocal cord in 9 cases. Isolated varix existed on the vocal cord in 10 cases, varix with vocal cord polyps or nodules in 10 cases, varix with vocal cord paralysis in 1 case. All the patients were diagnosed under the laryngovideoscopy. The lesions appeared on the superior surface of the vocal cord. Varices manifested as abnormally dilated capillary running in the anterior to posterior direction in 6 cases, as clusters of capillary in 3 cases, as a dot or small sheet or short line of capillary in 12 cases. The varices were disappeared in 2 of 8 cases with vocal cord varices and polyps after removed the polyps. The varices of others patients had no change after following up for more than 6 months, but one patient happened hemorrhage of the contralateral vocal cord. Varices are most commonly seen in female. Laryngovideoscopy is the key in determining the vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization.

  16. Antithrombotic drugs and non-variceal bleeding outcomes and risk scoring systems: comparison of Glasgow Blatchford, Rockall and Charlson scores

    Science.gov (United States)

    Taha, Ali S; McCloskey, Caroline; Craigen, Theresa; Angerson, Wilson J

    2016-01-01

    Objectives Antithrombotic drugs (ATDs) cause non-variceal upper gastrointestinal bleeding (NVUGIB). Risk scoring systems have not been validated in ATD users. We compared Blatchford, Rockall and Charlson scores in predicting outcomes of NVUGIB in ATD users and controls. Methods A total of 2071 patients with NVUGIB were grouped into ATD users (n=851) and controls (n=1220) in a single-centre retrospective analysis. Outcomes included duration of hospital admission, the need for blood transfusion, rebleeding requiring surgery and 30-day mortality. Results Duration of admission correlated with all scores in controls, but correlations were significantly weaker in ATD users. Rank correlation coefficients in control versus ATD: 0.45 vs 0.20 for Blatchford; 0.48 vs 0.32 for Rockall and 0.42 vs 0.26 for Charlson (all p<0.001). The need for transfusion was best predicted by Blatchford (p<0.001 vs Rockall and Charlson in both ATD users and controls), but all scores performed less well in ATD users. Area under the receiver operation characteristic curve (AUC) in control versus ATD: 0.90 vs 0.85 for Blatchford; 0.77 vs 0.61 for Rockall and 0.69 vs 0.56 for Charlson (all p<0.005). In predicting surgery, Rockall performed best; while mortality was best predicted by Charlson with lower AUCs in ATD patients than controls (p<0.05). Stratification showed the scores' performance to be age-dependent. Conclusions Blatchford score was the strongest predictor of transfusion, Rockall's had the strongest correlation with duration of admission and with rebleeding requiring surgery and Charlson was best in predicting 30-day mortality. Modifications of these systems should be explored to improve their efficiency in ATD users. PMID:28839866

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

    International Nuclear Information System (INIS)

    Kodama, Hideaki; Aikata, Hiroshi; Takaki, Shintaro; Azakami, Takahiro; Katamura, Yoshio; Kawaoka, Tomokazu; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Takahashi, Shoichi; Toyota, Naoyuki; Ito, Katsuhide; Chayama, Kazuaki

    2010-01-01

    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.

  18. Photocoagulation in the treatment of bleeding peptic ulcer

    Science.gov (United States)

    Otto, Wlodzimierz; Paczkowski, Pawel M.

    1996-03-01

    The authors present their experience in the endoscopic laser photocoagulation of bleeding peptic ulcer. From 1991 to June 1995, 203 patients admitted for UGI bleeding from peptic ulcer have been treated by this method. The source of bleeding was confirmed by endoscopy. The patients were divided into two groups: actively bleeding peptic ulcer (group IA and IB according to Forrest's classification) and ulcer with stigmata of recent bleeding (group IIA/IIB). The former group consisted of 106 patients, among whom over 40 percent (45 patients) presented signs of hypovolemic shock on admission. Nd:YAG laser (Surgical Laser Technologies) was used in a continuous mode with a contact (8 - 20 watts) or non-contact (over 50 watts) method of coagulation. In actively bleeding patients photocoagulation resulted in stopping the hemorrhage in 95 (90%). Recurrent bleeding occurred in 16 cases; in 9 of them it was stopped by repeated photocoagulation. In this group 18 patients required surgical intervention. The mortality was of 10.3% (11 patients). In 97 patients with recent bleeding stigmata photocoagulation provoked heavy hemorrhage in 3 (in 2 cases stopped by prolonged coagulation). In 9 of the remaining 94 patients recurrent bleeding occurred. Nine patients required surgical intervention. Mortality in this group was of 6%.

  19. Experimental and clinical application of laser doppler flowmetry in gastric and duodenal ulcerative bleedings

    Directory of Open Access Journals (Sweden)

    Afanasieva G.A.

    2011-12-01

    Full Text Available The research goal is to develop a new objective diagnostic method of prerecurrence syndrome that will prognose bleeding recurrence from gastroduodenal ulcers. Materials and methods. Method of laser Doppler flowmetry (LDF of the regional perfusion of tissue has been used. The experimental part has been done on 30 white laboratory rats. Characteristics of regional tissue perfusion in the simulation and laser hemostasis of bleeding have been studied. Gastroduodenal endoscopy has been performed with laser Doppler flowmetry (ELDF in clinical conditions to predict the recurrence of ulcerative bleeding. The prognostic method of gastroduodenal ulcerative bleeding was used in 58 patients hospitalized with such pathology and activity of bleeding Forrest II. Results. The study of microcirculation parameters and experimental hemostasis has showed the possibility of using LDF to measure its performance. Effective hemostasis has been accompanied by a significant decrease in perfusion. On the basis of microcirculation parameters in ulcerative bleeding, medical adrenaline test has been proposed for an objective verification pre-recurrence syndrome. To evaluate the effectiveness of endoscopic hemostasis perfusion has been measured before and after its implementation. Conclusion. ELDF has objectified the prognosis of ulcerative bleeding recurrence, verified pre-recurrence syndrome and evaluated the efficacy of endoscopic hemostasis

  20. Transjugular Intrahepatic Portosystemic Shunt (TIPS): Current Status and Future Possibilities

    International Nuclear Information System (INIS)

    Bilbao, Jose Ignacio; Quiroga, Jorge; Herrero, Jose Ignacio; Benito, Alberto

    2002-01-01

    Since the insertion of the first TIPS in 1989 much has been learned about this therapeutic procedure. It has an established role for the treatment of some complications of portal hypertension: prevention of recurrent variceal bleeding and rescue of patients with acute uncontrollable variceal bleeding. In addition TIPS is useful for Budd-Chiari syndrome, refractory ascites and hepatorenal syndrome, although its specific role in these indications remains to be definitively established. However, the decrease in sinusoidal blood flow induced by TIPS can lead to the patient developing hepatic encephalopathy and liver failure in some cases. Therefore, TIPS should be used with caution in patients with very poor liver function. From a technical point of view, successful placement of TIPS is achieved in more than 98% of cases by experienced groups. At present, evaluation of TIPS dysfunction based on morphology probably leads to an overdiagnosis of this complication since most of these cases are not associated with clinical manifestations (recurrent bleeding or refractory ascites). The major disadvantage of TIPS remains its poor long-term patency requiring a mandatory surveillance program. The indicator for shunt function/malfunction should be the portosystemic pressure gradient, which is best assessed by intravascular measurements. Shunt obstructions may be prevented or reduced by the use of stent-grafts in the future

  1. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study

    DEFF Research Database (Denmark)

    Jepsen, Peter; Ott, Peter; Andersen, Per Kragh

    2010-01-01

    The clinical course of alcoholic cirrhosis, a condition with a high mortality, has not been well described. We examined prevalence, risk, chronology, and mortality associated with three complications of cirrhosis: ascites, variceal bleeding, and hepatic encephalopathy. We followed a population......-risks methods. At diagnosis of alcoholic cirrhosis, 24% of patients had no complications, 55% had ascites alone, 6% had variceal bleeding alone, 4% had ascites and variceal bleeding, and 11% had hepatic encephalopathy. One-year mortality was 17% among patients with no initial complications, 20% following...... variceal bleeding alone, 29% following ascites alone, 49% following ascites and variceal bleeding (from the onset of the later of the two complications), and 64% following hepatic encephalopathy. Five-year mortality ranged from 58% to 85%. The risk of complications was about 25% after 1 year and 50% after...

  2. Gallbladder varices in extrahepatic portal venous obstruction: demonstration by intravenous

    International Nuclear Information System (INIS)

    Gulati, M.

    2002-01-01

    Full text: We performed a prospective study to determine frequency of presence of gallbladder varices (GBV) by intravenous CT portography (CTP) in patients with extrahepatic portal venous obstruction (EHPVO). 90 patients (age range: 2-55 years) with EHPVO (initially diagnosed on abdominal sonography) underwent CTP using a subsecond helical CT scanner. Axial overlapping sections of 2mm were obtained with collimation 3mm and table speed 4.5mm/sec (pitch 1.5). Presence and patterns of GBV were studied. CTP demonstrated GBV in 54 (60%) of 90 patients.GBV were said to be present when one or more of the following findings were seen: diffuse wall enhancement (26/90), pinpoint areas of enhancement in GB wall (33/90), obvious large collaterals in GB wall (8/90) and pericholecystic collaterals (49/90). Presence of GBV did not correlate with the site and extent of EHPVO. Contiguous intrahepatic collaterals extending from GB bed to intrahepatic portal vein branches were seen in 41 of 54 (76%) of patients with GBV, suggesting the role of GBV serving as bridging portoportal collaterals. Hepatic perfusion defects were seen in 5/54 patients with GBV and were not seen in remaining 36/90 patients of EHPVO. GB calculi were seen in only 4/54 cases with GBV (as determined on sonography) suggesting no increase in risk for cholelithiasis. GBV commonly develop as bridging collaterals in patients with EHPVO. CTP is very useful in detecting these varices and planning biliary surgery, given the frequency of iatrogenic surgical bleeding in these patients. Copyright (2002) Blackwell Science Pty Ltd

  3. Vascular parenchymal sources of upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M.; Rubaltelli, L.; Candiani, F.

    Fourteen cases of upper gastrointenstinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

  4. Vascular parenchymal sources of upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M.; Rubaltelli, L.; Candiani, F.

    1989-01-01

    Fourteen cases of upper gastrointenstinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment. (orig.)

  5. Endoscopic Color Doppler Ultrasonographic Evaluation of GastricVarices Secondary to Left-Sided Portal Hypertension

    Science.gov (United States)

    Sato, Takahiro; Yamazaki, Katsu; Kimura, Mutsuumi; Toyota, Jouji; Karino, Yoshiyasu

    2014-01-01

    Gastric varices that arise secondary to the splenic vein occlusion can result in gastrointestinal hemorrhaging. Endoscopic color Doppler ultrasonography (ECDUS) was performed in 16 patients with gastric varices secondary to splenic vein occlusion. This study retrospectively evaluated the role of ECDUS in the diagnosis of gastric varices secondary to splenic vein occlusion. Thirteen patients had co-existing pancreatic diseases: 8 with chronic pancreatitis, 4 with cancer of the pancreatic body or tail and 1 with severe acute pancreatitis. Of the remaining 3 patients, 1 had myeloproliferative disease, 1 had advanced gastric cancer, and the third had splenic vein occlusion due to an obscure cause. The endoscopic findings of gastric varices were: variceal form (F) classified as enlarged tortuous (F2) in 12 cases and large, coil-shaped (F3) in 4 cases, and positive for erosion or red color sign of the variceal surface in 4 cases and negative in 12 cases. ECDUS color flow images of gastric variceal flow clearly depicted a round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body in all 16 cases. The velocities of F3 type gastric varices were significantly higher than those of the F2 type. The wall thickness of varices positive for erosion or red color sign was significantly less than the negative cases. I conclude that ECDUS color flow images of gastric variceal flow depicted specific findings of gastric varices secondary to splenic vein occlusion at the round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body. PMID:26852679

  6. External validation of scoring systems in risk stratification of upper gastrointestinal bleeding.

    Science.gov (United States)

    Anchu, Anna Cherian; Mohsina, Subair; Sureshkumar, Sathasivam; Mahalakshmy, T; Kate, Vikram

    2017-03-01

    The aim of this study was to externally validate the four commonly used scoring systems in the risk stratification of patients with upper gastrointestinal bleed (UGIB). Patients of UGIB who underwent endoscopy within 24 h of presentation were stratified prospectively using the pre-endoscopy Rockall score (PRS) >0, complete Rockall score (CRS) >2, Glasgow Blatchford bleeding scores (GBS) >3, and modified GBS (m-GBS) >3 scores. Patients were followed up to 30 days. Prognostic accuracy of the scores was done by comparing areas under curve (AUC) in terms of overall risk stratification, re-bleeding, mortality, need for intervention, and length of hospitalization. One hundred and seventy-five patients were studied. All four scores performed better in the overall risk stratification on AUC [PRS = 0.566 (CI: 0.481-0.651; p-0.043)/CRS = 0.712 (CI: 0.634-0.790); p0.001); m-GBS = 0.802 (CI: 0.734-0.871; pbleed [AUC-0.679 (CI: 0.579-0.780; p = 0.003)]. All the scoring systems except PRS were found to be significantly better in detecting 30-day mortality with a high AUC (CRS = 0.798; p-0.042)/GBS = 0.833; p-0.023); m-GBS = 0.816; p-0.031). All four scores demonstrated significant accuracy in the risk stratification of non-variceal patients; however, only GBS and m-GBS were significant in variceal etiology. Higher cutoff scores achieved better sensitivity/specificity [RS > 0 (50/60.8), CRS > 1 (87.5/50.6), GBS > 7 (88.5/63.3), m-GBS > 7(82.3/72.6)] in the risk stratification. GBS and m-GBS appear to be more valid in risk stratification of UGIB patients in this region. Higher cutoff values achieved better predictive accuracy.

  7. Base of tongue varices associated with portal hypertension

    OpenAIRE

    Jassar, P; Jaramillo, M; Nunez, D

    2000-01-01

    A symptomatic case of tongue base varices in a patient with portal hypertension secondary to liver cirrhosis is presented. There are no previously documented cases in the world literature. Oesophageal varices may not be the only source of expectorated blood in a patient with portal hypertension.


Keywords: portal hypertension; lingual; tongue; varicose vein

  8. Prediction of Outcome in Acute Lower Gastrointestinal Bleeding Using Gradient Boosting.

    Directory of Open Access Journals (Sweden)

    Lakshmana Ayaru

    Full Text Available There are no widely used models in clinical care to predict outcome in acute lower gastro-intestinal bleeding (ALGIB. If available these could help triage patients at presentation to appropriate levels of care/intervention and improve medical resource utilisation. We aimed to apply a state-of-the-art machine learning classifier, gradient boosting (GB, to predict outcome in ALGIB using non-endoscopic measurements as predictors.Non-endoscopic variables from patients with ALGIB attending the emergency departments of two teaching hospitals were analysed retrospectively for training/internal validation (n=170 and external validation (n=130 of the GB model. The performance of the GB algorithm in predicting recurrent bleeding, clinical intervention and severe bleeding was compared to a multiple logic regression (MLR model and two published MLR-based prediction algorithms (BLEED and Strate prediction rule.The GB algorithm had the best negative predictive values for the chosen outcomes (>88%. On internal validation the accuracy of the GB algorithm for predicting recurrent bleeding, therapeutic intervention and severe bleeding were (88%, 88% and 78% respectively and superior to the BLEED classification (64%, 68% and 63%, Strate prediction rule (78%, 78%, 67% and conventional MLR (74%, 74% 62%. On external validation the accuracy was similar to conventional MLR for recurrent bleeding (88% vs. 83% and therapeutic intervention (91% vs. 87% but superior for severe bleeding (83% vs. 71%.The gradient boosting algorithm accurately predicts outcome in patients with acute lower gastrointestinal bleeding and outperforms multiple logistic regression based models. These may be useful for risk stratification of patients on presentation to the emergency department.

  9. 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.

  10. Etiological and Endoscopic Profile of Middle Aged and Elderly Patients with Upper Gastrointestinal Bleeding in a Tertiary Care Hospital in North India: A Retrospective Analysis.

    Science.gov (United States)

    Mahajan, Pranav; Chandail, Vijant Singh

    2017-01-01

    Upper gastrointestinal (GI) bleeding is a common medical emergency associated with significant morbidity and mortality. The clinical presentation depends on the amount and location of hemorrhage and the endoscopic profile varies according to different etiology. At present, there are limited epidemiological data on upper GI bleed and associated mortality from India, especially in the middle and elderly age group, which has a higher incidence and mortality from this disease. This study aims to study the clinical and endoscopic profile of middle aged and elderly patients suffering from upper GI bleed to know the etiology of the disease and outcome of the intervention. Out of a total of 1790 patients who presented to the hospital from May 2015 to August 2017 with upper GI bleed, and underwent upper GI endoscopy, data of 1270 patients, aged 40 years and above, was compiled and analyzed retrospectively. All the patients included in the study were above 40 years of age. Majority of the patients were males, with a male to female ratio of 1.6:1. The most common causes of upper GI bleed in these patients were portal hypertension-related (esophageal, gastric and duodenal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia GAVE), seen in 53.62% of patients, followed by peptic ulcer disease (gastric and duodenal ulcers) seen in 17.56% of patients. Gastric erosions/gastritis accounted for 15.20%, and duodenal erosions were seen in 5.8% of upper GI bleeds. The in-hospital mortality rate in our study population was 5.83%. The present study reported portal hypertension as the most common cause of upper GI bleeding, while the most common endoscopic lesions reported were esophageal varices, followed by gastric erosion/gastritis, and duodenal ulcer.

  11. Approach to upper gastrointestinal bleeding

    African Journals Online (AJOL)

    Benign ulcer. Mallory-Weiss tear .... pressure and direct thermal coagulation. Alternatively, use ... Forrest classification of peptic ulcer bleeding related to risks of rebleeding. (NBVV - non- .... esomeprazole for prevention of recurrent peptic ulcer ...

  12. Retrospective analysis of surgery and trans-arterial embolization for major non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Griffiths, Ewen A; McDonald, Chris R; Bryant, Robert V; Devitt, Peter G; Bright, Tim; Holloway, Richard H; Thompson, Sarah K

    2016-05-01

    With proton pump inhibitors and current sophisticated endoscopic techniques, the number of patients requiring surgical intervention for upper gastrointestinal bleeding has decreased considerably while trans-arterial embolization is being used more often. There are few direct comparisons between the effectiveness of surgery and embolization. A retrospective study of patients from two Australian teaching hospitals who had surgery or trans-arterial embolization (n = 103) for severe upper gastrointestinal haemorrhage between 2004 and 2012 was carried out. Patient demographics, co-morbidities, disease pathology, length of stay, complications, and overall clinical outcome and mortality were compared. There were 65 men and 38 women. The median age was 70 (range 36-95) years. Patients requiring emergency surgical intervention (n = 79) or trans-arterial embolization (n = 24) were compared. The rate of re-bleeding after embolization (42%) was significantly higher compared with the surgery group (19%) (P = 0.02). The requirement for further intervention (either surgery or embolization) was also higher in the embolization group (33%) compared with the surgery group (13%) (P = 0.03). There was no statistical difference in mortality between the embolization group (5/24, 20.8%) and the surgical group (13/79, 16.5%) (P = 0.75). Emergency surgery and embolization are required in 2.6% of patients with upper gastrointestinal bleeding. Both techniques have high mortalities reflecting the age, co-morbidities and severity of bleeding in this patient group. © 2014 Royal Australasian College of Surgeons.

  13. Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients.

    Science.gov (United States)

    Chang, Shen Shong; Hu, Hsiao-Yun

    2015-05-23

    The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag ≤120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.

  14. The use of 111In-labelled platelets for scintigraphic localization of gastrointestinal bleeding with special reference to occult bleeding

    International Nuclear Information System (INIS)

    Gjerloeff Schmidt, K.; Waever Rasmussen, J.; Grove, O.; Andersen, D.

    1986-01-01

    Gamma-camera imaging of the abdomen after injection of autologous 111 In-labelled platelets was applied for localization of gastrointestinal bleeding in a study of 22 patients. In 15 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 6, melaena in 4, and bloody stools in 5 patients. Scintigraphy could be done repeatedly for up to 1 week after a single tracer injection. The time interval between the injection and scintigraphic visualization of bleeding ranged from 10 min to 68 h, being longest in cases of occult bleeding. In most cases the scintigraphic findings were supported by other diagnostic modalities, including surgical removal of presumed sources of bleeding. In seven studies without scintigraphic signs of bleeding, a probable source of bleeding was identified by other means in one patient. The 111 In-platelet method seems to be a promising method for localization of gastrointestinal bleeding which may prove particularly useful in cases of occult or recurrent bleeding

  15. Optimal timing of vitamin K antagonist resumption after upper gastrointestinal bleeding. A risk modelling analysis.

    Science.gov (United States)

    Majeed, Ammar; Wallvik, Niklas; Eriksson, Joakim; Höijer, Jonas; Bottai, Matteo; Holmström, Margareta; Schulman, Sam

    2017-02-28

    The optimal timing of vitamin K antagonists (VKAs) resumption after an upper gastrointestinal (GI) bleeding, in patients with continued indication for oral anticoagulation, is uncertain. We included consecutive cases of VKA-associated upper GI bleeding from three hospitals retrospectively. Data on the bleeding location, timing of VKA resumption, recurrent GI bleeding and thromboembolic events were collected. A model was constructed to evaluate the 'total risk', based on the sum of the cumulative rates of recurrent GI bleeding and thromboembolic events, depending on the timing of VKA resumption. A total of 121 (58 %) of 207 patients with VKA-associated upper GI bleeding were restarted on anticoagulation after a median (interquartile range) of one (0.2-3.4) week after the index bleeding. Restarting VKAs was associated with a reduced risk of thromboembolism (HR 0.19; 95 % CI, 0.07-0.55) and death (HR 0.61; 95 % CI, 0.39-0.94), but with an increased risk of recurrent GI bleeding (HR 2.5; 95 % CI, 1.4-4.5). The composite risk obtained from the combined statistical model of recurrent GI bleeding, and thromboembolism decreased if VKAs were resumed after three weeks and reached a nadir at six weeks after the index GI bleeding. On this background we will discuss how the disutility of the outcomes may influence the decision regarding timing of resumption. In conclusion, the optimal timing of VKA resumption after VKA-associated upper GI bleeding appears to be between 3-6 weeks after the index bleeding event but has to take into account the degree of thromboembolic risk, patient values and preferences.

  16. Endoscopic variceal band ligation: a local experience | Jani | East ...

    African Journals Online (AJOL)

    Objective: To evaluate the results of endoscopic variceal band ligation (EVBL) in the local set-up. Design: Retrospective analysis of data of all patients who had EVBL. Setting: Patients having EVBL at the office endoscopy suite. The Nairobi Hospital, the Aga Khan Hospital and M.P Shah Hospital. Methods: The varices were ...

  17. Gallblader varices in children with portal cavernoma: duplex-Doppler and color Doppler ultrasound studies

    International Nuclear Information System (INIS)

    Muro, D.; Sanguesa, C.; Lopez, A.

    1998-01-01

    To determine the prevalence of varices in the gallbladder wall, observed by duplex-Doppler and color Doppler ultrasound, in children with cavernoma of the portal vein. Nineteen patients with portal hypertension were studied prospectively by duplex-Doppler and color Doppler ultrasound: 12 of the patients had developed a cavernoma of the portal vein. The presence of peri vesicular varices was assessed in the group of patients with portal cavernoma. Duplex-Doppler and color Doppler ultrasound disclosed the presence of varices in gallbladder wall in nine of the 12 patients (75%). The varices appeared as anechoic and serpiginous areas, and Doppler ultrasound revealed slowed venous flow. However, the three patients in whom gallbldder varices were not detected presented collateral gastric ciculation and spontaneous splenorenal shunt. Gallbladder varices are common in children with portal vein cavernoma; they present hepatopetal flow. Their developments is not related to the size of the portal cavernoma, the presence of spontaneous portosystemic shunts, or endoscopic obliteration of gastric and esophageal varices. The detection of gallbladder varices in patients with portal hypertension who are to undergo biliary surgery is highly important for the surgeon, helping to avoid perioperative complications. (Author) 15 refs

  18. 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.)

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

    International Nuclear Information System (INIS)

    Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent

    2007-01-01

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

  20. Does domperidon influence the haemodynamics of oesophageal varices. Beeinflusst Domperidon die Haemodynamik von Oesophagusvarizen

    Energy Technology Data Exchange (ETDEWEB)

    Hoevels, J [Staedtische Krankenanstalten Bielefeld (Germany, F.R.). Klinik fuer Roentgendiagnostik und Nuklearmedizin

    1989-04-01

    In three patients with portal venous hypertension and oesophageal varices the effect of domperidon on the haemodynamics of the varices was studied. Following transhepatic catheterisation of the left gastric vein the perfusion of the oesophageal varices before and after the application of domperidon was evaluated angiographically. No decrease of the perfusion of the oesophageal varices secondary to domperidon was observed using this method. (orig.).

  1. OPTIONS FOR USE OF APPROPRIATE ANTICOAGULANT THERAPY IN PATIENTS WITH THERMAL INJURY WITH A HIGH RISK OF THROMBOEMBOLIC COMPLICATIONS DEVELOPMENT ASSOCIATED WITH RECURRENT INTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    V. S. Borisov

    2015-01-01

    Full Text Available ABSTRACT. Patients with major thermal injury require anticoagulant therapy during almost the whole period of the burn disease, forcing the physician to balance constantly between the risk of possible bleeding associated with surgical treatment and the risk of thrombosis development in patients demonstrating a number of factors predisposing to the development of VTС. We report a clinical case of appropriate anticoagulant therapy using the new oral anticoagulants in a patient with a high risk of VTС development and recurrent bleeding from the tumor of the ascending colon. 

  2. 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. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Perfil evolutivo das varizes esofágicas pós esplenectomia associada à ligadura da veia gástrica esquerda e escleroterapia na hipertensão portal esquistossomótica Evolutional profile of the esophageal varices after splenectomy associated with ligation of the left gastric vein and sclerotherapy in schistosomal portal hypertension

    Directory of Open Access Journals (Sweden)

    João Batista-Neto

    2013-03-01

    Full Text Available RACIONAL: A esquistossomose mansônica afeta 200 milhões de pessoas em 70 países do mundo. Estima-se que 10% dos infectados evoluirão para a forma hepatoesplênica e, destes, 30% progredirão para hipertensão portal e varizes esofagogástricas, cuja expressão será através de hemorragia digestiva com mortalidade relevante no primeiro episódio hemorrágico. Múltiplas técnicas cirúrgicas foram desenvolvidas para prevenir o ressangramento. OBJETIVO: Avaliar o perfil evolutivo das varizes esofágicas após esplenectomia + ligadura da veia gástrica esquerda associada à escleroterapia endoscópica na hipertensão portal esquistossomótica. MÉTODO: Estudo prospectivo, observacional, de pacientes esquistossomóticos com antecedentes de hemorragia digestiva alta, submetidos à esplenectomia + ligadura da veia gástrica esquerda e escleroterapia. As variáveis estudadas foram perfil evolutivo das varizes esofágicas antes e após a operação e índice de recidiva hemorrágica. RESULTADOS: Amostra foi constituída por 30 pacientes distribuídos, quanto ao gênero, em 15 doentes para cada sexo. A idade variou de 19 a 74 anos (mediana=43 anos. Houve redução do grau, calibre e red spots em todos os pacientes (pBACKGROUND: The schistosomiasis affects 200 million people in 70 countries worldwide. It is estimated that 10% of those infected will develop hepatosplenic status and of these, 30% will progress to portal hypertension and esophagogastric varices, whose expression is through gastrointestinal bleeding with significant mortality in the first bleeding episode. Multiple surgical techniques have been developed to prevent re-bleeding. AIM: To evaluate the evolutional profile of esophageal varices after splenectomy + ligation of the left gastric vein associated with endoscopic sclerotherapy in schistosomal portal hypertension. METHODS: Prospective and observational study including schistosomiasis patients with previous history of upper digestive

  4. Upper Gastrointestinal Bleeding in Japanese Patients Prescribed Antithrombotic Drugs: Differences in Trends over Time.

    Science.gov (United States)

    Yamaguchi, Daisuke; Sakata, Yasuhisa; Tsuruoka, Nanae; Shimoda, Ryo; Higuchi, Toru; Sakata, Hiroyuki; Fujimoto, Kazuma; Iwakiri, Ryuichi

    2014-06-01

    We studied the features of upper gastrointestinal bleeding (UGIB) in patients taking antithrombotic drugs. The records of 430 patients taking antithrombotic drugs who underwent emergency endoscopy for UGIB in Saga Medical School Hospital between 2002 and 2011 were studied. We also compared the characteristics of our cohort of 11,919 patients prescribed antithrombotic drugs in our hospital between 2002 and 2011. UBGI patients of variceal bleeding were not included in this study. 186 patients presented with UGIB in the first period (2002-2006) and 244 in the second period (2007-2011). The proportion of patients infected with Helicobacter pylori was lower in the second period, while the proportion taking antithrombotic drugs rose significantly. Peptic ulcer disease was responsible for the majority of bleeding episodes; however, bleeding from other sources is increasing. In the whole cohort, the risk of UGIB was 1.08%; however, of the 31.8% who also took an acid-secretion inhibitor only 18 (0.28%) developed bleeding. In contrast, 102 (1.87%) of those not taking an acid-secretion inhibitor developed UGIB, a statistically significant difference. Risk of UGIB in Japanese patients taking antithrombotics was 1.01% and the incidence is increasing. Acid-secretion inhibitors reduced the risk of antithrombotic drug-related UGIB.

  5. Thrombotic recurrences and bleeding events in APS vascular patients: a review from the literature and a comparison with the APS Piedmont Cohort.

    Science.gov (United States)

    Bazzan, M; Vaccarino, A; Stella, S; Bertero, M T; Carignola, R; Montaruli, B; Roccatello, D; Shoenfeld, Y

    2013-06-01

    In APS vascular patients, thrombotic recurrences are more frequent than in non-APS thrombotic patients. To better define this clinical setting, a systematic review of the literature after 1999 was performed: 8 cohort studies (including the recent APS Piedmont Cohort) and 6 intervention studies were selected and evaluated. Thrombotic recurrences, bleeding events, therapeutic strategies, antiphospholipid (aPL) profile, inherited and acquired risk factors (when present) were calculated and compared. Emerging risk factors for thrombotic recurrences include withdrawal of oral anticoagulant therapy (OAT), high intensity OAT (INR range 3-4), aPL profile (triple positivity, Miyakis types 1 and 2a profiles) and association with inherited or acquired pro-thrombotic risk factors. Moreover, there are evidences that high risk (mainly for aPL profile) APS vascular patients have a high recurrence rate in spite of correct OAT treatment. Clinical trials in this clinical setting are needed. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Savić Željka

    2011-01-01

    Full Text Available Background/Aim. Portal hypertension (PH is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC: ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC. Methods. A total of 237 patients with ALC were observed in a 3-year period. Results. A total of 161 patients (68% were hospitalized because of PH elements: 86 (36.3% had upper gastrointestinal bleeding, 75 (31.7% were decompensated. Only 76 (32% of the patients had icterus. General mortality was 85 (36%. According to the source of bleeding, 61 (71% patients bled from varices, and 25 (29% from other sources with existing varices but non-incriminated for bleeding in 16 (64% of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73% cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78% patients, just octreotide in 32 (52.46%, and octreotid plus balloon tamponade in 9 (14.75%. According to Child-Pugh classification, 25 (29% of the bleeding patients were in class A, score 5.4; 43 (50% in class B, score 7.8; and 18 (21% in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L, ALT 37.74 U/L (normal to 40 U/L. Until this bleeding episode, 41 (47% of the patients already bled. In the decompensated patients 3 (4% were in Child Pugh class A, score 6; 42 (56% in class B, score 8.3; and 30 (40% in class C, score 10.6. Until this decompensation episode, 7 (9.3% patients already bled. Conclusion. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

  7. [Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis].

    Science.gov (United States)

    Savić, Zeljka; Vracarić, Vladimir; Hadnadjev, Ljiljana; Petrović, Zora; Damjanov, Dragomir

    2011-11-01

    Portal hypertension (PH) is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC): ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC). A total of 237 patients with ALC were observed in a 3-year period. A total of 161 patients (68%) were hospitalized because of PH elements: 86 (36.3%) had upper gastrointestinal bleeding, 75 (31.7%) were decompensated. Only 76 (32%) of the patients had icterus. General mortality was 85 (36%). According to the source of bleeding, 61 (71%) patients bled from varices, and 25 (29%) from other sources with existing varices but non-incriminated for bleeding in 16 (64%) of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73%) cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78%) patients, just octreotide in 32 (52.46%), and octreotid plus balloon tamponade in 9 (14.75%). According to Child-Pugh classification, 25 (29%) of the bleeding patients were in class A, score 5.4; 43 (50%) in class B, score 7.8; and 18 (21%) in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L), ALT 37.74 U/L (normal to 40 U/L). Until this bleeding episode, 41 (47%) of the patients already bled. In the decompensated patients 3 (4%) were in Child Pugh class A, score 6; 42 (56%) in class B, score 8.3; and 30 (40%) in class C, score 10.6. Until this decompensation episode, 7 (9.3%) patients already bled. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

  8. Post-TIPS Hepatic Encephalopathy Treated by Occlusion Balloon-Assisted Retrograde Embolization of a Coexisting Spontaneous Splenorenal Shunt

    International Nuclear Information System (INIS)

    Shioyama, Yasukazu; Matsueda, Kiyoshi; Horihata, Koushi; Kimura, Masashi; Nishida, Norifumi; Kishi, Kazushi; Terada, Masaki; Sato, Morio; Yamada, Ryusaku

    1996-01-01

    A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS

  9. Pre-Liver Transplant: Tips Versus Distal Splenorenal Shunt

    Directory of Open Access Journals (Sweden)

    Thomas W. Faust

    1997-01-01

    Full Text Available Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT. Endoscopic sclero-therapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS. In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients or DSRS (17 patients for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014 but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001. Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1. We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

  10. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com; Liang, Ming, E-mail: whliangming@163.com; Han, Ping, E-mail: cjr.hanping@vip.163.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)

    2016-03-15

    ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

  11. A Case of an Upper Gastrointestinal Bleeding Due to a Ruptured Dissection of a Right Aortic Arch

    International Nuclear Information System (INIS)

    Born, Christine; Forster, Andreas; Rock, Clemens; Pfeifer, Klaus-Juergen; Rieger, Johannes; Reiser, Maximilian

    2003-01-01

    We report a case of severe upper gastrointestinal hemorrhage with a rare underlying cause. The patient was unconscious when he was admitted to the hospital. No chest radiogram was performed. Routine diagnostic measures, including endoscopy, failed to reveal the origin of the bleeding, which was believed to originate from the esophagus secondary to a peptic ulcer or varices. Exploratory laparotomy added no further information, but contrast-enhanced multislice computed tomography (MSCT) of the chest showed dextroposition of the widened aortic arch with a ruptured type-B dissection and a consecutive aorto-esophageal fistula (AEF). The patient died on the day of admission. Noninvasive MSCT angiography gives rapid diagnostic information on patients with occult upper gastrointestinal bleeding and should be considered before more invasive conventional angiography or surgery

  12. The portal hypertension syndrome: etiology, classification, relevance, and animal models.

    Science.gov (United States)

    Bosch, Jaime; Iwakiri, Yasuko

    2018-02-01

    Portal hypertension is a key complication of portal hypertension, which is responsible for the development of varices, ascites, bleeding, and hepatic encephalopathy, which, in turn, cause a high mortality and requirement for liver transplantation. This review deals with the present day state-of-the-art preventative treatments of portal hypertension in cirrhosis according to disease stage. Two main disease stages are considered, compensated and decompensated cirrhosis, the first having good prognosis and being mostly asymptomatic, and the second being heralded by the appearance of bleeding or non-bleeding complications of portal hypertension. The aim of treatment in compensated cirrhosis is preventing clinical decompensation, the more frequent event being ascites, followed by variceal bleeding and hepatic encephalopathy. Complications are mainly driven by an increase of hepatic vein pressure gradient (HVPG) to values ≥10 mmHg (defining the presence of Clinically Significant Portal Hypertension, CSPH). Before CSPH, the treatment is limited to etiologic treatment of cirrhosis and healthy life style (abstain from alcohol, avoid/correct obesity…). When CSPH is present, association of a non-selective beta-blocker (NSBB), including carvedilol should be considered. NSBBs are mandatory if moderate/large varices are present. Patients should also enter a screening program for hepatocellular carcinoma. In decompensated patients, the goal is to prevent further bleeding if the only manifestation of decompensation was a bleeding episode, but to prevent liver transplantation and death in the common scenario where patients have manifested first non-bleeding complications. Treatment is based on the same principles (healthy life style..) associated with administration of NSBBs in combination if possible with endoscopic band ligation if there has been variceal bleeding, and complemented with simvastatin administration (20-40 mg per day in Child-Pugh A/B, 10-20 mg in Child C

  13. Transjugular Intrahepatic Portosystemic Shunts in Children with Biliary Atresia

    International Nuclear Information System (INIS)

    Huppert, Peter E.; Goffette, Pierre; Astfalk, Wolfgang; Sokal, Emil M.; Brambs, Hans-Juergen; Schott, Ullrich; Duda, Stephan H.; Schweizer, Paul; Claussen, Claus D.

    2002-01-01

    Purpose: We retrospectively evaluated the technical and long-term clinical results of transjugularintrahepatic portosystemic shunts (TIPS) in children with portal hypertension and biliary atresia (BA). Methods: Nine children with BA and recurrent bleeding from esophagogastric and/or intestinal varices were treated by TIPS at the age of 34-156 months and followed-up in two centers. Different types of stents were used. Results: Shunt insertion succeeded in all patients, but in two a second procedure was necessary. Seven procedures lasted more than 3 hr, mainly due to difficult portal vein puncture.Variceal bleeding ceased in all patients; however, 16 reinterventions were performed in eight patients for clinical reasons (n =11) and sonographically suspected restenosis (n =5). Four patients underwent successful liver transplantation 4-51 months after TIPS and five are in good clinical conditions 64-75 months after TIPS. Conclusions: TIPS in children with BA is technically difficult, mainly due to periportal fibrosis and small portal veins. Frequency of reinterventions seems to be higher compared with adults

  14. Portal Hypertensive Colopathy with Pelvic Varices presenting as Severe Lower GI Bleed treated with TIPSS

    LENUS (Irish Health Repository)

    Murphy, SF

    2018-02-01

    We present the case of a 71-year-old lady with a background of significant alcohol intake who presented with frank lower gastrointestinal (GI) bleeding, lower abdominal pain and haemoglobin 6.3g\\/dL. CT abdominal angiogram showed right-sided colonic thickening, atrophic liver and enlarged superior mesenteric vein (SMV) and right-sided pelvic varix. This lead to a diagnosis of portal hypertensive colopathy secondary to alcoholic liver cirrhosis. The patient failed conservative management and underwent a Transjugular Intrahepatic Portosystemic Shunt (TIPSS) procedure. This lead to an immediate resolution of her lower-GI bleeding. Repeat CT at three weeks showed a decompressed SMV and resolution of the right-sided pelvic varix. The patient was discharged after three months following optimization of medical condition and social circumstances.

  15. Discharge hemoglobin and outcome in patients with acute nonvariceal upper gastrointestinal bleeding

    Science.gov (United States)

    Lee, Jae Min; Kim, Eun Sun; Chun, Hoon Jai; Hwang, Young-Jae; Lee, Jae Hyung; Kang, Seung Hun; Yoo, In Kyung; Kim, Seung Han; Choi, Hyuk Soon; Keum, Bora; Seo, Yeon Seok; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck

    2016-01-01

    Background and study aims: Many patients with acute gastrointestinal bleeding present with anemia and frequently require red blood cell (RBC) transfusion. A restrictive transfusion strategy and a low hemoglobin (Hb) threshold for transfusion had been shown to produce acceptable outcomes in patients with acute upper gastrointestinal bleeding. However, most patients are discharged with mild anemia owing to the restricted volume of packed RBCs (pRBCs). We investigated whether discharge Hb influences the outcome in patients with acute nonvariceal upper gastrointestinal bleeding. Patients and methods: We retrospectively analyzed patients with upper gastrointestinal bleeding who had received pRBCs during hospitalization between January 2012 and January 2014. Patients with variceal bleeding, malignant lesion, stroke, or cardiovascular disease were excluded. We divided the patients into 2 groups, low (8 g/dL ≤ Hb  10 g/dL. Patients in the low Hb group had a lower consumption of pRBCs and shorter hospital stay than did those in the high Hb group. The Hb levels were not fully recovered at outpatient follow-up until 7 days after discharge; however, most patients showed Hb recovery at 45 days after discharge. The rate of rebleeding after discharge was not significantly different between the 2 groups. Conclusions: In patients with acute upper gastrointestinal bleeding, a discharge Hb between 8 and 10 g/dL was linked to favorable outcomes on outpatient follow-up. Most patients recovered from anemia without any critical complication within 45 days after discharge. PMID:27540574

  16. 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....

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

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, J S; Bahk, Y W; Lim, J L [Catholic University College of Medicine, Seoul (Korea, Republic of)

    1970-03-15

    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.

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

    International Nuclear Information System (INIS)

    Ahn, J. S.; Bahk, Y. W.; Lim, J. L.

    1970-01-01

    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.

  19. A study of clinical and endoscopic profile of acute upper, gastrointestinal bleeding.

    Science.gov (United States)

    Dewan, K R; Patowary, B S; Bhattarai, S

    2014-01-01

    Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality. To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome. This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis. Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score 6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6. Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.

  20. Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

    International Nuclear Information System (INIS)

    Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent

    2006-01-01

    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 χ 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

  1. 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.

  2. Multicenter Evaluation of Octreotide as Secondary Prophylaxis in Patients With Left Ventricular Assist Devices and Gastrointestinal Bleeding.

    Science.gov (United States)

    Shah, Keyur B; Gunda, Sampath; Emani, Sitaramesh; Kanwar, Manreet K; Uriel, Nir; Colombo, Paolo C; Uber, Patricia A; Sears, Melissa L; Chuang, Joyce; Farrar, David J; Brophy, Donald F; Smallfield, George B

    2017-11-01

    Gastrointestinal (GI) bleeding is one of the most common complications after continuous-flow left ventricular assist device implantation. More than one third of patients with incident bleed go on to develop recurrent GI bleeding. Octreotide, a somatostatin analog, is proposed to reduce the risk of recurrent GI bleeding in this population. This multicenter, retrospective analysis evaluated 51 continuous-flow left ventricular assist device patients who received secondary prophylaxis with octreotide after their index GI bleed from 2009 to 2015. All patients had a hospitalization for GI bleed and received octreotide after discharge. Patient demographics, medical and medication history, and clinical characteristics of patients who rebled after receiving octreotide were compared with non-rebleeders. These data were also compared with matched historical control patients previously enrolled in the HMII (HeartMate II) clinical trials, none of whom received octreotide, to provide a context for the bleeding rates. Twelve patients (24%) who received secondary octreotide prophylaxis developed another GI bleed, whereas 39 (76%) did not. There were similar intergroup demographics; however, significantly more bleeders had a previous GI bleeding history before left ventricular assist device placement (33% versus 5%; P =0.02) and greater frequency of angiodysplasia confirmed during endoscopy (58% versus 23%; P =0.03). Fewer patients in this study experienced a recurrent GI bleed compared with a matched historical control group that did not receive octreotide (24% versus 43%; P =0.04). Patients with continuous-flow left ventricular assist device receiving secondary prophylaxis with octreotide had a significantly lower GI bleed recurrence compared with historical controls not treated with octreotide. Additional prospective studies are needed to confirm these data. © 2017 American Heart Association, Inc.

  3. Empiric transcatheter arterial embolization for massive bleeding from duodenal ulcers: efficacy and complications.

    Science.gov (United States)

    Ichiro, Ikushima; Shushi, Higashi; Akihiko, Ishii; Yasuhiko, Iryo; Yasuyuki, Yamashita

    2011-07-01

    To evaluate the efficacy and safety of empiric transcatheter arterial embolization (TAE) for patients with massive bleeding from duodenal ulcers. During January 2000 and December 2009, 59 patients with duodenal ulcer bleeding in whom TAE was attempted after endoscopic therapy failed were retrospectively analyzed. The patients were divided into empiric TAE (n = 36) and identifiable TAE (n = 23) groups according to angiographic findings with or without identification of the bleeding sites. The technical and clinical success rate, recurrent bleeding rate, procedure-related complications, and clinical outcomes were evaluated. The technical and clinical success rates of TAE were 100% and 83%. The recurrent bleeding rate, clinical success, duodenal stenosis, and 30-day mortality after TAE were not significantly different between the empiric and identifiable TAE groups. A high rate of technical and clinical success was obtained with empiric TAE comparable to identifiable TAE in patients with massive bleeding from duodenal ulcers. There were no severe complications. Empiric TAE is an effective and safe method when a bleeding site cannot determined by angiography. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  4. Gastroesophageal Variceal Filling and Drainage Pathways: An Angiographic Description of Afferent and Efferent Venous Anatomic Patterns

    Directory of Open Access Journals (Sweden)

    Ron C Gaba

    2015-01-01

    Full Text Available Varices commonly occur in liver cirrhosis patients and are classified as esophageal (EV, gastroesophageal (GEV, or isolated gastric (IGV varices. These vessels may be supplied and drained by several different afferent and efferent pathways. A working knowledge of variceal anatomy is imperative for Interventional Radiologists performing transjugular intrahepatic portosystemic shunt and embolization/obliteration procedures. This pictorial essay characterizes the angiographic anatomy of varices in terms of type and frequency of venous filling and drainage, showing that different varices have distinct vascular anatomy. EVs typically show left gastric vein filling and “uphill” drainage, and GEVs and IGVs exhibit additional posterior/short gastric vein contribution and “downhill” outflow. An understanding of these variceal filling and drainage pathways can facilitate successful portal decompression and embolization/obliteration procedures.

  5. Prevalence of gastric varices and portal hypertensive gastropathy in patients with Symmer's periportal fibrosis

    International Nuclear Information System (INIS)

    Mudawi, H.; Ali, Y.; El-Tahir, M.

    2008-01-01

    Symmer's periportal fibrosis secondary to schistosomiasis is a common cause of portal hypertension worldwide. Data on the prevalence of gastric variances and portal hypertensive gastropathy in this group of patients with portal of hypertension is relatively scarce. The aim of this study was to determine the prevalence of gastric varices and portal hypertensive gastropathy in patients presenting with portal hypertension secondary to Symmer's periportal fibrosis. In a prospective study, upper gastrointestinal endoscopy was carried out to determine the prevalence of gastric varices and portal hypertensive gastropathy in patients with portal hypertension secondary to Symmer's fibrosis. Of 143 patients studied, 24 patients (16.8%) had gastric varices (grade I in 10.5%, grade Ii in 6.3%) and 31 patients (21.7%) had portal hypertensive gastropathy (mild in 11.2%, severe in 10.5%). Gastric varices were more prevalent in patients with grade I and II esophageal varices and portal hypertensive gastropathy was more prevalent in those with grade III and IV esophageal varices, but the differences were not statistically significant. We conclude that both gastric varices and portal hypertensive gastropathy seem to have a lower prevalence in patients with portal hypertension secondary to Symmer's periportal fibrosis when compared to reported data in patients with portal hypertension secondary to liver cirrhosis and non-cirrhotic portal fibrosis. (author)

  6. Splenic artery ligature associated with endoscopic banding for schistosomal portal hypertension.

    Science.gov (United States)

    Colaneri, Renata Potonyacz; Coelho, Fabrício Ferreira; de Cleva, Roberto; Perini, Marcos Vinícius; Herman, Paulo

    2014-11-28

    To propose a less invasive surgical treatment for schistosomal portal hypertension. Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study. Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein. During the procedure, direct portal vein pressure before and after the ligatures was measured. Upper gastrointestinal endoscopy was performed at the 30(th) postoperative day, when esophageal varices diameter were measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings. There was no intra-operative mortality and all patients had confirmed histologic diagnoses of schistosomal portal hypertension. During the immediate postoperative period, two of the ten patients had complications, one characterized by a splenic infarction, and the other by an incision hematoma. Mean hospitalization time was 4.1 d (range: 2-7 d). Pre- and post-operative liver function tests did not show any significant changes. During endoscopy thirty days after surgery, a decrease in variceal diameters was observed in seven patients. During the follow-up period (57-72 mo), endoscopic therapy was performed and seven patients had their varices eradicated. Considering the late postoperative evaluation, nine patients had a decrease in variceal diameters. A mean of 3.9 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence at the late postoperative period, which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient. Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion. Ligature of the splenic artery and left gastric vein with supraumbilical

  7. Streptococcus sanguinis meningitis following endoscopic ligation for oesophageal variceal haemorrhage.

    Science.gov (United States)

    Liu, Yu-Ting; Lin, Chin-Fu; Lee, Ya-Ling

    2013-05-01

    We report a case of acute purulent meningitis caused by Streptococcus sanguinis after endoscopic ligation for oesophageal variceal haemorrhage in a cirrhotic patient without preceding symptoms of meningitis. Initial treatment with flomoxef failed. The patient was cured after 20 days of intravenous penicillin G. This uncommon infection due to S. sanguinis adds to the long list of infectious complications among patients with oesophageal variceal haemorrhage.

  8. Correlation between severity of portal hypertensive gastropathy and size of oesophageal varices in cirrhotic hepatitis-C patients

    International Nuclear Information System (INIS)

    Saleem, K.; Baig, F.A.; Javed, M.

    2018-01-01

    Portal hypertension can lead to oesophageal varices (EV) and portal hypertensive gastropathy (PHG). The aim of this study is to determine the relationship between severity of Portal hypertensive gastropathy and size of oesophageal varices. Methods: One hundred and ninety-five patients of hepatitis C positive chronic liver disease having oesophageal varices were assessed for severity of portal hypertensive gastropathy. Results: Mild Portal Hypertensive Gastropathy was observed in 16 (8.2 %), moderate in 54 (27.7 %) and severe in 120 (61.6 %) patients. Grade 1 Oesophageal Varices were present in 79 (40.5%) patients, grade 2 in 44(21.9%) patients, grade 3 in 62 (31.8%) and grade 4 in 10 (5.2%) patients. No significant correlation was observed between grades of gastropathy and size of varices. Conclusion: The frequency of portal hypertensive gastropathy was 97.5% in Hepatitis C positive cirrhotic patients having oesophageal varices. Severity of gastropathy is not related to the grade or size of oesophageal varices. (author)

  9. A retrospective study demonstrating properties of nonvariceal upper gastrointestinal bleeding in Turkey.

    Science.gov (United States)

    Bor, Serhat; Dağli, Ulkü; Sarer, Banu; Gürel, Selim; Tözün, Nurdan; Sıvrı, Bülent; Akbaş, Türkay; Sahın, Burhan; Memık, Faruk; Batur, Yücel

    2011-06-01

    Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and peptic ulcer are considered as the major factors for upper gastrointestinal system bleeding. The objective of the study was to determine the sociodemographic and etiologic factors, management and outcome of patients with non-variceal upper gastrointestinal system bleeding in Turkey. Patients who admitted to hospitals with upper gastrointestinal system bleeding and in whom upper gastrointestinal endoscopy was performed were enrolled in this retrospective study. The detailed data of medical history, comorbid diseases, medications, admission to intensive care units, Helicobacter pylori infection, blood transfusion, upper gastrointestinal endoscopy, and treatment outcome were documented. The most frequent causes of bleeding (%) were duodenal ulcer (49.4), gastric ulcer (22.8), erosion (9.6), and cancer (2.2) among 1,711 lesions in endoscopic appearances of 1,339 patients from six centers. Seven hundred and four patients were evaluated for Helicobacter pylori infection and the test was positive in 45.6% of those patients. Comorbid diseases were present in 59.2% of the patients. The percentage of patients using acetylsalicylic acid and/or other non-steroidal anti-inflammatory drug was 54.3%. Bleeding was stopped with medical therapy in 66.9%. Only 3.7% of the patients underwent emergency surgery, and a 1.1% mortality rate was determined. Patients with upper gastrointestinal system bleeding were significantly older, more likely to be male, and more likely to use non-steroidal anti-inflammatory drugs. Though most of the patients were using gastro-protective agents, duodenal and gastric ulcers were the contributing factors in more than 70% of the upper gastrointestinal bleeding. The extensive use of non-steroidal anti-inflammatory drug is a hazardous health issue considering the use of these drugs in half of the patients.

  10. Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring.

    Science.gov (United States)

    Lee, J H; Kim, B K; Seol, D C; Byun, S J; Park, K H; Sung, I K; Park, H S; Shim, C S

    2013-06-01

    Nonvariceal upper gastrointestinal (UGI) bleeding recurs after appropriate endoscopic therapy in 10 % - 15 % of cases. The mortality rate can be as high as 25 % when bleeding recurs, but there is no consensus about the best modality for endoscopic re-treatment. The aim of this study was to evaluate clipping and detachable snaring (CDS) for rescue endoscopic control of nonvariceal UGI hemorrhage. We report a case series of seven patients from a Korean tertiary center who underwent endoscopic hemostasis using the combined method of detachable snares with hemoclips. The success rate of endoscopic hemostasis with CDS was 86 %: six of the seven patients who had experienced primary endoscopic treatment failure or recurrent bleeding after endoscopic hemostasis were treated successfully. In conclusion, rescue endoscopic bleeding control by means of CDS is an option for controlling nonvariceal UGI bleeding when no other method of endoscopic treatment for recurrent bleeding and primary hemostatic failure is possible. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Recurrent epistaxis following nasotracheal intubation--a case report.

    Science.gov (United States)

    Chen, Y H; Chen, J Y; Hsu, C S; Huang, C T; So, E

    1996-06-01

    Epistaxis is one of the common complications of nasotracheal intubation. Clinical patterns of all nasal bleeding are mild and may stop spontaneously in most patients. Serious nasal bleeding requiring hospitalization are rare. Nasal bleeding occurs more frequently in children than in adults. Among adults, men have a higher incidence than women. Although numerous publications have reported the cases of initial epistaxis caused by nasotracheal intubation, recurrent epistaxis was reported rarely. We experienced a case of recurrent epistaxis occurring in the 6th, 8th, 15th and 18th day after nasotracheal intubation. Herein, we describe the clinical events and discuss the causes of epistaxis.

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

    Directory of Open Access Journals (Sweden)

    Alan Barkun

    2004-01-01

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

  13. Transcatheter emboilization therapy of massive colonic bleeding

    International Nuclear Information System (INIS)

    Shin, G. H.; Oh, J. H.; Yoon, Y.

    1996-01-01

    To evaulate the efficacy and safety of emergent superselective transcatheter embolization for controlling massive colonic bleeding. Six of the seven patients who had symptom of massive gastrointestinal bleeding underwent emergent transcatheter embolization for control of the bleeding. Gastrointestinal bleeding in these patients was originated from various colonic diseases: rectal cancer(n=1), proctitis(n=1), benign ulcer(n=1), mucosal injury by ventriculoperitoneal shunt(n=1), and unknown(n=2). All patients except one with rectal cancer were critically ill. Superselective embolization were done by using Gelfoam particles and/or coils. The vessels embolized were ileocolic artery(n=1). superior rectal artery(n=2), inferior rectal artery (n=1), and middle and inferior rectal arteries(n=1). Hemostasis was successful immediately in all patients. Two underwnet surgery due to recurrent bleeding developed 3 days after the procedure(n=1) or in associalion with underlying rectal cancer(n=1). On surgical specimen of two cases, there was no mucosal ischemic change. Transcatheter embolization is a safe and effective treatment of method for the control of massive colonic bleeding

  14. Hepatic angiography: Portal hypertension

    International Nuclear Information System (INIS)

    Oliver, T.W. Jr.; Sones, P.J. Jr.

    1985-01-01

    Portal hypertension is usually a manifestation of underlying hepatic parenchymal disease, although it may be secondary to portal or hepatic venous thrombosis and rarely to hyperdynamic portal states. Portal hypertension may present as encephalopathy, ascites, jaundice, hepatic failure, or catastrophic upper gastrointestinal hemorrhage. Radiologic investigation should include indirect or direct measurements of portal pressure, assessment of portal venous perfusion, visualization of collaterals, and demonstration of arterial and venous anatomy for potential shunt procedure. Following survival of initial variceal bleeding, the most effective procedure to prevent recurrent hemorrhage is a shunt to decompress the varices. The decision whether to intervene medically or surgically during the acute hemorrhagic episode as well as the type of shunt used to prevent future hemorrhage is the subject of continuing controversy

  15. Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy.

    Directory of Open Access Journals (Sweden)

    Jehn-Hsiahn Yang

    Full Text Available An endometrial polyp is a frequently encountered gynecologic disease with abnormal uterine bleeding and infertility being the two common presenting problems, and hysteroscopic polypectomy is an effective method to remove them. The postoperative polyp recurrence might result in reappearance of abnormal uterine bleeding or infertility, whereas factors influencing the postoperative recurrence potential have limited data.This case-series report included 168 premenopausal women who suffered from endometrial polyps and underwent hysteroscopic polypectomy. All of them were awaiting a future pregnancy. Office hysteroscopy was done before and after hysteroscopic polypectomy, in which preoperative hysteroscopy examined the number, type, and location of endometrial polyps, and postoperative hysteroscopy checked the polyp recurrence. Surgical indications, either infertility or the presentation of abnormal uterine bleeding, and follow-up duration were recorded.Seventy-three out of 168 (43% women had polyp recurrence after hysteroscopic polypectomy. Multivariate logistic regression analysis revealed that more endometrial polyps (P = 0.015 and longer duration of follow-up (P = 0.004 were significantly associated with an increased risk of postoperative polyp recurrence. The type of endometrial polyps was not correlated with polyp recurrence potential, whereas pedunculated type endometrial polyps were closely related to the presentation of abnormal uterine bleeding (P = 0.001.A higher number of endometrial polyps and longer follow-up duration are associated with a greater potential of polyp recurrence after hysteroscopic polypectomy.

  16. Assessing the risk of recurrent venous thromboembolism--a practical approach.

    Science.gov (United States)

    Fahrni, Jennifer; Husmann, Marc; Gretener, Silvia B; Keo, Hong H

    2015-01-01

    Recurrent venous thromboembolism (VTE) is associated with increased morbidity and mortality. This risk is lowered by anticoagulation, with a large effect in the initial phase following the venous thromboembolic event, and with a smaller effect in terms of secondary prevention of recurrence when extended anticoagulation is performed. On the other hand, extended anticoagulation is associated with an increased risk of major bleeding and thus leads to morbidity and mortality. Therefore, it is necessary to assess the risk of recurrence for VTE on an individual basis, and a recommendation for secondary prophylaxis should be specifically based on risk calculation of recurrence of VTE and bleeding. In this review, we provide a comprehensive summary of relevant risk factors for recurrent VTE and a practical approach for assessing the risk of recurrence in daily practice.

  17. Frequency of gastric varices in patients with portal hypertension based on endoscopic findings

    International Nuclear Information System (INIS)

    Mir, A.W.; Chaudry, A.A.; Mir, S.; Ahmed, N.; Khan, A.A.; Shahzadi, M.

    2017-01-01

    To find out the frequency of gastric varices in patients with portal hypertension based on endoscopic findings. Study Design: Descriptive Study. Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi from Jan to Jun 2011. Material and Methods: All patients fulfilling the inclusion criteria were selected through consecutive sampling. The patients presenting with hematemesis, melena or ascites with portal hypertension on ultrasound abdomen were admitted in the hospital. The patients were first stabilized hemodynamically and then kept empty stomach for at least four hours before endoscopy. The patients were sedated with intravenous midazolam and endoscopic findings obtained were entered on the patient proforma. Results: The overall frequency of gastric varices was 11 percent, whereas 89 percent had no gastric varices. Conclusion: A large number of patients with portal hypertension have gastric varices. It is recommended that endoscopy be carried out in all patients with identified portal hypertension. (author)

  18. The role of nuclear medicine in acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Robinson, P.

    1993-01-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. 99 Tc m -sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. 99 Tc m -labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author)

  19. The role of nuclear medicine in acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

    1993-10-01

    In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).

  20. Non-cirrhotic portal hypertension entity in South Africa? A report of 6 ...

    African Journals Online (AJOL)

    Three of these patients also had extrahepatic portal vein occlusion. All patients had varying degrees of portal hypertension and hypersplenism. Three patients underwent splenectomy and the remainder had sclerotherapy to control variceal bleeding. The overall prognosis is excellent if variceal bleeding can be controlled by ...

  1. Evaluation of the formation of esophageal varices by per-rectal portal scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Ikeoka, Naoko; Monna, Takeyuki; Shiomi, Susumu; Kuroki, Tetsuo; Kobayashi, Kenzo; Ochi, Hironobu; Onoyama, Yasuto (Osaka City Univ. (Japan). Faculty of Medicine); Yamamoto, Sukeo

    1989-12-01

    Portal circulation in patients with liver diseases was evaluated by {sup 99m}Tc-pertechnetate per-rectal portal scintigraphy, and we retrospectively examined the relationship between the extent of abnormality in the portal circulation and the development of esophageal varices. The per-rectal portal shunt index (PRPSI) was calculated for 13 healthy subjects and 79 patients with chronic hepatitis and 214 with cirrhosis of the liver. In the healthy subjects, the mean PRPSI was 4.8%. In the patients with hepatitis, the mean PRPSI was 8.4%, and in the patients with cirrhosis, it was 48.5%. The PRPSI was significantly higher in the cirrhotic patients with esophageal varices than in those without it, and also in the cirrhotic patients with encephalopathy than in those without it. The cumulative incidence of esophageal varices in the 3 years of the study in patients whose PRPSI was 20% or over was significantly higher than that in patients whose PRPSI was under 20%. The results suggested that this non-invasive method should be useful for predictions of the formation of esophageal varices. (author).

  2. Evaluation of the formation of esophageal varices by per-rectal portal scintigraphy

    International Nuclear Information System (INIS)

    Ikeoka, Naoko; Monna, Takeyuki; Shiomi, Susumu; Kuroki, Tetsuo; Kobayashi, Kenzo; Ochi, Hironobu; Onoyama, Yasuto; Yamamoto, Sukeo.

    1989-01-01

    Portal circulation in patients with liver diseases was evaluated by 99m Tc-pertechnetate per-rectal portal scintigraphy, and we retrospectively examined the relationship between the extent of abnormality in the portal circulation and the development of esophageal varices. The per-rectal portal shunt index (PRPSI) was calculated for 13 healthy subjects and 79 patients with chronic hepatitis and 214 with cirrhosis of the liver. In the healthy subjects, the mean PRPSI was 4.8%. In the patients with hepatitis, the mean PRPSI was 8.4%, and in the patients with cirrhosis, it was 48.5%. The PRPSI was significantly higher in the cirrhotic patients with esophageal varices than in those without it, and also in the cirrhotic patients with encephalopathy than in those without it. The cumulative incidence of esophageal varices in the 3 years of the study in patients whose PRPSI was 20% or over was significantly higher than that in patients whose PRPSI was under 20%. The results suggested that this non-invasive method should be useful for predictions of the formation of esophageal varices. (author)

  3. Natural history of patients with non cirrhotic portal hypertension: Comparison with patients with compensated cirrhosis.

    Science.gov (United States)

    Gioia, Stefania; Nardelli, Silvia; Pasquale, Chiara; Pentassuglio, Ilaria; Nicoletti, Valeria; Aprile, Francesca; Merli, Manuela; Riggio, Oliviero

    2018-01-31

    The knowledge of natural history of patients with portal hypertension (PH) not due to cirrhosis is less well known than that of cirrhotic patients. To describe the clinical presentation and the outcomes of 89 patients with non-cirrhotic PH (25 with non-cirrhotic portal hypertension, INCPH, and 64 with chronic portal vein thrombosis, PVT) in comparison with 77 patients with Child A cirrhosis. The patients were submitted to a standardized clinical, laboratory, ultrasonographic and endoscopic follow-up. Variceal progression, incidence of variceal bleeding, portal vein thrombosis, ascites and survival were recorded. At presentation, the prevalence of varices, variceal bleeding and ascites was similar in the 3 groups. During follow-up, the rate of progression to varices at risk of bleeding (p portal hypertension in these patients and cannot be simply derived by the observation of cirrhotic patients. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  4. Advances in the management of childhood portal hypertension.

    Science.gov (United States)

    McKiernan, Patrick; Abdel-Hady, Mona

    2015-05-01

    Portal hypertension is one of the most serious complications of childhood liver disease, and variceal bleeding is the most feared complication. Most portal hypertension results from cirrhosis but extra hepatic portal vein obstruction is the single commonest cause. Upper gastrointestinal endoscopy endoscopy remains necessary to diagnose gastro-esophageal varices. Families of children with portal hypertension should be provided with written instructions in case of gastrointestinal bleeding. Children with large varices should be considered for primary prophylaxis on a case-by-case basis. The preferred method is variceal band ligation. Children with acute bleeding should be admitted to hospital and treated with antibiotics and pharmacotherapy before urgent therapeutic endoscopy. All children who have bled should then receive secondary prophylaxis. The preferred method is variceal band ligation and as yet there is little evidence to support the use of β-blockers. Children with extrahepatic portal vein obstruction should be assessed for suitability of mesoportal bypass.

  5. Beneficial long term effect of a phosphodiesterase-5-inhibitor in cirrhotic portal hypertension: A case report with 8 years follow-up.

    Science.gov (United States)

    Deibert, Peter; Lazaro, Adhara; Stankovic, Zoran; Schaffner, Denise; Rössle, Martin; Kreisel, Wolfgang

    2018-01-21

    Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5 (PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored. In the acute setting, the PDE-5-inhibitor Vardenafil lowered portal pressure by 13%. The portal blood flow increased by 28% based on Doppler sonography and by 16% using MRI technique. As maintenance medication the PDE-5-inhibitor Tadalafil was used for eight consecutive years with comparable effects on portal pressure and portal blood flow. There were no recurrence of bleeding and no formation of new varices. Influencing the NO-pathway by the use of PDE-5 inhibitors may have long-term beneficial effects in compensated cirrhosis.

  6. Pulmonary arteriovenous malformation in cryptogenic liver

    International Nuclear Information System (INIS)

    Afzal, N.

    2013-01-01

    The cause in 10 - 20% cases of liver cirrhosis (LC) cannot be elucidated, and are thus termed cryptogenic. Pulmonary arteriovenous malformations (PAVMs) are relatively rare, but the most common anomaly involving the pulmonary tree. Although the rare correlation between LC and PAVM is well-known, there have been no reports of PAVMs occurring in cryptogenic LC. We report a case of PAVM that occurred in cryptogenic liver cirrhosis in a 3 years old male child. The child presented with complaints of malena, hematemesis and variceal bleed. The examination revealed a child with respiratory distress, irritability, tachycardia, clubbing and abdominal distention. He was worked up for recurrent variceal bleeding secondary to portal hypertension but the oxygen saturation during hospital stay kept deteriorating. The diagnosis of hepatopulmonary syndrome as the cause of persistent hypoxemia in the absence of other cardio-pulmonary causes was then made by enhanced echocardiogram using agitated saline. He improved significantly after liver transplantation performed abroad. At a 6 months follow-up, the child was stable with no evidence of intrapulmonary shunting on repeat echo. (author)

  7. Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kwang Hun; Lee, Do Yun; Won, Jong Yoon [Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Sang Joon [Hallym University College of Medicine, Seoul (Korea, Republic of); Kim, Jae Kyu; Yoon, Woong [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2003-03-01

    To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins. Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1). Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy. In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.

  8. Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results

    International Nuclear Information System (INIS)

    Lee, Kwang Hun; Lee, Do Yun; Won, Jong Yoon; Park, Sang Joon; Kim, Jae Kyu; Yoon, Woong

    2003-01-01

    To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins. Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1). Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy. In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible

  9. Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease

    Science.gov (United States)

    Yee, Brittany; Chi, Nai-Wen; Hansen, Lawrence A.; Lee, Roland R.; U, Hoi-Sang; Savides, Thomas J.; Vinetz, Joseph M.

    2015-01-01

    A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 am cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection. PMID:26195463

  10. Diagnostic Accuracy of APRI, AAR, FIB-4, FI, and King Scores for Diagnosis of Esophageal Varices in Liver Cirrhosis: A Retrospective Study.

    Science.gov (United States)

    Deng, Han; Qi, Xingshun; Peng, Ying; Li, Jing; Li, Hongyu; Zhang, Yongguo; Liu, Xu; Sun, Xiaolin; Guo, Xiaozhong

    2015-12-20

    BACKGROUND Aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), FIB-4, fibrosis index (FI), and King scores might be alternatives to the use of upper gastrointestinal endoscopy for the diagnosis of esophageal varices (EVs) in liver cirrhosis. This study aimed to evaluate their diagnostic accuracy in predicting the presence and severity of EVs in liver cirrhosis. MATERIAL AND METHODS All patients who were consecutively admitted to our hospital and underwent upper gastrointestinal endoscopy between January 2012 and June 2014 were eligible for this retrospective study. Areas under curve (AUCs) were calculated. Subgroup analyses were performed according to the history of upper gastrointestinal bleeding (UGIB) and splenectomy. RESULTS A total of 650 patients with liver cirrhosis were included, and 81.4% of them had moderate-severe EVs. In the overall analysis, the AUCs of these non-invasive scores for predicting moderate-severe EVs and presence of any EVs were 0.506-0.6 and 0.539-0.612, respectively. In the subgroup analysis of patients without UGIB, their AUCs for predicting moderate-severe varices and presence of any EVs were 0.601-0.664 and 0.596-0.662, respectively. In the subgroup analysis of patients without UGIB or splenectomy, their AUCs for predicting moderate-severe varices and presence of any EVs were 0.627-0.69 and 0.607-0.692, respectively. CONCLUSIONS APRI, AAR, FIB-4, FI, and King scores had modest diagnostic accuracy of EVs in liver cirrhosis. They might not be able to replace the utility of upper gastrointestinal endoscopy for the diagnosis of EVs in liver cirrhosis.

  11. Effectiveness of the double interventional therapy for portal hypertension in liver cirrhosis

    International Nuclear Information System (INIS)

    Du Wei; Chen Lei; Yuan Guibin; Ouyang Tianzhao; Duan Wenshuai

    2011-01-01

    Objective: To assess the value of double interventional therapy for upper gastrointestinal bleeding and hypersplenism caused by portal hypertension. Methods: 32 patients with upper gastrointestinal bleeding and hypersplenism due to portal hypertension in liver cirrhosis were enrolled in the study. Ultrasound-guided percutaneous punctures of both the intrahepatic portal varices and femoral artery were performed on all patients. The catheters were inserted into the vena coronaria ventriculi and branches of splenic artery selectively and then embolized using mixture of alcohol, gelatin sponge and metal coin. Results: The overall success rate of percutaneous transhepatic variceal puncture was 100% with single puncture in 66% and the success rate of embolization was 100%. Partial splenic artery embolization was performed involving 40%-70% of the vascular lumen. White blood cell and platelet counts increased significantly 24 hours and 1 week after embolization. The cumulative incidences of rebleeding were 0, 3.1%, 12.5%, 25% and 31.3% in the 1 month, 6 month, 1 year, 2 year and follow-up respectively. Causes of recurrent bleeding included varices rupture (26.1%), portal hypertensive gastropathy (56.5%), and peptic ulcer (17.4%). All of the patients had various degrees of fever, abdominal pain, nausea and vomiting after embolization. These symptoms subsided without further complications. Conclusion: The double interventional approach is useful in the treatment of upper digestive tract hemorrhage and hypersplenism from portal hypertension. The method is relatively simple with low invasiveness especially for patients with poor liver function who cannot tolerate surgical shunt and de-vascularization operation. (authors)

  12. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    International Nuclear Information System (INIS)

    Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung

    2007-01-01

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy

  13. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung [Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of)

    2007-02-15

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

  14. [Evaluation and treatment of portal hypertension].

    Science.gov (United States)

    Brůha, Radan; Petrtýl, Jaromír

    Liver cirrhosis is a serious disease shortening the life expectancy. Unavoidable consequence of cirrhosis is portal hypertension, which usually limits the prognosis by its complications. Portal hypertension is a prognostic factor for cirrhosis decompensation, variceal bleeding and even the mortality in cirrhotic patients. In the evaluation of portal hypertension hepatic venous pressure gradient (HVPG) measurement is used.Measurement of HVPG is used in clinical praxis in these situations: diagnosis of portal hypertension, evaluation of prognosis of patients with cirrhosis, monitoring the treatment efficacy in the prevention of variceal bleeding, management of acute variceal bleeding. Decrease of HVPG below 12 mmHg or at least for more than 20% of initial value in the treatment by beta-blockers is associated with the lower risk of bleeding from varices or other complications. HVPG above 20 mm Hg is associated with the high risk of early rebleeding from varices and can discriminate those patients profiting from early TIPS.HVPG measurement is an invasive, but simple, reproducible and safe catheterization technique with minimal complication rate. The most frequent complication could be incorrect assessment of obtained values. HVPG measurement should be a routine technique in centers specialized to liver diseases.

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

    International Nuclear Information System (INIS)

    Abbasi, A.; Butt, N.; Bhutto, A.R.; Munir, S.M.

    2010-01-01

    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

  16. Use of a Stent Graft for Bleeding Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Leoncio L. Kaw, Jr

    2006-10-01

    Full Text Available Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

  17. Unusual Upper Gastrointestinal Bleeding due to Late Metastasis from Renal Cell Carcinoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Wen-Tsan Chang

    2004-03-01

    Full Text Available A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63-year-old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow-up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life-long follow-up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease-free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.

  18. Transcaval TIPS in patients with failed revision of occluded previous TIPS

    Energy Technology Data Exchange (ETDEWEB)

    Seong, Chang Kyu; Kim, Yong Joo; Shin, Tae Beom; Park, Hyo Yong; Kim, Tae Hun; Kang, Duk Sik [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2001-12-01

    To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) in patients with occluded previous TIPS. Between February 1996 and December 2000 we performed five transcaval TIPS procedures in four patients with recurrent gastric cardiac variceal bleeding. All four had occluded TIPS, which was between the hepatic and portal vein. The interval between initial TIPS placement and revisional procedures with transcaval TIPS varied between three and 31 months; one patient underwent transcaval TIPS twice, with a 31-month interval. After revision of the occluded shunt failed, direct cavoportal puncture at the retrohepatic segment of the IVC was attempted. Transcaval TIPS placement was technically successful in all cases. In three, tractography revealed slight leakage of contrast materials into hepatic subcapsular or subdiaphragmatic pericaval space. There was no evidence of propagation of extravasated contrast materials through the retroperitoneal space or spillage into the peritoneal space. After the tract was dilated by a bare stent, no patient experienced trans-stent bleeding and no serious procedure-related complications occurred. After successful shunt creation, variceal bleeding ceased in all patients. Transcaval TIPS placement is an effective and safe alternative treatment in patients with occluded previous TIPS and no hepatic veins suitable for new TIPS.

  19. 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.

  20. Assessing the risk of recurrent venous thromboembolism – a practical approach

    Science.gov (United States)

    Fahrni, Jennifer; Husmann, Marc; Gretener, Silvia B; Keo, Hong H

    2015-01-01

    Recurrent venous thromboembolism (VTE) is associated with increased morbidity and mortality. This risk is lowered by anticoagulation, with a large effect in the initial phase following the venous thromboembolic event, and with a smaller effect in terms of secondary prevention of recurrence when extended anticoagulation is performed. On the other hand, extended anticoagulation is associated with an increased risk of major bleeding and thus leads to morbidity and mortality. Therefore, it is necessary to assess the risk of recurrence for VTE on an individual basis, and a recommendation for secondary prophylaxis should be specifically based on risk calculation of recurrence of VTE and bleeding. In this review, we provide a comprehensive summary of relevant risk factors for recurrent VTE and a practical approach for assessing the risk of recurrence in daily practice. PMID:26316770

  1. Size of gastroesophageal varices: its behavior after the surgical treatment of portal hypertension

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    Strauss Edna

    1999-01-01

    Full Text Available The size of gastroesophageal varices is one of the most important factors leading to hemorrhage related to portal hypertension. An endoscopic evaluation of the size of gastroesophageal varices before and after different operations for portal hypertension was performed in 73 patients with schistosomiasis, as part of a randomized trial: proximal splenorenal shunt (PSS n=24, distal splenorenal shunt (DSS n=24, and esophagogastric devascularization with splenectomy (EGDS n=25. The endoscopic evaluation was performed before and up to 10 years after the operations. Variceal size was graded according to Palmer's classification: grade 1 -- up to 3 mm, grade 2 -- from 3 to 6 mm, grade 3 -- greater than 6 mm, and were analyzed in four anatomical locations: inferior, middle or superior third of the esophagus, and proximal stomach. The total number of points in the pre-operative grading minus the number of points in the post-operative grading gave a differential grading, allowing statistical comparison among the surgical groups. Good results, in terms of disappearance or decrease of variceal size, were observed more frequently after PSS than after DSS or EGDS - 95.8%, 83.3%, and 72%, respectively. When differential grading was analyzed, a statistically significant difference was observed between PSS and EGDS, but not between proximal and distal splenorenal shunts. In conclusion, shunt surgeries were more efficient than devascularization in diminishing variceal size.

  2. Endoscopic evaluation of upper and lower gastro-intestinal bleeding

    Directory of Open Access Journals (Sweden)

    Emeka Ray-Offor

    2015-01-01

    Full Text Available Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB. The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software. Results: A total of 159 upper and lower gastro-intestinal (GI endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13-86 years (mean age 52.4 ΁ 20.6 years. The primary presentations were hematochezia, hematemesis, and melena in 44 (75%, 9 (15%, and 6 (10% cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%. The majority of pathologies in upper GIB were seen in the stomach (39%: Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment

  3. [Esophageal motor disorders in cirrhotic patients with esophageal varices non-submitted to endoscopic treatment].

    Science.gov (United States)

    Flores, Priscila Pollo; Lemme, Eponina Maria de Oliveira; Coelho, Henrique Sérgio Moraes

    2005-01-01

    The hepatic cirrhosis has as one of the main morbid-mortality causes, the portal hypertension with the development of esophageal varices, the possibility of a digestive hemorrhage and worsening of hepatic insufficiency. It is important to identify causal predictive or aggravating factors and if possible to prevent them. In the last years, it has been observed the association of esophageal motor disorders and gastro-esophageal reflux in cirrhotic patients with esophageal varices. To study the prevalence of the esophageal motility disorders and among them, the ineffective esophageal motility, in patients with hepatic cirrhosis and esophageal varices, without previous endoscopic therapeutic and the predictive factors. Prospectively, it has been evaluate 74 patients suffering from liver cirrhosis and esophagic varices, without previous endoscopic treatment. All of them were submitted to a clinical protocol, esophageal manometry and 55 patients also held the ambulatory esophageal pHmetry. Esophageal motility disorders have been found in 44 patients (60%). The most prevalent was the ineffective esophageal motility, observed in 28%. The abnormal reflux disease was diagnosed through the pHmetry in 35% of the patients. There were no correlation between the manometrical abnormality in general and the ineffective esophageal motility in particular and the esophageal or gastroesophageal reflux disease symptoms, the abnormal reflux, the disease seriousness, the ascites presence and the gauge of the varices. The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.

  4. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  5. Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study.

    Science.gov (United States)

    Cheng, Hsiu-Chi; Wu, Chung-Tai; Chang, Wei-Lun; Cheng, Wei-Chun; Chen, Wei-Ying; Sheu, Bor-Shyang

    2014-12-01

    Patients with high Rockall scores have increased risk of ulcer rebleeding after 3-day esomeprazole infusions. To investigate whether double oral esomeprazole given after a 3-day esomeprazole infusion decreases ulcer rebleeding for patients with high Rockall scores. We prospectively enrolled 293 patients with peptic ulcer bleeding who had achieved endoscopic haemostasis. After a 3-day esomeprazole infusion, patients with Rockall scores ≥6 were randomised into the oral double-dose group (n=93) or the oral standard-dose group (n=94) to receive 11 days of oral esomeprazole 40 mg twice daily or once daily, respectively. The patients with Rockall scores peptic ulcer rebleeding. Among patients with Rockall scores ≥6, the oral double-dose group had a higher cumulative rebleeding-free proportion than the oral standard-dose group (p=0.02, log-rank test). The proportion of patients free from recurrent bleeding during the 4th-28th day in the oral double-dose group remained lower than that of the group with Rockall scores peptic ulcer bleeding in high-risk patients with Rockall scores ≥6. NCT01591083. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Embolia cutis medicamentosa: an unusual adverse reaction to terlipressin

    Science.gov (United States)

    Gatos-Gatopoulos, Polychronis; Kostantoudakis, Stephanos; Panayiotides, Ioannis G.; Dimitriadis, George D.; Triantafyllou, Konstantinos

    2017-01-01

    Terlipressin is a synthetic long-acting analog of vasopressin widely used to control variceal bleeding by lowering portal venous pressure. We report an unusual adverse reaction to terlipressin in a 78-year-old patient with esophageal variceal bleeding who developed skin necrosis soon after treatment initiation. Skin biopsy revealed embolia cutis medicamentosa. PMID:29118569

  7. 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.

  8. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial.

    Science.gov (United States)

    Hou, Ming-Chih; Lin, Han-Chieh; Liu, Tsu-Te; Kuo, Benjamin Ing-Tieu; Lee, Fa-Yauh; Chang, Full-Young; Lee, Shou-Dong

    2004-03-01

    Bacterial infection may adversely affect the hemostasis of patients with gastroesophageal variceal bleeding (GEVB). Antibiotic prophylaxis can prevent bacterial infection in such patients, but its role in preventing rebleeding is unclear. Over a 25-month period, patients with acute GEVB but without evidence of bacterial infection were randomized to receive prophylactic antibiotics (ofloxacin 200 mg i.v. q12h for 2 days followed by oral ofloxacin 200 mg q12h for 5 days) or receive antibiotics only when infection became evident (on-demand group). Endoscopic therapy for the GEVB was performed immediately after infection work-up and randomization. Fifty-nine patients in the prophylactic group and 61 patients in the on-demand group were analyzed. Clinical and endoscopic characteristics of the gastroesophageal varices, time to endoscopic treatment, and period of follow-up were not different between the two groups. Antibiotic prophylaxis decreased infections (2/59 vs. 16/61; P actuarial probability of rebleeding was higher in patients without prophylactic antibiotics (P =.0029). The difference of rebleeding was mostly due to early rebleeding within 7 days (4/12 vs. 21/27, P =.0221). The relative hazard of rebleeding within 7 days was 5.078 (95% CI: 1.854-13.908, P <.0001). The multivariate Cox regression indicated bacterial infection (relative hazard: 3.85, 95% CI: 1.85-13.90) and association with hepatocellular carcinoma (relative hazard: 2.46, 95% CI: 1.30-4.63) as independent factors predictive of rebleeding. Blood transfusion for rebleeding was also reduced in the prophylactic group (1.40 +/- 0.89 vs. 2.81 +/- 2.29 units, P <.05). There was no difference in survival between the two groups. In conclusion, antibiotic prophylaxis can prevent infection and rebleeding as well as decrease the amount of blood transfused for patients with acute GEVB following endoscopic treatment.

  9. Recurrent bleeding after arterial embolization in patients with hemoptysis : Comparison of angiographic findings and relapsing period

    International Nuclear Information System (INIS)

    Park, Sung Keun; Choi, Seok Jin; Choi, Gi Bok; Kim, Hae Yeon; Park, Auh Whan; Juhn, Jae Ryang; Cha, Seong Sook

    2001-01-01

    To describe the angiographic findings of patients with recurrent hemoptysis after bronchial artery embolization (BAE) according to the point at which relapse occurred. From 125 patients who underwent BAE due to hemoptysis between 1996 and 2000, we selected 18 of 23 who underwent additional BAE due to recurrent bleeding after initial BAE. Depending on the point at which relapse occurred, they were divided into two groups (I and ll, according to whether additional BAE was performed within two weeks of initial BAE or more than two weeks after this) We retrospectively compared the two groups in terms of angiographic findings, number of embolized arteries, and character of feeding arteries at initial and additional BAE. Nine patients in group I (additional BAE: n=10) and nine in group ll (additional BAE: n=13) were admitted for recurrent hemoptysis within two weeks of initial BAE and more than two weeks after this, respectively. In group I (n=29) and ll(n=31), angiography demonstrated two direct and 27 indirect, and two direct and 29 indirect signs of hemorrhage, respectiveIy. No statistically significant differences were observed (x 2 =0.005, ρ=0.945). Among the embolized feeder ressels in group I (n=30) there were 20 bronchial artery and 10 non bronchial systemic collaterals, while for group ll (n=35), the corresponding totals were 21 and 14. Again, no statistically significant differences were encountered(x 2 =0.308; ρ=0.579). In group I, feeders were newly developed in one case(10%), previously embolized in five(50%), and missed in four(40%), while in group two the corresponding figures were none, twelve(92.3%), and one(7.7%) No significant differences were noted, though the incidence of previously embolized feeders in Group ll was very high (x 2 =5.383, ρ=0.068). Among patients in whom hemoptysis after BAE recurred at different times, the angiographic findings and number of embolized arteries were not significantly different, but differences in the nature of the

  10. Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.

    Science.gov (United States)

    Jacques, Jérémie; Projetti, Fabrice; Legros, Romain; Valgueblasse, Virginie; Sarabi, Matthieu; Carrier, Paul; Fredon, Fabien; Bouvier, Stéphane; Loustaud-Ratti, Véronique; Sautereau, Denis

    2013-09-21

    We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation.

  11. Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

    International Nuclear Information System (INIS)

    Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E.

    2017-01-01

    PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

  12. Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E., E-mail: jsilberzweig@chpnet.org [Mount Sinai Beth Israel, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2017-02-15

    PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

  13. Long-term prognosis in patients continuing taking antithrombotics after peptic ulcer bleeding.

    Science.gov (United States)

    Wang, Xi-Xu; Dong, Bo; Hong, Biao; Gong, Yi-Qun; Wang, Wei; Wang, Jue; Zhou, Zhen-Yu; Jiang, Wei-Jun

    2017-01-28

    To investigate the long-term prognosis in peptic ulcer patients continuing taking antithrombotics after ulcer bleeding, and to determine the risk factors that influence the prognosis. All clinical data of peptic ulcer patients treated from January 1, 2009 to January 1, 2014 were retrospectively collected and analyzed. Patients were divided into either a continuing group to continue taking antithrombotic drugs after ulcer bleeding or a discontinuing group to discontinue antithrombotic drugs. The primary outcome of follow-up in peptic ulcer bleeding patients was recurrent bleeding, and secondary outcome was death or acute cardiovascular disease occurrence. The final date of follow-up was December 31, 2014. Basic demographic data, complications, and disease classifications were analyzed and compared by t - or χ 2 -test. The number of patients that achieved various outcomes was counted and analyzed statistically. A survival curve was drawn using the Kaplan-Meier method, and the difference was compared using the log-rank test. COX regression multivariate analysis was applied to analyze risk factors for the prognosis of peptic ulcer patients. A total of 167 patients were enrolled into this study. As for the baseline information, differences in age, smoking, alcohol abuse, and acute cardiovascular diseases were statistically significant between the continuing and discontinuing groups (70.8 ± 11.4 vs 62.4 ± 12.0, P peptic ulcer bleeding, continuing antithrombotics increases the risk of recurrent bleeding events, while discontinuing antithrombotics would increase the risk of death and developing cardiovascular disease. This suggests that clinicians should comprehensively consider the use of antithrombotics after peptic ulcer bleeding.

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

    International Nuclear Information System (INIS)

    Bastos, J.L.A.

    1990-01-01

    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 (Ethamolin R ) 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)

  15. Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids

    Science.gov (United States)

    Jutabha, Rome; Jensen, Dennis M.; Chavalitdhamrong, Disaya

    2013-01-01

    OBJECTIVES: Our purpose was to compare the efficacy, complications, success rate, recurrence rate at 1 year, and crossovers of rubber band ligation (RBL) with those of bipolar electrocoagulation (BPEC) treatment for chronically bleeding internal hemorrhoids. METHODS: A total of 45 patients of mean age 51.5 years, who had rectal bleeding from grade II or III hemorrhoids and in whom intensive medical therapy failed, were randomized in a prospective study comparing RBL with BPEC. Treatment failure was predefined as continued bleeding, occurrence of a major complication, or failure to reduce the size of all internal hemorrhoidal segments to grade I in ≤ 3 treatments. Patients were followed up for 1 year. RESULTS: With similar patients, rectal bleeding and other symptoms were controlled with significantly fewer treatments of RBL than of BPEC (2.3±0.2 vs. 3.8±0.4, P 0.05), but significantly fewer failures and crossovers (8% vs. 38%). Symptomatic recurrence at 1 year was 10% RBL and 15% BPEC. CONCLUSIONS: For patients with chronically bleeding grade II or III internal hemorrhoids that are unresponsive to medical therapy, safety and complication rates of banding and BPEC were similar. The success rate was significantly higher with RBL than with BPEC. Symptom recurrence rates at 1 year were similar. PMID:19513028

  16. Clinical results of the transjugular intrahepatic portosystemic shunt

    Energy Technology Data Exchange (ETDEWEB)

    Park, Auh Whan; Sim, Jae In; Ryeom, Hun Kyu; Kim, Yong Joo [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    1994-04-15

    To evaluate the clinical results of transjugular intrahepatic portosystemic shunt(TIPS) for the control of variceal bleeding. TIPS creation was attempted in 23 patients with endoscopically confirmed variceal bleeding. Most patients had multiple episodes of bleeding in the past and have been treated with multiple endoscopic sclerotherapies. Pre-and post-procedural hepatic and portal vein pressures were measured. After creation of TIPS patients were followed up at regular intervals. TIPS has been successfully accomplished in 22 of 23 patients using Wallstent(n = 21) and Strecker stent(n = 1). Immediate bleeding control was achieved in all patients with shunt creation. No procedure-related complication was noted. Portal vein pressure was reduced from 30.7 {+-} 5.8 mmHg to 20.8 {+-} 4.7 mmHg. The mean pressure gradient of portosystemic shunt dropped from 22.8 {+-} 6.0 prior to TIPS to 12.2 {+-} 4.1 immediately after. During the follow-up period (6-556 days, mean; 10 months), seven patients died; progressive hepatic failure (n 4), variceal rebleeding (n = 2), and respiratory failure(n = 1). Hepatic encephalopathy after TIPS was noted in 7 patients(31.8%). Variceal rebleeding occurred in 3 patients(13.6%). The remaining 15 patients have survived an average of 11 months. This results suggest that TIPS is a safe and effective method for lowering portal pressure and controlling variceal bleeding. Furthermore if these initial results are encouraged by further long-term observation, TIPS could replace endoscopic and risky surgical intervention.

  17. The White Nipple Sign: Please Do Not Disturb

    Directory of Open Access Journals (Sweden)

    Naser M. Khan

    2011-07-01

    Full Text Available Blood spurting or oozing from a varix confirms the diagnosis of variceal hemorrhage. In most cases of variceal hemorrhage, however, the bleeding has ceased by the time endoscopy is performed. Endoscopists rely on identification of stigmata of recent hemorrhage to determine whether varices are the cause of bleeding and to predict the likelihood of rebleeding. Most of the attention has focused on red color signs, such as red wale markings, described by Beppu et al. [Gastrointest Endosc 1981;27:213–218] and well known to endoscopists. Here we describe our experience with a less recognized stigma of variceal hemorrhage known as the ‘white nipple sign’, which resulted in active hemorrhage when manipulated.

  18. Renal phlebographic findings in painless macrohematuria

    International Nuclear Information System (INIS)

    Seidel, K.; Federschmidt, K.

    1982-01-01

    After extensive review of literature concerning renal varices including suburothelial phlebectasia three cases of painless macrohematuria are recommended with unusual phlebographic findings: 1. a large renoiliac anastomosis combined with associated varices of the ureter, 2. a wide renohemazygal anastomosis draining nearly totally left renal venous blood into the vena cava superior, simultaneous existing varices of renal pelvis and ureter and 3. a persisting circumaortal ring. It is discussed whether phlebographic revealed renal varicosity is origin of bleeding in any case or bleeding may be caused eventually by associated suburothelial phlebectasia. (orig.) [de

  19. 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 development in connection with ascites, HCC and variceal bleeding. Measurement of HVPG is a simple and safe method and it can, moreover, be used to guide pharmacotherapy for primary and secondary prophylaxis of variceal bleeding. Assessment of HVPG should be available in larger centres that manage portal...... hypertensive patients....

  20. Esophagus after injection sclerotherapy of varices

    Energy Technology Data Exchange (ETDEWEB)

    Brambs, H J; Billmann, P; Hoppe-Seyler, P; Buechsel, R

    1985-11-01

    Endoscopic sclerotherapy of esophageal varices is a widely used procedure. It reduces the frequency of rebleeding and improves the survival of cirrhotics with portal hypertension. The intravariceal or paravariceal injection of sclerosing agents causes structural changes of the esophageal wall recognisable radiologically. Stricture is a late complication which occurs in about 10 percent. In residual dysphagia balloon dilatation is recommended.

  1. Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

    International Nuclear Information System (INIS)

    Bercu, Zachary L.; Sheth, Sachin B.; Noor, Amir; Lookstein, Robert A.; Fischman, Aaron M.; Nowakowski, F. Scott; Kim, Edward; Patel, Rahul S.

    2015-01-01

    The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation

  2. Cardiac and renal effects of a transjugular intrahepatic portosystemic shunt in cirrhosis

    DEFF Research Database (Denmark)

    Busk, Troels M; Bendtsen, Flemming; Møller, Søren

    2013-01-01

    Refractory ascites and recurrent variceal bleeding are among the serious complications of portal hypertension and cirrhosis for which a transjugular intrahepatic portosystemic shunt (TIPS) can be used. Cirrhotic patients have varying degrees of haemodynamic derangement, mainly characterized...... to improve in patients with the hepatorenal syndrome. The clinical and haemodynamic effects of TIPS have been studied intensively and will be reviewed in the present paper. Considerable knowledge on the effects of TIPS on the pathophysiology of cirrhosis has been gained, but studies on the central...

  3. Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Bercu, Zachary L., E-mail: zachary.bercu@mountsinai.org; Sheth, Sachin B., E-mail: sachinsheth@gmail.com [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States); Noor, Amir, E-mail: amir.noor@gmail.com [The George Washington University School of Medicine and Health Sciences (United States); Lookstein, Robert A., E-mail: robert.lookstein@mountsinai.org; Fischman, Aaron M., E-mail: aaron.fischman@mountsinai.org; Nowakowski, F. Scott, E-mail: scott.nowakowski@mountsinai.org; Kim, Edward, E-mail: edward.kim@mountsinai.org; Patel, Rahul S., E-mail: rahul.patel@mountsinai.org [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States)

    2015-10-15

    The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation.

  4. Embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy

    International Nuclear Information System (INIS)

    Sakurabayashi, Shin; Sezai, Shuichi; Yamamoto, Yoshihiro; Hirano, Masanori; Oka, Hiroshi

    1997-01-01

    Purpose. To evaluate the efficacy of embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy (CRHE). Methods. Seven cirrhotic patients with CRHE refractory to medical treatment (3 men and 4 women, mean age 66 years) were studied. Five patients had splenorenal shunts, 1 had a gastrorenal shunt, and 1 had an intrahepatic portal vein-hepatic vein shunt. Shunt embolization was performed using stainless steel coils, with a percutaneous transhepatic portal vein approach in 4 patients and a transrenal vein approach in 3 patients. Results. After embolization, the shunt disappeared in 4 patients on either ultrasound pulsed Doppler monitoring or portography. Complications observed in the 7 patients were fever, transient pleural effusion, ascites, and mild esophageal varices. For 3-6 months after embolization, the 4 patients whose shunts disappeared showed minimal or no reappearance of a shunt, and had no recurrence of encephalopathy. The serum ammonia levels decreased and electroencephalograms also improved. One of the 4 patients, who developed mild esophageal varices, required no treatment. Treatment was effective in 3 of the 4 patients (75%) who underwent embolization via a transhepatic portal vein. Conclusion. Transvascular embolization of shunts improved the outcome in 4 of 7 patients. The most effective embolization was achieved via the percutaneous transhepatic portal vein approach

  5. Bronchoscopic findings and bleeding control predict survival in patients with solid malignancies presenting with mild hemoptysis.

    Science.gov (United States)

    Grosu, Horiana B; Casal, Roberto F; Morice, Rodolfo C; Nogueras-González, Graciela M; Eapen, Georgie A; Ost, David; Sarkiss, Mona G; Jimenez, Carlos A

    2013-08-01

    Regardless of its volume, hemoptysis is a concerning symptom. Mild hemoptysis and its significance in patients with solid malignancies has not been studied. We conducted a retrospective chart review of patients with solid malignancies who presented for evaluation of mild hemoptysis. In this population, we studied the impact of bronchoscopic findings and endobronchial therapies on overall survival and bleeding recurrence. Patients were categorized into four groups on the basis of the presence or absence of active bleeding and endobronchial disease at the time of initial bronchoscopy: active bleeding with endobronchial lesion (AB/EBL), active bleeding without endobronchial lesion (AB/no-EBL), absence of active bleeding but with endobronchial lesion (no-AB/EBL), and absence of active bleeding and endobronchial lesion (no-AB/no-EBL). Ninety-five of the 112 patients with solid malignancies and mild hemoptysis underwent bronchoscopies. There was a significantly lower median survival time for patients with bronchoscopic findings of active bleeding and endobronchial lesion compared with patients with no active bleeding and/or no endobronchial lesion (3.48 mo; 95% confidence interval [CI], 2.14-6.05). On a multivariate analysis, factors independently associated with improved survival were higher hemoglobin values (hazard ratio [HR], 0.78; 95% CI, 0.67-0.91) and cessation of hemoptysis without recurrence at 48 hours (HR, 0.43; 95% CI, 0.22-0.84). Variables independently associated with worse survival were disease stage (HR, 10.8; 95% CI, 2.53-46.08) and AB/EBL (HR, 3.20; 95% CI, 1.74-5.89). In patients with solid malignancies presenting with mild hemoptysis, bronchoscopic findings of AB/EBL are associated with decreased survival. Hemoptysis control without recurrence at 48 hours after endobronchial intervention may improve survival.

  6. Fluoroscopically-guided foam sclerotherapy with sodium morrhuate for the treatment of lower extremity varices

    International Nuclear Information System (INIS)

    Wang Haiting; Jiang Zhongpu; Zhou Yi

    2011-01-01

    Objective: To evaluate fluoroscopically-guided foam sclerotherapy with injection of domestic sodium morrhuate in treating lower extremity varices. Methods: A total of 30 cases (39 diseased lower limbs) with lower extremity varices were enrolled in this study. Under fluoroscopic guidance foam sclerotherapy with injection of domestic sodium morrhuate was carried out in all patients. The obstructed condition of the great saphenous vein was observed during the following three months. Results: The technical success was achieved in all 39 patients. The mean dose of foam sclerosant used for each diseased limb was 5.9 ml (3.4-8.2 ml). Disappearance of blood flow reflux in lower extremity vein immediately after the treatment was seen in 35 patients (90%). Three months after the therapy, vascular sonography showed that the great saphenous vein was obstructed, and no serious complications occurred. Conclusion: For the treatment of lower extremity varices, fluoroscopically-guided foam sclerotherapy with injection of domestic sodium morrhuate is safe and effective with satisfactory results. This technique is a newly-developed micro-invasive therapy for lower extremity varices. (authors)

  7. The clinical results of balloon-occluded retrograde transvenous obliteration in treatment of gastric varices compared with transjugular intrahepatic portosystemic shunt

    International Nuclear Information System (INIS)

    Lee, Nam Kyung; Kim, Chang Won; Jeon, Ung Bae; Kim, Suk; Lee, Jun Woo; Jo, Mong; Heo, Jeong

    2007-01-01

    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

  8. 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.

  9. Therapeutic Endoscopy for the Control of Nonvariceal Upper Gastrointestinal Bleeding in Children: A Case Series.

    Science.gov (United States)

    Banc-Husu, Anna M; Ahmad, Nuzhat A; Chandrasekhara, Vinay; Ginsberg, Gregory G; Jaffe, David L; Kochman, Michael L; Rajala, Michael W; Mamula, Petar

    2017-04-01

    Gastrointestinal bleeding is one of the most common indications for urgent endoscopy in the pediatric setting. The majority of these procedures are performed for control of variceal bleeding, with few performed for nonvariceal upper gastrointestinal (NVUGI) bleeding. The data on therapeutic endoscopy for NVUGI are sparse. The aims of our study were to review our experience with NVUGI bleeding, describe technical aspects and outcomes of therapeutic endoscopy, and determine gastroenterology fellows' training opportunities according to the national training guidelines. We performed a retrospective review of endoscopy database (Endoworks, Olympus Inc, Center Valley, PA) from January 2009 to December 2014. The search used the following keywords: bleeding, hematemesis, melena, injection, epinephrine, cautery, clip, and argon plasma coagulation. The collected data included demographics, description of bleeding lesion and medical/endoscopic therapy, rate of rebleeding, relevant laboratories, physical examination, and need for transfusion and surgery. The study was approved by the institutional review board. During the study period 12,737 upper endoscopies (esophagogastroduodenoscopies) were performed. A total of 15 patients underwent 17 esophagogastroduodenoscopies that required therapeutic intervention to control bleeding (1:750 procedures). The mean ± standard deviation (median) age of patients who required endoscopic intervention was 11.6 ± 6.0 years (14.0 years). Seven out of 17 patients received dual therapy to control the bleeding lesions. All but 3 patients received medical therapy with intravenous proton pump inhibitor, and 3 received octreotide infusions. Six of the patients experienced rebleeding (40%), with 4 out of 6 initially only receiving single modality therapy. Two of these patients eventually required surgical intervention to control bleeding and both patients presented with bleeding duodenal ulcers. There were no cases of aspiration

  10. Splenic vein thrombosis with chronic pancreatitis: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Nasiri SH, Khorgami J, Donboli K

    2008-07-01

    Full Text Available "nBackground: Chronic pancreatitis and perivasculitis is the most common etiology of splenic vein thrombosis (SVT. Reported in up to 45% of patients with chronic pancreatitis, SVT may also be seen in patients with acute pancreatitis and pancreatic adenocarcinoma. It causes a localized portal hypertension called sinistral portal hypertension. Unlike those with generalized portal hypertension, patients with sinistral portal hypertension are asymptomatic and have normal liver function. Upper gastrointestinal bleeding from gastric varices is a life threatening complication of SVT. In patients with gastrointestinal bleeding secondary to esophageal or gastric varices, late-phase celiac angiography is used to determine the presence SVT. Splenectomy is effective in treating the collateral outflow for patients with massive gastrointestinal bleeding."n"nCase report: a 23-year-old patient with SVT due to chronic pancreatitis with gastrointestinal bleeding. The patient came to the hospital with upper gastrointestinal bleeding of unknown etiology. Diagnostic workups revealed chronic pancreatitis and SVT with bleeding gastric fundal varices, after which the patient underwent splenectomy. A review of current literature on SVT, known etiologies, diagnosis and treatment is discussed

  11. Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital, northern Uganda.

    Science.gov (United States)

    Alema, O N; Martin, D O; Okello, T R

    2012-12-01

    Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda. The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed. A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB. Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.

  12. Management of stomal varices with transvenous obliteration utilizing sodium tetradecyl sulfate foam sclerosis.

    Science.gov (United States)

    Saad, Wael E A; Schwaner, Sandra; Lippert, Allison; Sabri, Saher S; Al-Osaimi, Abdullah; Matsumoto, Alan H; Angle, John F; Caldwell, Stephen

    2014-12-01

    The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21-37%. The purpose of the study is to determine the effectiveness of transvenous obliteration using sodium tetradecyl sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10-15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2-33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).

  13. Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery

    Directory of Open Access Journals (Sweden)

    Paulo Fernandes Saad

    2012-12-01

    Full Text Available CONTEXT: Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to gastroesophagic varices is frequent. OBJECTIVE: To evaluate the outcome of treatment based on embolization of the left gastric vein to control the reoccurrence of hemorrhages caused by gastroesophagic varices in patients with schistosomiasis previously submitted to non-derivative surgery. METHODS: Rates of reoccurrence of hemorrhages and the qualitative and quantitative reduction of gastroesophagic varices in patients undergoing transhepatic embolization of the left gastric vein between December 1999 and January 2009 were studied based on medical charts and follow-up reports. RESULTS: Seven patients with a mean age of 39.3 years underwent percutaneous transhepatic embolization of the left gastric vein. The mean time between azigoportal disconnections employed in combination with splenectomy and the percutaneous approach was 8.4 ± 7.3 years, and the number of episodes of digestive hemorrhaging ranged from 1 to 7 years. No episodes of reoccurrence of hemorrhaging were found during a follow-up period which ranged from 6 months to 7 years. Endoscopic postembolization studies revealed reductions in gastroesophagic varices in all patients compared to preembolization endoscopy. CONCLUSIONS: Percutaneous transhepatic embolization of the left gastric vein in patients with schistosomiasis previously submitted to surgery resulted in a decrease in gastroesophagic varices and was shown to be effective in controlling hemorrhage reoccurrence.

  14. Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding - a single center experience.

    Science.gov (United States)

    Cahyadi, Oscar; Bauder, Markus; Meier, Benjamin; Caca, Karel; Schmidt, Arthur

    2017-11-01

     TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB.  Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods.  Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs.  TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an "add-on" therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a

  15. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery

    OpenAIRE

    Greco, Marco Giuseppe; Mattioli, Francesco; Alberici, Maria Paola; Presutti, Livio

    2016-01-01

    A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator’s experience and radiological support (cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the ...

  16. Similar Efficacy of Proton-Pump Inhibitors vs H2-Receptor Antagonists in Reducing Risk of Upper Gastrointestinal Bleeding or Ulcers in High-Risk Users of Low-Dose Aspirin.

    Science.gov (United States)

    Chan, Francis K L; Kyaw, Moe; Tanigawa, Tetsuya; Higuchi, Kazuhide; Fujimoto, Kazuma; Cheong, Pui Kuan; Lee, Vivian; Kinoshita, Yoshikazu; Naito, Yuji; Watanabe, Toshio; Ching, Jessica Y L; Lam, Kelvin; Lo, Angeline; Chan, Heyson; Lui, Rashid; Tang, Raymond S Y; Sakata, Yasuhisa; Tse, Yee Kit; Takeuchi, Toshihisa; Handa, Osamu; Nebiki, Hiroko; Wu, Justin C Y; Abe, Takashi; Mishiro, Tsuyoshi; Ng, Siew C; Arakawa, Tetsuo

    2017-01-01

    It is not clear whether H 2 -receptor antagonists (H2RAs) reduce the risk of gastrointestinal (GI) bleeding in aspirin users at high risk. We performed a double-blind randomized trial to compare the effects of a proton pump inhibitor (PPI) vs a H2RA antagonist in preventing recurrent upper GI bleeding and ulcers in high-risk aspirin users. We studied 270 users of low-dose aspirin (≤325 mg/day) with a history of endoscopically confirmed ulcer bleeding at 8 sites in Hong Kong and Japan. After healing of ulcers, subjects with negative results from tests for Helicobacter pylori resumed aspirin (80 mg) daily and were assigned randomly to groups given a once-daily PPI (rabeprazole, 20 mg; n = 138) or H2RA (famotidine, 40 mg; n = 132) for up to 12 months. Subjects were evaluated every 2 months; endoscopy was repeated if they developed symptoms of upper GI bleeding or had a reduction in hemoglobin level greater than 2 g/dL and after 12 months of follow-up evaluation. The adequacy of upper GI protection was assessed by end points of recurrent upper GI bleeding and a composite of recurrent upper GI bleeding or recurrent endoscopic ulcers at month 12. During the 12-month study period, upper GI bleeding recurred in 1 patient receiving rabeprazole (0.7%; 95% confidence interval [CI], 0.1%-5.1%) and in 4 patients receiving famotidine (3.1%; 95% CI, 1.2%-8.1%) (P = .16). The composite end point of recurrent bleeding or endoscopic ulcers at month 12 was reached by 9 patients receiving rabeprazole (7.9%; 95% CI, 4.2%-14.7%) and 13 patients receiving famotidine (12.4%; 95% CI, 7.4%-20.4%) (P = .26). In a randomized controlled trial of users of low-dose aspirin at risk for recurrent GI bleeding, a slightly lower proportion of patients receiving a PPI along with aspirin developed recurrent bleeding or ulcer than of patients receiving an H2RA with the aspirin, although this difference was not statistically significant. ClincialTrials.gov no: NCT01408186. Copyright © 2017 AGA

  17. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

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

  18. 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.

  19. Detection and localization of lower gastrointestinal bleeding site with scintigraphic techniques

    International Nuclear Information System (INIS)

    Alavi, A.

    1988-01-01

    Successful management of acute gastrointestinal (GI) bleeding frequently depends on accurate localization of the bleeding site. History and clinical findings are often misleading in localizing the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provides accurate diagnoses for the majority of patients with upper GI tract hemorrhage, but lower GI bleeding still is a serious diagnostic problem. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases, has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding. Since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. Repeated angiography to pursue recurrent episodes of bleeding is impractical. Because of these shortcomings, in the past decade several noninvasive scintigraphic techniques have been developed to detect and localize sites of GI bleeding. In this chapter the authors discuss details related to the technetium 99m sulfur colloid (Tc-SC) and technetium 99m-labeled red blood cell (Tc-RBC) techniques

  20. Admission time is associated with outcome of upper gastrointestinal bleeding: results of a multicentre prospective cohort study

    NARCIS (Netherlands)

    de Groot, N. L.; Bosman, J. H.; Siersema, P. D.; van Oijen, M. G. H.; Bredenoord, A. J.

    2012-01-01

    Background It has been suggested that patients presenting with upper gastrointestinal bleeding (UGIB) during the weekend have a worse outcome compared with weekdays, with an increased risk of recurrent bleeding and mortality. Aim To investigate the association between timing of admission and adverse

  1. Recanalization of an Occluded Intrahepatic Portosystemic Covered Stent via the Percutaneous Transhepatic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Chih Yang; Liang, Po Chin [National Taiwan University Hospital, Taipei (China)

    2010-08-15

    A 41-year-old woman with liver cirrhosis had recurrent portal hypertension and bleeding from esophageal varices due to complete occlusion of a previously inserted transjugular intrahepatic portosystemic shunt stent. Because recanalization of the stent by the transjugular approach was unsuccessful, ultrasound-guided entry to the splenic vein and portal vein was used. After catheter-directed intrathrombus thrombolysis, successful opening of the stent was achieved and a stent was placed. We herein report a rare case in which thrombolysis and recanalization of a TIPS stent were performed via a percutaneous transhepatic approach

  2. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    Directory of Open Access Journals (Sweden)

    G Raghavendra Prasad

    2013-01-01

    Full Text Available Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

  3. Banding ligation versus no intervention for primary prevention in adults with oesophageal varices

    DEFF Research Database (Denmark)

    Yong, Charles Wei Kit; Vadera, Sonam; Morgan, Marsha Y.

    2017-01-01

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of banding ligation versus no intervention in adults with cirrhosis and gastro-oesophageal varices that have not bled.......This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of banding ligation versus no intervention in adults with cirrhosis and gastro-oesophageal varices that have not bled....

  4. [AIMS65 score validation for upper gastrointestinal bleeding in the National Hospital Cayetano Heredia].

    Science.gov (United States)

    Aguilar Sánchez, Víctor; Bravo Paredes, Eduar Alban; Pinto Valdivia, José Luis; Valenzuela Granados, Vanessa; Espinoza-Rios, Jorge Luis

    2015-01-01

    To validate the score AIMS65 in patients with upper gastrointestinal bleeding, in terms of mortality and rebleeding a 30-day event. Patients included were those with higher age to 18 years attending the Hospital Nacional Cayetano Heredia during the period May 2013 to December 2014, by upper gastrointestinal bleeding. Data were analyzed using ROC curve (Receiver Operating Characteristic) and the area was obtained under the curve (AUC) to properly qualify the score AIMS65. 209 patients were included, 66.03% were male, with an average age of 58.02 years. The mortality rate was 7.65%, the multiorgan failure the most common cause of death. Plus 3.82% of the patients had recurrent bleeding and 11% required a transfusion of more than 2 units of blood. When analyzing the ROC curve with AIMS65 and mortality score a value of 0.9122 is reported; identifying it as cutoff greater than or equal to 3 value in the score AIMS65 to discriminate patients at high risk of death, likewise the ROC curve was analyzed for recurrence of bleeding with a value of 0.6266 and the need to Transfusion of packed red blood cells over two a value of 0.7421. And it was determined the average hospital stay with a value of 4.8 days, however, no correlation was found with the score AIMS65. AIMS65 score is a good predictor of mortality, and is useful for predicting the need for transfusion of more than 2 globular packages. However it is not a good predictor for recurrence of bleeding, or hospital stay.

  5. Recurrent epistaxis caused by an intranasal supernumerary tooth in a young adult.

    Science.gov (United States)

    Al Dhafeeri, Hamed O; Kavarodi, Abdulmajid; Al Shaikh, Khalil; Bukhari, Ahmed; Al Hussain, Omair; El Baramawy, Ahmed

    2014-01-01

    Male, 27. Recurrent epistaxis. Nasal bleeding. -. -. Pediatrics and Neonatology. Congenital defects/diseases. Recurrent epistaxis is a common disorder among children and young adults. We report an unusual cause, intranasal supernumerary tooth causing friction with Little's area of the nasal septum. A 22-year-old male presented with recurrent, mild, unilateral left-sided epistaxis once to twice per month for 3 years. This usually occurred after minor nasal trauma or rubbing his nose. The patient also suffered from recurrent tonsillitis. There was neither history of blood transfusion or nasal packing, nor a history suggestive of bleeding diathesis. Anterior rhinoscopy revealed ivory white nasal mass antero-inferiorly in the left nasal cavity touching Little's area. There was no bleeding. Nasal endoscopy showed a white cylindrical bony mass 1 cm long arising from the floor of the nose, with no attachment to the nasal septum or the lateral wall of the nose. Examination of the right nasal cavity was unremarkable. Nasal teeth result from the ectopic eruption of supernumerary teeth and may cause a variety of symptoms including recurrent epistaxis. Their clinical and radiologic presentation is so characteristic that their diagnosis is not difficult. CT scan is helpful in planning management. Early extraction prevents further complications and prevents further attacks of epistaxis.

  6. Clinical value of acoustic radiation force impulse in quantitative prediction of the degree of esophageal varices in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    CHEN Min

    2018-01-01

    Full Text Available Objective To investigate the clinical value of acoustic radiation force impulse (ARFI in quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension. Methods A total of 116 patients with liver cirrhosis who were admitted to 302 Hospital of PLA from October 2014 to February 2016 were enrolled. ARFI was used to measure real-time liver and spleen stiffness for all patients. With the degree of esophageal varices determined by gastroscopy as the gold standard for diagnosis, these patients were divided into non-varices group (EV0, 16 patients, mild varices group (EV1, 39 patients, moderate varices group (EV2, 26 patients, and severe varices group (EV3, 35 patients. The receiver operating characteristic (ROC curve was used to analyze the clinical value of liver/spleen ARFI in predicting the degree of esophageal varices. An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the least significant difference Mann-Whitney U test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between the stiffness measured by ARFI and the degree of esophageal varices. Results The ARFI value of the spleen was 2.54±0.34 m/s for EV0 patients, 3.05±0.34 m/s for EV1 patients, 3.48±0.50 m/s for EV2 patients, and 3.69±0.33 m/s for EV3 patients (χ2=60.121,P<0.001. The ARFI value of the spleen was positively correlated with the grade of esophageal varices (r=0.713, P<0.001. The areas under the ROC curve for the ARFI value of the spleen in the diagnosis of ≥EV1, ≥EV2, or EV3 esophageal varices were 0.93, 0.88, and 0.83, respectively. There was no significant difference in the ARFI value of the liver between groups (P=0.085, and the ARFI value of the liver was not correlated with the degree of

  7. Bleeding tendency in dual antiplatelet therapy with aspirin/clopidogrel: rescue of the template bleeding time in a single-center prospective study

    Directory of Open Access Journals (Sweden)

    Altman Raul

    2012-01-01

    Full Text Available Abstract Background Patients with heightened platelet reactivity in response to antiplatelet agents are at an increased risk of recurrent ischemic events. However, there is a lack of diagnostic criteria for increased response to combined aspirin/clopidogrel therapy. The challenge is to identify patients at risk of bleeding. This study sought to characterize bleeding tendency in patients treated with aspirin and clopidogrel. Patients/methods In a single-center prospective study, 100 patients under long-term aspirin/clopidogrel treatment, the effect of therapy was assayed by template bleeding time (BT and the inhibition of platelet aggregation (IPA by light transmission aggregometry (LTA. Arachidonic acid (0.625 mmol/L and adenosine diphosphate (ADP; 2, 4, and 8 μmol/L were used as platelet agonists. Results Bleeding episodes (28 nuisance, 2 hematuria [1 severe], 1 severe proctorrhagia, 1 severe epistaxis were significantly more frequent in patients with longer BT. Template BT ≥ 24 min was associated with bleeding episodes (28 of 32. Risk of bleeding increased 17.4% for each 1 min increase in BT. Correlation was found between BT and IPAmax in response to ADP 2 μmol/L but not to ADP 4 or 8 μmol/L. Conclusion In patients treated with dual aspirin/clopidogrel therapy, nuisance and internal bleeding were significantly associated with template BT and with IPAmax in response to ADP 2 μmol/L but not in response to ADP 4 μmol/L or 8 μmol/L.

  8. Acute gastrointestinal bleeding following aortic valve replacement in a patient with Heyde's sindrome. Case report.

    Science.gov (United States)

    De Palma, G D; Salvatori, F; Masone, S; Simeoli, I; Rega, M; Celiento, M; Persico, G

    2007-09-01

    A 58-year old man was admitted to the hospital because of melena. He had a 1-year history of mechanical aortic valve replacement and coronary stent placement because of myocardial infarction and he was taking warfarin and clopidogrel. Esophagogastroduodenoscopy and colonoscopy were negative for bleeding. Capsule endoscopy showed bleeding diffuse angiodysplasia of the small bowel. The patient was treated with octreotide 20 mg, at monthly interval. After 25 months there had been no recurrence of gastrointestinal bleeding. The case suggests that mechanical valve replacement may not prevent gastrointestinal bleeding in Heyde syndrome and that octreotide treatment should be considered in these cases.

  9. iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience.

    Science.gov (United States)

    Faggioni, L; Neri, E; Bargellini, I; Scalise, P; Calcagni, F; Mantarro, A; D'Ippolito, G; Bartolozzi, C

    2015-03-01

    To evaluate the effectiveness of the iPad (Apple Inc., Cupertino, CA) for two-dimensional (2D) reading of CT angiography (CTA) studies performed for suspected acute non-variceal gastrointestinal bleeding. 24 CTA examinations of patients with suspected acute gastrointestinal bleeding confirmed (19/24, 79.2%) or ruled out (5/24, 20.8%) by digital subtraction angiography (DSA) were retrospectively reviewed by three independent readers on a commercial picture archiving communication system (PACS) workstation and on an iPad with Retina Display® 64 GB (Apple Inc.). The time needed to complete reading of every CTA examination was recorded, as well as the rate of detection of arterial bleeding and identification of suspected bleeding arteries on both devices. Overall, the area under the receiver operating characteristic curve, sensitivity, specificity, positive- and negative-predictive values for bleeding detection were not significantly different while using the iPad and workstation (0.774 vs 0.847, 0.947 vs 0.895, 0.6 vs 0.8, 0.9 vs 0.944 and 0.750 vs 0.667, respectively; p > 0.05). In DSA-positive cases, the iPad and workstation allowed correct identification of the bleeding source in 17/19 cases (89.5%) and 15/19 cases (78.9%), respectively (p > 0.05). Finally, the time needed to complete reading of every CTA study was significantly shorter using the iPad (169 ± 74 vs 222 ± 70 s, respectively; p < 0.01). Compared with a conventional PACS workstation, iPad-based preliminary 2D reading of CTA studies has comparable diagnostic accuracy for detection of acute gastrointestinal bleeding and can be significantly faster. The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.

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

    Directory of Open Access Journals (Sweden)

    Isabel Macías, PhD

    2016-01-01

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

  11. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

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

  12. Nasal granuloma gravidarum presenting with recurrent massive epistaxis.

    Science.gov (United States)

    Tantinikorn, Weerachai; Uiprasertkul, Mongkol; Assanasen, Paraya

    2003-05-01

    Nasal granuloma gravidarum is a rare condition associated with pregnancy and minor trauma. This condition presents with a nasal mass with varying degree of bleeding and obstruction. We report a patient with nasal granuloma gravidarum in the third trimester of pregnancy. Surgical excision is the definite treatment for this condition in order to stop the vicious cycle of recurrent massive bleeding. Possible etiology, clinical features and management are discussed.

  13. Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

    Directory of Open Access Journals (Sweden)

    V. V. Izbitsky

    2013-06-01

    Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

  14. Indications for portal pressure measurement in chronic liver disease

    DEFF Research Database (Denmark)

    Hobolth, Lise; Bendtsen, Flemming; Møller, Søren

    2012-01-01

    Portal hypertension leads to development of serious complications such as esophageal varices, ascites, renal and cardiovascular dysfunction. The importance of the degree of portal hypertension has been substantiated within recent years. Measurement of the portal pressure is simple and safe...... and the hepatic venous pressure gradient (HVPG) independently predicts survival and development of complications such as ascites, HCC and bleeding from esophageal varices. Moreover, measurements of HVPG can be used to guide pharmacotherapy for primary and secondary prophylaxis for variceal bleeding. Assessment...... of HVPG should therefore be considered as a part of the general characterization of patients with portal hypertension in departments assessing and treating this condition....

  15. Analysis of risk factor and clinical characteristics of angiodysplasia presenting as upper gastrointestinal bleeding.

    Science.gov (United States)

    Kim, Dae Bum; Chung, Woo Chul; Lee, Seok Jong; Sung, Hea Jung; Woo, Seokyung; Kim, Hyo Suk; Jeong, Yeon Oh; Lee, Hyewon; Kim, Yeon-Ji

    2016-07-01

    Angiodysplasia is important in the differential diagnosis of upper gastrointestinal bleeding (UGIB), but the clinical features and outcomes associated with UGIB from angiodysplasia have not been characterized. We aimed to analyze the clinical characteristics and outcomes of angiodysplasia presented as UGIB. Between January 2004 and December 2013, a consecutive series of patients admitted with UGIB were retrospectively analyzed. Thirty-five patients with bleeding from angiodysplasia were enrolled. We compared them with an asymptomatic control group (incidental finding of angiodysplasia in health screening, n = 58) and bleeding control group (simultaneous finding of angiodysplasia and peptic ulcer bleeding, n = 28). When patients with UGIB from angiodysplasia were compared with the asymptomatic control group, more frequent rates of nonantral location and large sized lesion (≥ 1 cm) were evident in multivariate analysis. When these patients were compared with the bleeding control group, they were older (mean age: 67.94 ± 9.16 years vs.55.07 ± 13.29 years, p = 0.03) and received less transfusions (p = 0.03). They also had more frequent rate of recurrence (40.0% vs. 20.7%, p = 0.02). Non-antral location and large lesions (≥ 1 cm) could be risk factors of UGIB of angiodysplasia. UGIB due to angiodysplasia was more common in older patients. Transfusion requirement would be less and a tendency of clinical recurrence might be apparent.

  16. SAJS SAJS

    African Journals Online (AJOL)

    2009-07-20

    Jul 20, 2009 ... efficacy of treatment of bleeding oesophageal varices should be based on ... accuracy in the interpretation of data from different studies, specific and .... of upper gastrointestinal bleeding that occurred after the initial bleed.

  17. Effect of splenectomy on liver cirrhosis and related surgical issues

    Directory of Open Access Journals (Sweden)

    KONG Degang

    2016-12-01

    Full Text Available Patients with liver fibrosis and cirrhosis experience certain changes in spleen morphology and function, and there is always a controversy over whether to perform splenectomy in patients with liver cirrhosis. As a surgical treatment of recurrent portal hypertension complicated by esophagogastric variceal bleeding, splenectomy can reduce portal venous pressure, reduce the possibility of gastrointestinal bleeding, and correct the reduced white blood cell count and platelet count. It can also protect the liver by improving liver function, promoting regeneration of hepatocytes, and inhibiting the progression of liver fibrosis. With reference to available clinical and laboratory data, this article reviews the effect of splenectomy on the cirrhotic liver and related issues such as selection of surgical procedures and prevention and treatment of postoperative complications, in order to promote splenectomy in patients with liver cirrhosis.

  18. A splenic artery aneurysm presenting with multiple episodes of upper gastrointestinal bleeding: a case report.

    Science.gov (United States)

    De Silva, W S L; Gamlaksha, D S; Jayasekara, D P; Rajamanthri, S D

    2017-05-03

    Splenic artery aneurysm is rare and its diagnosis is challenging due to the nonspecific nature of the clinical presentation. We report a case of a splenic artery aneurysm in which the patient presented with chronic dyspepsia and multiple episodes of minor intragastric bleeding. A 60-year-old, previously healthy Sri Lankan man presented with four episodes of hematemesis and severe dyspeptic symptoms over a period of 6 months. The results of two initial upper gastrointestinal endoscopies and an abdominal ultrasound scan were unremarkable. A third upper gastrointestinal endoscopy detected a pulsatile bulge at the posterior wall of the gastric antrum. A contrast-enhanced computed tomogram of his abdomen detected a splenic artery aneurysm measuring 3 × 3 × 2.5 cm. While awaiting routine surgery, he developed a torrential upper gastrointestinal bleeding and shock, leading to emergency laparotomy. Splenectomy and en bloc resection of the aneurysm with the posterior stomach wall were performed. Histology revealed evidence for a true aneurysm without overt, acute, or chronic inflammation of the surrounding gastric mucosa. He became completely asymptomatic 2 weeks after the surgery. Splenic artery aneurysms can result in recurrent upper gastrointestinal bleeding. The possibility of impending catastrophic bleeding should be remembered when managing patients with splenic artery aneurysms after a minor bleeding. Negative endoscopy and ultrasonography should require contrast-enhanced computed tomography to look for the cause of recurrent upper gastrointestinal bleeding.

  19. Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy.

    Science.gov (United States)

    Marmo, Riccardo; Del Piano, Mario; Rotondano, Gianluca; Koch, Maurizio; Bianco, Maria Antonia; Zambelli, Alessandro; Di Matteo, Giovanni; Grossi, Enzo; Cipolletta, Livio; Prometeo Investigators

    2012-02-01

    Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). Secondary analysis of prospectively collected data from 3 national databases. Community and teaching hospitals. Consecutive patients admitted for acute nonvariceal UGIB. Early endoscopy, medical and endoscopic treatment as appropriate. Thirty-day mortality, recurrent bleeding, and need for surgery. A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P bleeding peptic ulcers in the clinical context of a high-risk patient. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  20. Case series

    African Journals Online (AJOL)

    ebutamanya

    2015-02-17

    Feb 17, 2015 ... Therefore, the present study has been undertaken to determine ... variceal bleeding is a severe complication occurring in up to 30% of patients ... of large esophageal varices is an upper gastrointestinal endoscopy. It is now ...

  1. Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding – a single center experience

    Science.gov (United States)

    Cahyadi, Oscar; Bauder, Markus; Meier, Benjamin; Caca, Karel; Schmidt, Arthur

    2017-01-01

    Background and study aims  TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. Patients and methods  Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods Results  Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. Conclusions  TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an “add-on” therapy after unsuccessful hemostasis. However, rebleeding was frequent

  2. Assessing the risk of recurrent venous thromboembolism – a practical approach

    Directory of Open Access Journals (Sweden)

    Fahrni J

    2015-08-01

    Full Text Available Jennifer Fahrni,1 Marc Husmann,2 Silvia B Gretener,3 Hong H Keo1 1Division of Angiology, Medical University Clinic, Kantonsspital Aarau AG, Aarau, Switzerland; 2Clinic for Angiology, University Hospital, University of Zurich, Zürich, Switzerland; 3Clinic for Angiology Oberaargau, Langenthal, Switzerland Abstract: Recurrent venous thromboembolism (VTE is associated with increased morbidity and mortality. This risk is lowered by anticoagulation, with a large effect in the initial phase following the venous thromboembolic event, and with a smaller effect in terms of secondary prevention of recurrence when extended anticoagulation is performed. On the other hand, extended anticoagulation is associated with an increased risk of major bleeding and thus leads to morbidity and mortality. Therefore, it is necessary to assess the risk of recurrence for VTE on an individual basis, and a recommendation for secondary prophylaxis should be specifically based on risk calculation of recurrence of VTE and bleeding. In this review, we provide a comprehensive summary of relevant risk factors for recurrent VTE and a practical approach for assessing the risk of recurrence in daily practice. Keywords: thrombosis, hemorrhage, risk assessment 

  3. Aspirin for the prevention of recurrent venous thromboembolism: the INSPIRE collaboration.

    Science.gov (United States)

    Simes, John; Becattini, Cecilia; Agnelli, Giancarlo; Eikelboom, John W; Kirby, Adrienne C; Mister, Rebecca; Prandoni, Paolo; Brighton, Timothy A

    2014-09-23

    In patients with a first unprovoked venous thromboembolism (VTE) the risk of recurrent VTE remains high after anticoagulant treatment is discontinued. The Aspirin for the Prevention of Recurrent Venous Thromboembolism (the Warfarin and Aspirin [WARFASA]) and the Aspirin to Prevent Recurrent Venous Thromboembolism (ASPIRE) trials showed that aspirin reduces this risk, but they were not individually powered to detect treatment effects for particular outcomes or subgroups. An individual patient data analysis of these trials was planned, before their results were known, to assess the effect of aspirin versus placebo on recurrent VTE, major vascular events (recurrent VTE, myocardial infarction, stroke, and cardiovascular disease death) and bleeding, overall and within predefined subgroups. The primary analysis, for VTE, was by intention to treat using time-to-event data. Of 1224 patients, 193 had recurrent VTE over 30.4 months' median follow-up. Aspirin reduced recurrent VTE (7.5%/yr versus 5.1%/yr; hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.51-0.90; P=0.008), including both deep-vein thrombosis (HR, 0.66; 95% CI, 0.47-0.92; P=0.01) and pulmonary embolism (HR, 0.66; 95% CI, 0.41-1.06; P=0.08). Aspirin reduced major vascular events (8.7%/yr versus 5.7%/yr; HR, 0.66; 95% CI, 0.50-0.86; P=0.002). The major bleeding rate was low (0.4%/yr for placebo and 0.5%/yr for aspirin). After adjustment for treatment adherence, recurrent VTE was reduced by 42% (HR, 0.58; 95% CI, 0.40-0.85; P=0.005). Prespecified subgroup analyses indicate similar relative, but larger absolute, risk reductions in men and older patients. Aspirin after anticoagulant treatment reduces the overall risk of recurrence by more than a third in a broad cross-section of patients with a first unprovoked VTE, without significantly increasing the risk of bleeding. www.anzctr.org.au. Unique identifier: ACTRN12611000684921. © 2014 American Heart Association, Inc.

  4. Rare cause of upper gastrointestinal bleeding owing to hepatic cancer invasion: a case report.

    Science.gov (United States)

    Wu, Wei-Ding; Wu, Jia; Yang, Hong-Guo; Chen, Yuan; Zhang, Cheng-Wu; Zhao, Da-Jian; Hu, Zhi-Ming

    2014-09-21

    Upper gastrointestinal bleeding refers to bleeding that arises from the gastrointestinal tract proximal to the ligament of Treitz. The primary reason for gastrointestinal bleeding associated with hepatocellular carcinoma is rupture of a varicose vein owing to pericardial hypotension. We report a rare case of gastrointestinal bleeding with hepatocellular carcinoma in a patient who presented with recurrent gastrointestinal bleeding. The initial diagnosis was gastric cancer with metastasis to the multiple lymph nodes of the lesser curvature. The patient underwent exploratory laparotomy, which identified two lesions in the gastric wall. Total gastrectomy and hepatic local excision was then performed. Pathological results indicated that the hepatocellular carcinoma had invaded the stomach directly, which was confirmed immunohistochemically. The patient is alive with a disease-free survival of 1 year since the surgery. Hepatocellular carcinoma with gastric invasion should be considered as a rare cause of upper gastrointestinal bleeding in hepatocellular carcinoma patients, especially with lesions located in the left lateral hepatic lobe. Surgery is the best solution.

  5. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery.

    Science.gov (United States)

    Greco, Marco Giuseppe; Mattioli, Francesco; Alberici, Maria Paola; Presutti, Livio

    2016-01-01

    A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator's experience and radiological support (cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses.

  6. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery

    Directory of Open Access Journals (Sweden)

    Marco Giuseppe Greco

    2016-01-01

    Full Text Available A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator’s experience and radiological support (cranial angiography allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses.

  7. Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Huei-Lung, E-mail: hlliang@vghks.gov.tw [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China); Chiang, Chia-Ling [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); Chen, Matt Chiung-Yu [Department of Radiology, Yuan' s General Hospital, Kaohsiung. Taiwan (China); Lin, Yih-Huie; Huang, Jer-Shyung; Pan, Huay-Ben [Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (China); National Yang-Ming University, Taipei, Taiwan (China)

    2014-10-15

    Purpose: To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB). Materials and methods: Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3–5 units/h) for 3 h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported. Results: Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%. Conclusions: Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.

  8. Long-term effects of interventional devascularization in treating cirrhosis patients with portal hypertension

    International Nuclear Information System (INIS)

    Hu Yubin; Feng Gansheng; Liang Huimin; Zhou Guofeng; Xia Xiangwen; Zheng Chuansheng; Xiong Bin

    2009-01-01

    Objective: To analyze long-term cumulative survival and re-bleeding rate of cirrhosis patients with portal hypertension after interventional devascularization and to evaluate long-term efficacy and importance of interventional devascularization. Methods: Sixty-one cirrhosis patients with portal hypertension were retrospectively studied after interventional devascularization. The number of patients in Child A, B and C was respectively 25, 25 and 11, while that of mild, moderate and severe gastro- esophageal varices was 10, 31 and 20 respectively. Forty-seven patients had gastrointestinal bleeding history. Kaplan-Meier was used to analyze the long-term survival and re-bleeding rates, Log rank test was applied to measure differences in survival among the patients with different degree of hepatic function or gastro-esophageal varices, and Cox regression was used for multivariate analysis of survival, which had statistical significance with P 2 =14.1993, P=0.0002) and Child B patients (χ 2 =9.7887, P=0.0022), but there was no significant difference between the latter two groups (χ 2 =0.8664, P=0.352). The cumulative survival at 1-, 3-, 5-, 8-year for mild gastro-esophageal varices patients was 100.0%, 100.0%, 100.0%, 80.0%, and for moderate varices patients was 93.2%, 78.5%, 61.0%, 27.2%, while at 1-, 3-, 5-year for severe varices patients was 95.0%, 67.1%, 53.8%, respectively. The cumulative survival rate of patients with mild gastro-esophageal varices were significantly higher than those of patients with moderate (χ 2 =4.5425, P=0.033) and severe gastro-esophageal varices (χ 2 =5.448, P=0.0196), but there was no significant difference between the latter two groups (χ 2 = 0.3772, P=0.5391). Cox analysis of preoperative risk factors found Child MELD scores≥12(OR=5.119, P=0.0029), gastro-esophageal varices (OR=3.291, P=0.0391) and the last bleeding volume > 800 ml (OR=11.024, P=0.0003) before therapy were independent predictors of poor long-term survival

  9. Regression of esophageal varices and splenomegaly in two patients with hepatitis-C-related liver cirrhosis after interferon and ribavirin combination therapy

    Directory of Open Access Journals (Sweden)

    Soon Jae Lee

    2016-09-01

    Full Text Available Some recent studies have found regression of liver cirrhosis after antiviral therapy in patients with hepatitis C virus (HCV-related liver cirrhosis, but there have been no reports of complete regression of esophageal varices after interferon/peg-interferon and ribavirin combination therapy. We describe two cases of complete regression of esophageal varices and splenomegaly after interferon-alpha and ribavirin combination therapy in patients with HCV-related liver cirrhosis. Esophageal varices and splenomegaly regressed after 3 and 8 years of sustained virologic responses in cases 1 and 2, respectively. To our knowledge, this is the first study demonstrating that complications of liver cirrhosis, such as esophageal varices and splenomegaly, can regress after antiviral therapy in patients with HCV-related liver cirrhosis.

  10. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  11. Epidemiology and Endoscopic Findings of the Patients Suffering from Upper Gastrointestinal System Bleeding

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    Mehmet Suat Yalçın

    2016-03-01

    Full Text Available Objective: In the present study, we aim to investigate general and endoscopic findings of the patients who were hospitalized in our clinic because of upper gastrointestinal system bleeding (UGSB. Methods: The files of 403 patients who applied to our clinic between January 2014 and December 2014 with UGSB diagnosis were scanned retrospectively. The de­mographic, laboratorial and endoscopic findings of the patients were examined. Results: The average age of 403 patients were 61.12±17.1 (min. 17- max. 96 and while 263 of these patients were male (65.3(%, 140 of them were female (34.7%. Of all, 234 patients had an additional disease. The most fre­quently observed diseases were hypertension, diabetes mellitus and coronary artery. 259 (64.3% of the patients used to take at least one drug and 212 (52.6% of the patients used to get non-steroid anti-inflammatory drugs and/or aspirin. The most common reasons of UGSB were duodenal ulcer in 158 patients (39.2%, stomach ulcer in 97 patients (24%, erosive gastroduodenitis in 66 patients (16.3% and esophageal varices in 38 patients (9.4%. Unfortunately, 18 of the patients died. Conclusion: The most common reason of UGSB is duo­denal ulcer bleeding. In spite of the technological devel­opment nowadays, it is a disease which has mortality.

  12. Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

    Science.gov (United States)

    Kim, Seung Young; Hyun, Jong Jin; Suh, Sang Jun; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Park, Jong Jae; Chun, Hoon Jai; Lee, Sang Woo

    2016-04-01

    To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke. Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups. Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.

  13. [Retrospective statistical analysis of clinical factors of recurrence in chronic subdural hematoma: correlation between univariate and multivariate analysis].

    Science.gov (United States)

    Takayama, Motoharu; Terui, Keita; Oiwa, Yoshitsugu

    2012-10-01

    Chronic subdural hematoma is common in elderly individuals and surgical procedures are simple. The recurrence rate of chronic subdural hematoma, however, varies from 9.2 to 26.5% after surgery. The authors studied factors of the recurrence using univariate and multivariate analyses in patients with chronic subdural hematoma We retrospectively reviewed 239 consecutive cases of chronic subdural hematoma who received burr-hole surgery with irrigation and closed-system drainage. We analyzed the relationships between recurrence of chronic subdural hematoma and factors such as sex, age, laterality, bleeding tendency, other complicated diseases, density on CT, volume of the hematoma, residual air in the hematoma cavity, use of artificial cerebrospinal fluid. Twenty-one patients (8.8%) experienced a recurrence of chronic subdural hematoma. Multiple logistic regression found that the recurrence rate was higher in patients with a large volume of the residual air, and was lower in patients using artificial cerebrospinal fluid. No statistical differences were found in bleeding tendency. Techniques to reduce the air in the hematoma cavity are important for good outcome in surgery of chronic subdural hematoma. Also, the use of artificial cerebrospinal fluid reduces recurrence of chronic subdural hematoma. The surgical procedures can be the same for patients with bleeding tendencies.

  14. von Willebrand factor as a novel noninvasive predictor of portal hypertension and esophageal varices in hepatitis B patients with cirrhosis.

    Science.gov (United States)

    Wu, Hao; Yan, Shiping; Wang, Guangchuan; Cui, Shaobo; Zhang, Chunqing; Zhu, Qiang

    2015-01-01

    At present, there is no perfect noninvasive method to assess portal hypertension and esophageal varices. Early predicting esophageal varices can provide evidence for managing cirrhotic patients. We aimed to further investigate von Willebrand factor (vWF) as a noninvasive predictor of portal hypertension, especially of esophageal varices. A total of 60 hepatitis B patients with cirrhosis and 45 healthy subjects were enrolled in this study. Levels of six markers were examined. All patients underwent hepatic venous pressure gradient (HVPG) and esophagogastroduodenoscopy. We evaluated the performance of six factors for diagnosis of portal hypertension and esophageal varices. The vWF levels in liver tissues were observed by immunohistochemistry. Correlations between the level of vWF in liver tissues and HVPG and between levels of vWF in tissues and plasma were examined. Cutoff values of plasma vWF (1510.5 mU/mL and 1701 mU/mL) showed high positive predictive value (PPV, 90.2% and 87.5%) in predicting clinically significant portal hypertension and severe portal hypertension. Cutoff values of vWF (1414 mU/ml and 1990 mU/mL, PPV 90.3% and 86.3%, respectively) were provided to detect the presence and degree of esophageal varices. Linear correlations were observed between levels of vWF in liver tissues and HVPG (r(2) = 0.552, p portal hypertension and esophageal varices in hepatitis B patients with cirrhosis. Increased levels of vWF in liver tissues may induce the elevated plasma vWF levels, but molecular mechanism is needed for further study.

  15. Prognostic indicators in alcoholic cirrhotic men

    DEFF Research Database (Denmark)

    Gluud, C; Henriksen, Jens Henrik Sahl; Nielsen, G

    1988-01-01

    as wedged minus free hepatic vein pressure, and median pressure was 14 mm Hg (range = 3 to 26 mm Hg). Fourteen of 31 patients (45%) had esophageal varices at upper gastrointestinal endoscopy (the size being considered large in nine patients). During follow-up (median = 31 months; range = 2 to 51 months), 12...... patients (21%) developed variceal hemorrhage. Applying Cox's regression analysis, information about previous variceal bleeding (p = 0.0046), large varices at endoscopy (p = 0.012), hepatic vein pressure gradient (p = 0.0056) and indocyanine green clearance (p = 0.038) all contained significant prognostic...

  16. Emergency TIPS in a Child-Pugh B patient

    DEFF Research Database (Denmark)

    Trebicka, Jonel

    2017-01-01

    Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis such as variceal bleeding and refractory ascites, but it also bears the risk of liver failure, overt hepatic encephalopathy (HE) and cardiac decompensation. Variceal bleeding may be controlled using...... translocation. Both these processes mediate an impaired immunological and hemodynamic response, thereby facilitating the development of acute-on-chronic liver failure (ACLF) and/or death. Similarly, in patients with refractory ascites, TIPS should be used early in treatment to prevent acute kidney injury (AKI...

  17. Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients.

    Science.gov (United States)

    Gurvits, Grigoriy E; Fradkov, Elena

    2017-06-14

    Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vitamin K antagonist therapy, activation of fibrinolytic pathway, acquired von Willebrand factor deficiency, and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump. Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions, extended hospital stays, multiple readmissions, and overall mortality. Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients, addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion. Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.

  18. Hypoalbuminemia is a predictor of mortality and rebleeding in peptic ulcer bleeding under proton pump inhibitor use.

    Science.gov (United States)

    Cheng, Hsiu-Chi; Yang, Er-Hsiang; Wu, Chung-Tai; Wang, Wen-Lun; Chen, Po-Jun; Lin, Meng-Ying; Sheu, Bor-Shyang

    2018-04-01

    Peptic ulcer bleeding remains a deadly disease, and a simple indicator of long-term outcomes is crucial. This study validated whether hypoalbuminemia and its related factors in patients with peptic ulcer bleeding can indicate long-term mortality and rebleeding under proton pump inhibitor use. The prospective cohort study enrolled 426 patients with peptic ulcer bleeding who had high risk stigmata at endoscopy and had received endoscopic hemostasis. They were divided into 79 patients in the hypoalbuminemia group (Hypo-AG, serum albumin ulcer size ≥1.0 cm independently (p peptic ulcer bleeding can be an alarm indicator of all-cause mortality and recurrent bleeding in a long-term follow-up situation under proton pump inhibitor use (NCT01591083). Copyright © 2017. Published by Elsevier B.V.

  19. Gastrointestinal bleeding

    Science.gov (United States)

    ... Sigmoidoscopy Alternative Names Lower GI bleeding; GI bleeding; Upper GI bleeding; Hematochezia Images GI bleeding - series Fecal occult blood test References Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman- ...

  20. Transjugular intrahepatic portosystemic shunt: results and prognostic factors in patients with post-necrotic liver cirrhosis

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Han, Man Chung; Kim, Yong Joo

    1997-01-01

    To evaluate the effectiveness of transjugular intrahepatic portosystemic shunt(TIPS) in the management of gastroesophageal variceal bleeding and predictive factors for long-term survival in patients with post-necrotic liver cirrhosis. A total of 49 patients with post-necrotic liver cirrhosis underwent TIPS over a recent three-year period. Forty-five had a history of hepatitis B viral infection, and four, of hepatitis C viral infection. In all patients, the indication for the procedure was variceal bleeding. Child-Pugh class was A in seven patients, B in 16 and C in 26 patients at the time of the last bleeding. The effectiveness of portal decompression and bleeding control was evaluated. Long-term survival was calculated by the Kaplan-Meier method and predictive factors were analyzed using the Wilcoxon test. The procedure was technically successful in all cases. The portosystemic pressure gradient decreased significantly from 21.4 ± 6.4 mmHg to 12.0 ± 5.1 mmHg(N=45). Active variceal bleeding was controlled in 34 of the 37 emergency patients. The total length of follow-up was from one day to three and a half years(mean : 383 ± 357 days). Rebleeding developed in 17 patients (35%). Hepatic encephalopathy, either newly developed or aggravated, occurred in 16 (32.7%). The thirty-day mortality rate was 20.4%, and the one-year survival rate was 63.8%. The significant predictive factors for poor prognosis were Child-Pugh class C and post-TIPS hepatic encephalopathy. TIPS is effective in portal decompression in the patients with variceal bleeding due to post-necrotic liver cirrhosis. The Child-Pugh classification and hepatic encephalopathy after TIPS are considered to be significant predictive factors for long-term survival

  1. Transjugular intrahepatic portosystemic shunt: results and prognostic factors in patients with post-necrotic liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Joo [Kyungbook National University College of Medicine, Taegu (Korea, Republic of)

    1997-01-01

    To evaluate the effectiveness of transjugular intrahepatic portosystemic shunt(TIPS) in the management of gastroesophageal variceal bleeding and predictive factors for long-term survival in patients with post-necrotic liver cirrhosis. A total of 49 patients with post-necrotic liver cirrhosis underwent TIPS over a recent three-year period. Forty-five had a history of hepatitis B viral infection, and four, of hepatitis C viral infection. In all patients, the indication for the procedure was variceal bleeding. Child-Pugh class was A in seven patients, B in 16 and C in 26 patients at the time of the last bleeding. The effectiveness of portal decompression and bleeding control was evaluated. Long-term survival was calculated by the Kaplan-Meier method and predictive factors were analyzed using the Wilcoxon test. The procedure was technically successful in all cases. The portosystemic pressure gradient decreased significantly from 21.4 {+-} 6.4 mmHg to 12.0 {+-} 5.1 mmHg(N=45). Active variceal bleeding was controlled in 34 of the 37 emergency patients. The total length of follow-up was from one day to three and a half years(mean : 383 {+-} 357 days). Rebleeding developed in 17 patients (35%). Hepatic encephalopathy, either newly developed or aggravated, occurred in 16 (32.7%). The thirty-day mortality rate was 20.4%, and the one-year survival rate was 63.8%. The significant predictive factors for poor prognosis were Child-Pugh class C and post-TIPS hepatic encephalopathy. TIPS is effective in portal decompression in the patients with variceal bleeding due to post-necrotic liver cirrhosis. The Child-Pugh classification and hepatic encephalopathy after TIPS are considered to be significant predictive factors for long-term survival.

  2. Clinical usefulness of Tc-99M pertechnetate per-rectal portal scintigraphy in evaluation the severity of portal hypertension in cirrhotic patients

    International Nuclear Information System (INIS)

    Namwongprom, S.; Ekmahachai, M.; Boonyaprapa, S.; Vilasdechanon, N.; Taya, P.; Chankaew, N.; Chitapanarux, T.

    2004-01-01

    Objectives: Variceal hemorrhage is a potentially life-threatening complication in cirrhotic patients. Identification of patients at high risk for bleeding is particularly important. The aim of this study was to determine the clinical usefulness of per-rectal portal scintigraphy in evaluation the severity of portal hypertension in cirrhotic patients in terms of correlation between cirrhosis and classic indicators of hepatic functional reserve and identifying the difference of the portal shunt index (PSI) of the bleeding esophageal varices group and non-bleeding esophageal varices group. Material and methods: Portal circulations in 15 healthy volunteer's and in 67 patients with cirrhosis were evaluated by Tc-99m pertechnetate per-rectal p. ortal scintigraphy. Tc-99m pertechnetate (550 MBq) was instilled into the upper rectum, and dynamic images were taken. Radioactivity curves of the liver and the heart were generated sequentially. Through the analysis of these curves, the PSI was determined by calculating the ratio of counts of the liver to counts of the heart integrated for 24 seconds immediately after the appearance of the liver time-activity curve. Results: The results, expressed as PSI were: 13.63 +/- 6.28 % in healthy subjects and 66.32+/-22.80 % in cirrhotic patients. Of these, the PSIs were 56036 +/- 27.14 % in 31 cirrhotic patients without esophageal varices, and 74.89 +/- 13.62 % in 36 cirrhotic patients with esophageal varices. The PSI was significantly lower in cirrhotic patients without bleeding esophageal vances (BEV) than those with BEV (p=0.001). The PSI calculated with this method was correlated with the serum albumin, the serum bilirubin and the Child-Pugh's score. Conclusion: The Tc-99m pertechnetate per-rectal portal scintigraphy has clinical usefulness as a relatively non-invasive method of choice for quantitative evaluating the severity of portal hypertension in cirrhotic patients. (authors)

  3. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  4. Transcatheter Arterial Embolization of Arterial Esophageal Bleeding with the Use of N-Butyl Cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Hoon; Kim, Hyo Cheol; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospita, Seoul (Korea, Republic of)

    2009-08-15

    To evaluate the clinical efficacy and safety of a transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding. Between August 2000 and April 2008, five patients diagnosed with arterial esophageal bleeding by conventional angiography, CT angiography or endoscopy, underwent a TAE with NBCA. We mixed NBCA with iodized oil at ratios of 1:1 to 1:4 to supply radiopacity and achieve a proper polymerization time. After embolization, we evaluated the angiographic and clinical success, recurrent bleeding, and procedure-related complications. The bleeding esophageal artery directly originated from the aorta in four patients and from the left inferior phrenic artery in one patient. Although four patients had an underlying coagulopathy at the time of the TAE, angiographic and clinical success was achieved in all five patients. In addition, no procedurerelated complications such as esophageal infarction were observed during this study. NBCA can be an effective and feasible embolic agent in patients with active arterial esophageal bleeding, even with pre-existing coagulopathy.

  5. Transcatheter Arterial Embolization of Arterial Esophageal Bleeding with the Use of N-Butyl Cyanoacrylate

    International Nuclear Information System (INIS)

    Park, Ji Hoon; Kim, Hyo Cheol; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung

    2009-01-01

    To evaluate the clinical efficacy and safety of a transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding. Between August 2000 and April 2008, five patients diagnosed with arterial esophageal bleeding by conventional angiography, CT angiography or endoscopy, underwent a TAE with NBCA. We mixed NBCA with iodized oil at ratios of 1:1 to 1:4 to supply radiopacity and achieve a proper polymerization time. After embolization, we evaluated the angiographic and clinical success, recurrent bleeding, and procedure-related complications. The bleeding esophageal artery directly originated from the aorta in four patients and from the left inferior phrenic artery in one patient. Although four patients had an underlying coagulopathy at the time of the TAE, angiographic and clinical success was achieved in all five patients. In addition, no procedurerelated complications such as esophageal infarction were observed during this study. NBCA can be an effective and feasible embolic agent in patients with active arterial esophageal bleeding, even with pre-existing coagulopathy

  6. Evaluation and management of abnormal uterine bleeding in premenopausal women.

    Science.gov (United States)

    Sweet, Mary Gayle; Schmidt-Dalton, Tarin A; Weiss, Patrice M; Madsen, Keith P

    2012-01-01

    Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. Chronic anovulation can lead to irregular bleeding, prolonged unopposed estrogen stimulation of the endometrium, and increased risk of endometrial cancer. Causes include polycystic ovary syndrome, uncontrolled diabetes mellitus, thyroid dysfunction, hyperprolactinemia, and use of antipsychotics or antiepileptics. Women 35 years or older with recurrent anovulation, women younger than 35 years with risk factors for endometrial cancer, and women with excessive bleeding unresponsive to medical therapy should undergo endometrial biopsy. Treatment with combination oral contraceptives or progestins may regulate menstrual cycles. Histologic findings of hyperplasia without atypia may be treated with cyclic or continuous progestin. Women who have hyperplasia with atypia or adenocarcinoma should be referred to a gynecologist or gynecologic oncologist, respectively. Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia. The levonorgestrel-releasing intrauterine system is an effective treatment for menorrhagia. Oral progesterone for 21 days per month and nonsteroidal anti-inflammatory drugs are also effective. Tranexamic acid is approved by the U.S. Food and Drug Administration for the treatment of ovulatory bleeding, but is expensive. When clear structural causes are identified or medical management is ineffective, polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation may be considered. Hysterectomy is the most definitive treatment.

  7. Transcatheter arterial embolization for upper gastrointestinal tract bleeding.

    Science.gov (United States)

    Širvinskas, Audrius; Smolskas, Edgaras; Mikelis, Kipras; Brimienė, Vilma; Brimas, Gintautas

    2017-12-01

    Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

  8. [Validation of the Glasgow-Blatchford Scoring System to predict mortality in patients with upper gastrointestinal bleeding in a hospital of Lima, Peru (June 2012-December 2013)].

    Science.gov (United States)

    Cassana, Alessandra; Scialom, Silvia; Segura, Eddy R; Chacaltana, Alfonso

    2015-07-01

    Upper gastrointestinal bleeding is a major cause of hospitalization and the most prevalent emergency worldwide, with a mortality rate of up to 14%. In Peru, there have not been any studies on the use of the Glasgow-Blatchford Scoring System to predict mortality in upper gastrointestinal bleeding. The aim of this study is to perform an external validation of the Glasgow-Blatchford Scoring System and to establish the best cutoff for predicting mortality in upper gastrointestinal bleeding in a hospital of Lima, Peru. This was a longitudinal, retrospective, analytical validation study, with data from patients with a clinical and endoscopic diagnosis of upper gastrointestinal bleeding treated at the Gastrointestinal Hemorrhage Unit of the Hospital Nacional Edgardo Rebagliati Martins between June 2012 and December 2013. We calculated the area under the curve for the receiver operating characteristic of the Glasgow-Blatchford Scoring System to predict mortality with a 95% confidence interval. A total of 339 records were analyzed. 57.5% were male and the mean age (standard deviation) was 67.0 (15.7) years. The median of the Glasgow-Blatchford Scoring System obtained in the population was 12. The ROC analysis for death gave an area under the curve of 0.59 (95% CI 0.5-0.7). Stratifying by type of upper gastrointestinal bleeding resulted in an area under the curve of 0.66 (95% CI 0.53-0.78) for non-variceal type. In this population, the Glasgow-Blatchford Scoring System has no diagnostic validity for predicting mortality.

  9. Validation of the Glasgow-Blatchford Scoring System to predict mortality in patients with upper gastrointestinal bleeding in a hospital of Lima, Peru (June 2012-December 2013

    Directory of Open Access Journals (Sweden)

    Alessandra Cassana

    2015-08-01

    Full Text Available Background and aim: Upper gastrointestinal bleeding is a major cause of hospitalization and the most prevalent emergency worldwide, with a mortality rate of up to 14%. In Peru, there have not been any studies on the use of the Glasgow-Blatchford Scoring System to predict mortality in upper gastrointestinal bleeding. The aim of this study is to perform an external validation of the Glasgow-Blatchford Scoring System and to establish the best cutoff for predicting mortality in upper gastrointestinal bleeding in a hospital of Lima, Peru. Methods: This was a longitudinal, retrospective, analytical validation study, with data from patients with a clinical and endoscopic diagnosis of upper gastrointestinal bleeding treated at the Gastrointestinal Hemorrhage Unit of the Hospital Nacional Edgardo Rebagliati Martins between June 2012 and December 2013. We calculated the area under the curve for the receiver operating characteristic of the Glasgow-Blatchford Scoring System to predict mortality with a 95% confidence interval. Results: A total of 339 records were analyzed. 57.5% were male and the mean age (standard deviation was 67.0 (15.7 years. The median of the Glasgow-Blatchford Scoring System obtained in the population was 12. The ROC analysis for death gave an area under the curve of 0.59 (95% CI 0.5-0.7. Stratifying by type of upper gastrointestinal bleeding resulted in an area under the curve of 0.66 (95% CI 0.53-0.78 for non-variceal type. Conclusions: In this population, the Glasgow-Blatchford Scoring System has no diagnostic validity for predicting mortality.

  10. A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the "GRAPHE" registry).

    Science.gov (United States)

    Haddara, Sami; Jacques, Jeremie; Lecleire, Stéphane; Branche, Julien; Leblanc, Sarah; Le Baleur, Yann; Privat, Jocelyn; Heyries, Laurent; Bichard, Philippe; Granval, Philippe; Chaput, Ulriikka; Koch, Stephane; Levy, Jonathan; Godart, Bruno; Charachon, Antoine; Bourgaux, Jean-François; Metivier-Cesbron, Elodie; Chabrun, Edouard; Quentin, Vincent; Perrot, Bastien; Vanbiervliet, Geoffroy; Coron, Emmanuel

    2016-12-01

    Background and study aims: The hemostatic powder TC-325 (Hemospray; Cook Medical, Winston-Salem, North Carolina, USA) has shown promising results in the treatment of upper gastrointestinal bleeding (UGIB) in expert centers in pilot studies. The aim of this study was to evaluate the feasibility and efficacy of TC-325 in a large prospective registry of use in routine practice. Patients and methods: The data of all patients treated with TC-325 were prospectively collected through a national registry. Outcomes were the immediate feasibility and efficacy of TC-325 application, as well as the rates of rebleeding at Day 8 and Day 30. Multivariate analysis was performed to determine predictive factors of rebleeding. Results: A total of 202 patients were enrolled and 64 endoscopists participated from 20 centers. TC-325 was used as salvage therapy in 108 patients (53.5 %). The etiology of bleeding was an ulcer in 75 patients (37.1 %), tumor in 61 (30.2 %), postendoscopic therapy in 35 (17.3 %), or other in 31 (15.3 %). Application of the hemostatic powder was found to be very easy or easy in 31.7 % and 55.4 %, respectively. The immediate efficacy rate was 96.5 %. Recurrence of UGIB was noted at Day 8 and Day 30 in 26.7 % and 33.5 %, respectively. Predictive factors of recurrence at Day 8 were melena at initial presentation and use of TC-325 as salvage therapy. Conclusion: These multicenter data confirmed the high rate of immediate hemostasis, excellent feasibility, and good safety profile of TC-325, which could become the treatment of choice in bleeding tumors or postendoscopic bleeding but not in bleeding ulcers where randomized studies are needed. ClinicalTrials.gov (NCT02595853). © Georg Thieme Verlag KG Stuttgart · New York.

  11. Predictive Risk Factors for Upper Gastrointestinal Bleeding with Simultaneous Myocardial Injury

    Directory of Open Access Journals (Sweden)

    I-Chen Wu

    2007-01-01

    Full Text Available The aims of this study were to: (1 evaluate the epidemiology of simultaneous upper gastrointestinal bleeding (UGIB and myocardial injury using parameters including troponin I (TnI; and (2 investigate the predictive risk factors of this syndrome. One hundred and fifty-five patients (101 men, 54 women; mean age, 64.7 ± 10.4 years; range, 38–94 years at the emergency department (ED with the major diagnosis of UGIB were included. They underwent serial electrocardiography (ECG and cardiac enzyme follow-up. Emergent gastroendoscopy was performed within 24 hours in most patients except for those who refused or were contraindicated. Mild myocardial injury was defined as the presence of any of the following: typical ST-T change on ECG, elevated creatine kinase-MB (CK-MB > 12U/L, or TnI > 0.2ng/dL. Moderate myocardial injury was defined as the presence of any two of the previously mentioned conditions. In total, 51 (32.9% and 12 (7.74% patients developed mild and moderate myocardial injuries, respectively. Myocardial injury was more common among patients with variceal bleeding (20/25 = 80.0% than those with ulcer bleeding (23/112 = 20.5%. It could partially be attributed to a higher baseline TnI level in cirrhotic patients. After adjusting for significant risk factors revealed by the univariate analysis, UGIB patients with a history of liver cirrhosis and more than three cardiac risk factors comprised a high-risk group for simultaneously developing myocardial injury. Other factors including age, gender, the color of nasogastric tube irrigation fluid, history of nonsteroidal anti-inflammatory drug use, vasopressin or terlipressin administration, vital signs, and creatinine recorded at the ED were not significant predictors. Those who developed myocardial injury had a longer hospital stay (mean duration, 8.73 ± 6.94 vs. 6.34 ± 2.66 days; p = 0.03 and required transfusion of more units of packed erythrocytes.

  12. Long-term efficacy of Nd:YAG laser photocoagulation vs. liquid paraffin plus antiseptic cream in the treatment of recurrent epistaxis.

    Science.gov (United States)

    Zhang, Jing; Qiu, Rongxing; Wei, Chunsheng

    2015-12-01

    The objective of this study was to evaluate the long-term efficacy of Nd:YAG laser photocoagulation with that of liquid paraffin plus antiseptic cream in the management of recurrent epistaxis. Eighty consecutive patients who suffered from recurrent anterior epistaxis presented to the Otolaryngology Department at the Eye and ENT Hospital, Fudan University between February 2011 and June 2011. These patients with histories of recurrent epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either a combination of liquid paraffin plus antiseptic cream (Group 1) or Nd:YAG laser photocoagulation (Group 2). the following outcome measures were assessed: bleeding intensity; bleeding frequency 2 years after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, 3 = worse), participant's perception of discomfort during the management (grade 0-10, where 10 is the worst pain), and complications. Finally, 70 patients remain in our study. At 2 years, 86 % of laser patients versus 31 % of control patients had no reported bleeding. The outcome score at 2 years after treatment showed a significant difference between the two groups (P = 0.000, P < 0.01). The median and mean ± SD pain levels experienced were 5.0 and 5.2 ± 2.2. Both groups had no complications. It can be further concluded that Nd:YAG laser photocoagulation is a preferable therapy in the treatment of recurrent epistaxis in long-term efficacy. The level of pain associated with the procedure was well tolerated. It is a simple, easy, safe and rapid therapy, which can be performed in an office setting.

  13. Octreotide-induced thrombocytopenia: a case report

    Directory of Open Access Journals (Sweden)

    Rizvi Nahid

    2011-07-01

    Full Text Available Abstract Introduction Thrombocytopenia is an extremely rare complication of octreotide therapy and can be life threatening in the setting of esophageal variceal bleeding. We report a case of octreotide-induced reversible thrombocytopenia in a 54-year-old Caucasian man with alcohol-induced cirrhosis and upper gastrointestinal bleeding. Case presentation Our patient's platelet count dropped from 155,000/mm3 upon admission to 77,000/mm3 a few hours after initiation of octreotide therapy and stayed low until the drug's administration was discontinued. Significant recovery was achieved quickly after discontinuation of octreotide. Conclusions Thrombocytopenia is a rare but potentially serious side effect of octreotide therapy and may complicate esophageal variceal bleeding. Physicians should be vigilant in identifying this potentially serious condition.

  14. Vaginal Bleeding

    Science.gov (United States)

    ... or period, is a woman's monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It ... therapy) Cancer of the cervix, ovaries, uterus or vagina Thyroid problems Bleeding during pregnancy can have several ...

  15. Active iris vascular tufts bleeding successfully treated with argon laser photocoagulation.

    Science.gov (United States)

    Sarmad, Ambreen; Alfaqawi, Fadi; Chakrabarti, Monali; Mitra, Arijit; Mushtaq, Bushra

    2018-03-01

    Iris vascular tufts (IVT) are rare biomicroscopic capillary outgrowths from the pupillary margins. Patients are usually asymptomatic until presenting with blurred vision due to spontaneous hyphema or with raised intraocular pressure. A 61-year-old woman presented to eye casualty with left eye (LE) blurred vision and discomfort for 1 day. Her external ocular examination was unremarkable and visual acuity was 6/6 in the right eye (RE) and 6/9 in the LE. Biomicroscopic examination revealed a 2-mm hyphema in her LE and bilateral multiple small IVT and active bleeding from IVT at the pupillary margin of the LE at the 5 o'clock position. Diagnosis of LE active bleeding from IVT was made and she underwent argon laser photocoagulation directed at the source of bleeding. The bleeding stopped immediately after the second burn. She was followed up for 3 months; her visual acuity was 6/5 and 6/6 in the RE and LE, respectively, with no further problems. Iris vascular tufts are benign and recurrent hemorrhages are unlikely. Therefore, definitive argon laser photocoagulation or surgical treatment are reserved to arrest further episodes of hyphema. Our case demonstrates the effective use of argon laser photocoagulation to completely arrest active bleeding from IVT and excellent recovery of hyphema with no further problems for 5 years.

  16. Varic acid analogues from fungus as PTP1B inhibitors: Biological evaluation and structure-activity relationships.

    Science.gov (United States)

    Sun, Wenlong; Zhuang, Chunlin; Li, Xia; Zhang, Bowei; Lu, Xinhua; Zheng, Zhihui; Dong, Yuesheng

    2017-08-01

    Protein tyrosine phosphatase 1B (PTP1B) inhibitors as potential therapies for diabetes and obesity have attracted much attention in recent years. Six varic acid analogues were isolated from two strains of fungi and evaluated for PTP1B inhibition activities. The structure-activity relationships were also characterized and predicted by molecular modeling. Further kinetic studies indicated the reversible and competitive inhibition manner of varic acid analogues. Trivaric acid showed insulin-sensitizing effect not only in vitro but also in vivo, representing a promising lead compound for further optimization. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. www. ...

  18. A fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: a retrospective review of 240 cases.

    Science.gov (United States)

    Jaka, Hyasinta; Koy, Mheta; Liwa, Anthony; Kabangila, Rodrick; Mirambo, Mariam; Scheppach, Wolfgang; Mkongo, Eliasa; McHembe, Mabula D; Chalya, Phillipo L

    2012-07-03

    Upper gastrointestinal (GI) bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world. A total of 240 patients representing 18.7% of all patients (i.e. 1292) who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0%) were aged 40 years and below. The vast majority of the patients (80.4%) presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2%) patients. Nine (3.8%) patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3%) followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8%) were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3%) patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P bleeding, shock, hepatic decompensation, HIV infection, comorbidities, malignancy, age > 60 years and in patients with

  19. Combination of TIPSS and azygoportal disconnection for portal hypertension

    International Nuclear Information System (INIS)

    Cao Jianmin; Wu Xingjiang; Han Jianming; Wu Xuehao; Li Jieshou

    2002-01-01

    Objective: To investigate the clinical results of combined TIPSS and azygoportal disconnection for portal hypertension in controlling and preventing esophageal variceal bleeding. Methods: From Oct. 1996 to Dec. 2001, 60 patients with portal hypertension were admitted to authors' department because of variceal bleeding and submitted to the treatment with the combination TIPSS and azygoportal disconnection. According to Child-Pugh classification, 11 patients were in class A, 37 in class B, and 12 in class C. 41 patients showed mild ascites and 8 with severe ascites. The mild and severe esophageal varices were proven by upper digestive barium meal. The procedure was divided into two stages; first, TIPSS procedure with the stent of diameter 0.8 cm and length 6-7 cm was successfully in planted in all patients, second, all patients underwent azygoportal disconnection two weeks later after TIPSS. Results: After the combination TIPSS and azygoportal disconnection, the recent complications included three cases with bleeding at operative fields, one case with infradiaphragmatic abscess and seven with slight encephalopathy. No rebleeding of esophageal varices and death occurred during the treatment. During the follow-up of 1-5 years, the rates of shunt occlusion, rebleeding and death were 11.9%, 3.5% and 7.0% respectively. Conclusions: The combination TIPSS and azygoportal disconnection is an efficient therapeutic methods for portal hypertension

  20. Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN: analysis from the German SAL-MPN-registry

    Directory of Open Access Journals (Sweden)

    A. Kaifie

    2016-03-01

    Full Text Available Abstract Background Patients with Ph-negative myeloproliferative neoplasms (MPN, such as polycythemia vera (PV, essential thrombocythemia (ET, and primary myelofibrosis (PMF, are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN. Methods The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008. For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events. Results MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length. While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95 % CI = 1.39–8.48 and splenomegaly (OR 1.76; 95 % CI = 1.15–2.71. Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95 % CI = 1.36–5.40, splenomegaly (OR = 2.22; 95 % CI 1.01–4.89, and the administration of heparin (OR = 5.64; 95 % CI = 1.84–17.34. Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups

  1. Approach to upper gastrointestinal bleeding

    African Journals Online (AJOL)

    Upper gastrointestinal haemorrhage has a variety of causes (Table 1) and is the commonest complication of peptic ulceration and portal hypertension. Peptic ulceration in the duo- denum or stomach and oesophageal varices are the conditions most often responsible for patients who have the potential to present.

  2. Black Bleeds and the Sites of a Trauma in GB Tran’s Vietnamerica

    Directory of Open Access Journals (Sweden)

    Jin Lee

    2017-09-01

    Full Text Available ‘The gutter’ is the space between panels where panel transitions happen—readers fill in the blank space by connecting panels to make sense of the story. In GB Tran’s 'Vietnamerica' (2010, however, black gutters become part of black ‘bleeds’ (pages congruent with single panels in them to portray the sites of a trauma. This article argues that if bleeds, as Scott McCloud claims, can depict timeless space, they could also represent the sites of a trauma where the memory of the past is intervened by the future interpretation of the memory. In 'Vietnamerica', the panels in black in a waffle-iron grid are simultaneously black gutters and a black bleed, where reinterpretation of trauma takes place as speech balloons are later imposed on the same recurrent waffle-iron grid. While Cathy Caruth’s trauma theory helps read Tran’s black bleeds as the sites of a trauma, the latter also extends Caruth’s notion of ‘traumatic awakenings’ since the black bleeds as the sites of a trauma turn into the places of reconciliation and healing.

  3. Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

    International Nuclear Information System (INIS)

    Sawicki, Marcin; Marlicz, Wojciech; Czapla, Norbert; Łokaj, Marek; Skoczylas, Michał M.; Donotek, Maciej; Kołaczyk, Katarzyna

    2015-01-01

    Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence

  4. Evaluation of large esophageal varices in cirrhotic patients by transient elastography: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Tao Li

    Full Text Available Background and purpose: Transient elastography (TE has been shown to be a valuable tool for the prediction of large esophageal varices. However, the conclusions have not been always consistent throughout the different studies. Therefore, we performed a further meta-analysis in order to evaluate the diagnostic accuracy of transient elastography for the prediction of large esophageal varices. Methods: We performed a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL in The Cochrane Library without time restriction. The strategy we used was "(fibroscan OR transient elastography OR stiffness AND esophageal varices". Accuracy measures such as pooled sensitivity, specificity, among others, were calculated using Meta-DiSc statistical software. Results: Twenty studies (2,994 patients were included in our meta-analysis. The values of pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio were as follows: 0.81 (95% CI, 0.79-0.84, 0.71 (95% CI, 0.69-0.73, 2.63 (95% CI, 2.15-3.23, 0.27 (95% CI, 0.22-0.34 and 10.30 (95% CI, 7.33-14.47. The area under the receiver operating characteristics curve was 0.83. The Spearman correlation coefficient was 0.246 with a p-value of 0.296, indicating the absence of any significant threshold effects. In our subgroup analysis, the heterogeneity could be partially explained by the geographical origin of the study or etiology; or it could be partially explained blindingly, through the appropriate interval and cut-off value of the liver stiffness (LS. Conclusions: Transient elastography could be used as a valuable non-invasive screening tool for the prediction of large esophageal varices. However, since LS cut-off values vary throughout the different studies and significant heterogeneity also exists among them, we need more reasonable approaches or flow diagram in order to improve the operability of this technology.

  5. Custom-made covered transjugular intrahepatic portosystemic shunt (TIPS) in an infant with trisomy 22 and biliary atresia

    International Nuclear Information System (INIS)

    Chlapoutaki, Chrysanthi Emmanouil; Franchi-Abella, Stephanie; Pariente, Daniele; Habes, Dalila

    2009-01-01

    We report an 8-month-old girl with portal hypertension secondary to biliary atresia. The decision to treat with TIPS was made at the age of 8 months due to recurrent variceal bleeding. The procedure was carried out with a 6-mm bare stent due to her small size. Radiological follow-up with Doppler US showed gradual stenosis and finally occlusion of the stent 80 days after implantation. Revision was performed with placement of an additional 6-mm expanded polytetrafluoroethylene (e-PTFE) stent-graft that had remained patent for 9 months, proving that in small children with a portal vein diameter less than 8 mm, the combination of a bare stent and stent-graft can provide excellent results. (orig.)

  6. Custom-made covered transjugular intrahepatic portosystemic shunt (TIPS) in an infant with trisomy 22 and biliary atresia

    Energy Technology Data Exchange (ETDEWEB)

    Chlapoutaki, Chrysanthi Emmanouil; Franchi-Abella, Stephanie; Pariente, Daniele [Bicetre Hospital University Paris XI, Assistance Publique Hopitaux de Paris, Department of Paediatric Radiology, Paris (France); Habes, Dalila [Bicetre Hospital University Paris XI, Assistance Publique Hopitaux de Paris, Pediatric Hepatology and National Reference Center for Biliary Atresia, Paris (France)

    2009-07-15

    We report an 8-month-old girl with portal hypertension secondary to biliary atresia. The decision to treat with TIPS was made at the age of 8 months due to recurrent variceal bleeding. The procedure was carried out with a 6-mm bare stent due to her small size. Radiological follow-up with Doppler US showed gradual stenosis and finally occlusion of the stent 80 days after implantation. Revision was performed with placement of an additional 6-mm expanded polytetrafluoroethylene (e-PTFE) stent-graft that had remained patent for 9 months, proving that in small children with a portal vein diameter less than 8 mm, the combination of a bare stent and stent-graft can provide excellent results. (orig.)

  7. Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

    International Nuclear Information System (INIS)

    Mondel, Prabath Kumar; Anand, Sunanda; Limaye, Uday S.

    2015-01-01

    Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described

  8. Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Mondel, Prabath Kumar, E-mail: prabathmondel@gmail.com; Anand, Sunanda, E-mail: sunandaanand@gmail.com; Limaye, Uday S., E-mail: uslkem@gmail.com [Lilavati Hospital and Research Centre, Department of Interventional Neuroradiology (India)

    2015-08-15

    Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described.

  9. Mortality and need of surgical treatment in acute upper gastrointestinal bleeding: a one year study in a tertiary center with a 24 hours / day-7 days / week endoscopy call. Has anything changed?

    Science.gov (United States)

    Botianu, Am; Matei, D; Tantau, M; Acalovschi, M

    2013-01-01

    Acute upper gastrointestinal bleeding, previously often a surgical problem, is now the most common gastroenterological emergency. To evaluate the current situation in terms of mortality and need of surgery. Retrospective non-randomised clinical study performed between 1st January-31st December 2011, at "Professor Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology in Cluj Napoca. 757 patients with upper gastrointestinal bleeding were endoscopically examined within 24 hours from presentation in the emergency unit. Data were collected from admission charts and Hospital Manager programme. Statistical analysis was performed with GraphPad 2004, using the following tests: chi square, Spearman, Kruskall-Wallis, Mann-Whitney, area under receiver operating curve. Non-variceal etiology was predominant, the main cause was bleeding being peptic ulcer. In hospital global mortality was of 10.43%, global rebleeding rate was 12.02%, surgery was performed in 7.66% of patients. Urgent haemostatic surgery was needed in 3.68% of patients with nonvariceal bleeding. The need for surgery correlated with the postendoscopic Rockall score (p=0.0425). In peptic ulcer, the need for surgery was not influenced by time to endoscopy or type of treatment (p=0.1452). Weekend (p=0.996) or night (p=0.5414) admission were not correlated with a higher need for surgery. Over the last decade, the need for urgent surgery in upper gastrointestinal bleeding has decreased by half, but mortality has remained unchanged. Celsius.

  10. Report from two cases of vesicular varices secondary to thrombosis of the aorta vein, diagnosed by ultrasound Doppler color and pressed

    International Nuclear Information System (INIS)

    Triana R, Gustavo; Romero E, Javier; Prada, Mario; Uribe, Tomas

    1999-01-01

    We report two cases of gallbladder varices diagnosed by ultrasound. The first one is a 71-year-old patient who was diagnosed with liver cirrhosis of unknown etiology. The second patient is a 27-year-old woman who was diagnosed with a hypercoagulability state. Both of them were evaluated with Doppler ultrasound of the esplenoportal circulation, gallbladder varices associated with complete portal vein thrombosis were found

  11. 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....

  12. Evaluation of the patients that followed up for upper gastrointestinal system bleeding

    Directory of Open Access Journals (Sweden)

    Hüseyin Gölgeli

    2014-09-01

    Full Text Available Objective: In this study, it was aimed to evaluate demographic and laboratory characteristics of the patients with upper gastrointestinal system (GIS bleeding define the factors leading to bleeding. Methods: The study included 285 patients aged between 18 and 89 years who were followed and treated for upper GIS bleeding in our Internal Medicine Clinics. Patients’ demographic and aboratory data, endoscopic findings, treatment methods, ospitalization length and need for blood transfusions were determined. Results: The mean age was 62.7±18.3 years with the male/female ratio of 2.2/1. The most common finding was melena (45.3%, and the second melena with hematemesis (33%. 76.84% of the patients had the history of drug use, mostly non-steroid anti-inflammatory drugs (NSAIDs (45.26% and aspirin (23.86%. The mean hospitalization length was 8.3±4.9 days. Blood transfusion was required in 74.04% with the mean 3,14±1,41 units. Bleeding recurrence was seen in 10.25%. Duodenal ulcer was observed as the most common cause of GIS bleeding (29.82% and gastric ulcer was the second (21.75%. The treatment methods were medical in 73.34%, endoscopic sclerotherapy in 22.46%, hemoclips in 1.40% and band ligation in 0.70% of the patients. Upper GIS bleedings were mostly occurred in August (11.9% and least occurred in December (3.5%. Conclusion: The majority of the patients have history of drug use, like NSAIDs and aspirin leading to bleeding. We suggest that the usage of these drugs should be controlled and used only with accurate indications especially in elderly patients.

  13. Clinical and endoscopic profile of the patients with upper gastrointestinal bleeding in central rural India: A hospital-based cross-sectional study

    Directory of Open Access Journals (Sweden)

    Jyoti Jain

    2018-01-01

    Full Text Available Introduction: Acute Upper Gastrointestinal bleeding (UGIB is one of the common causes with which the patients present to emergency. The upper gastrointestinal (UGI endoscopy remains a crucial tool in identification of UGIB. The aim of the present study was to determine the endoscopic profile of UGIB in adult population of rural central India admitted with history of UGIB (hemetemesis and/or malena. Methods: This prospective, cross sectional study was conducted in rural hospital in central India and we enrolled all consecutive patients aged 18 years and above who were admitted in the hospital ward with the history of UGIB. After obtaining the demographic data, all patients underwent clinical examination, laboratory investigations and video-endoscopy. We used Student's t test to compare means, Chi-square test to compare proportions and Mann-Whitney test to compare medians. P value <0.05 will be considered significant. Results: The mean age of our study population (N = 118 was 46.2 years. Among 118 patients who underwent endoscopy, 47.4% had esophageal varices, 27.1% had portal hypertensive gastropathy, 14.4% had gastric erosions, 5.9% each had duodenal ulcers and esophagitis, 5% had gastric ulcer disease, 4.2% each had Mallory-Weiss tear and had gastric malignancy, 1.7% had esophageal malignancy and 16.1% had normal endoscopic findings. Conclusion: Esophageal varices were the most common cause of UGIB in the adult population of rural central India presenting with UGIB, when diagnosed by video-endoscopy.

  14. Control of severe bleeding episode in case of glanzmann's thrombasthenia refractory to platelet transfusion therapy by administering recombinant

    International Nuclear Information System (INIS)

    Asim, A.; Khan, B.; Hussain, T.

    2009-01-01

    Glanzmann's thrombasthenia is an autosomal recessive inherited platelet function defect. Though, quantitatively normal, the aggregation ability of platelets is reduced leading to bleeding episodes requiring transfusion of platelet concentrates. We describe a case of 13-year-old girl who had recurrent episodes of epistaxis since birth and was managed with multiple platelet concentrate transfusions and recently admitted with severe epistaxis refractory to platelet transfusion. At this stage administration of recombinant activated factor VII (fVIIa) was considered, which was initially given at 90 mu g/kg dose with little control of bleeding but subsequent second dose of 120 mu g/kg was administered with excellent response and immediate control of bleeding. (author)

  15. Effectiveness and safety of rivaroxaban versus warfarin for treatment and prevention of recurrence of venous thromboembolism.

    Science.gov (United States)

    Coleman, Craig I; Bunz, Thomas J; Turpie, Alexander G G

    2017-10-05

    The efficacy and safety or rivaroxaban versus enoxaparin/vitamin K antagonist for treatment and prevention recurrence of venous thromboembolism (VTE) was demonstrated in the randomised EINSTEIN trials. We assessed the effectiveness and safety of rivaroxaban versus warfarin in VTE patients managed in routine practice. Using US MarketScan claims from 1/2012-6/2015, we included adults with a primary diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE) during a hospitalisation/emergency department visit, newly-initiated on rivaroxaban or warfarin within 30-days after the VTE and with ≥180-days of continuous medical/prescription benefits prior to the VTE (baseline). Patients with a claim for anticoagulation at baseline were excluded. Recurrent VTE, major bleeding, intracranial haemorrhage (ICH) and gastrointestinal bleeding (GIB) were assessed. Differences in baseline characteristics between cohorts were adjusted for using inverse probability of treatment weights based on propensity-scores. Patients had a maximum of 12-months period of follow-up post-VTE or until endpoint occurrence, switch/discontinuation of index anticoagulation, insurance disenrollment or end-of-follow-up. Cox regression was performed and reported as hazard ratios (HRs) with 95 % confidence intervals (CIs). In total, 13,609 rivaroxaban and 32,244 warfarin users experiencing VTE were included. Rivaroxaban was associated with an 19 % (95 %CI=10-27 %) reduction in recurrent VTE and a 21 % (95 %CI=4-35 %) reduction in major bleeding hazard versus warfarin. Rivaroxaban was also associated with significantly decreased hazards of ICH (HR=0.40) and GIB (HR=0.72). Rivaroxaban appears to reduce patients' hazard of both recurrent VTE and major bleeding in routine practice. These results appear consistent with EINSTEIN and post-marketing registry studies.

  16. Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.

    Science.gov (United States)

    Dowlut-McElroy, Tazim; Williams, Karen B; Carpenter, Shannon L; Strickland, Julie L

    2015-12-01

    To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders. We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area. Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders. Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment. Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy.

    Science.gov (United States)

    Ahn, Dong-Won; Park, Young Soo; Lee, Sang Hyub; Shin, Cheol Min; Hwang, Jin-Hyeok; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho

    2016-05-01

    This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

  18. 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...

  19. Embolization for non-variceal upper gastrointestinal tract haemorrhage: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Mirsadraee, S.; Tirukonda, P.; Nicholson, A. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Everett, S.M. [Department of Gastroenterology, Leeds General Infirmary, Leeds (United Kingdom); McPherson, S.J., E-mail: simon.mcpherson@leedsth.nhs.u [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2011-06-15

    Aim: To assess the published evidence on the endovascular treatment of non-variceal upper gastrointestinal haemorrhage. Materials and methods: An Ovid Medline search of published literature was performed (1966-2009). Non-English literature, experimental studies, variceal haemorrhage and case series with fewer than five patients were excluded. The search yielded 1888 abstracts. Thirty-five articles were selected for final analysis. Results: The total number of pooled patients was 927. The technical and clinical success of embolization ranged from 52-100% and 44-100%, respectively. The pooled mean technical/clinical success rate in primary upper gastrointestinal tract haemorrhage (PUGITH) only, trans-papillary haemorrhage (TPH) only, and mixed studies were 84%/67%, 93%/89%, and 93%/64%, respectively. Clinical outcome was adversely affected by multi-organ failure, shock, corticosteroids, transfusion, and coagulopathy. The anatomical source of haemorrhage and procedural variables did not affect the outcome. A successful embolization improved survival by 13.3 times. Retrospective comparison with surgery demonstrated equivalent mortality and clinical success, despite embolization being applied to a more elderly population with a higher prevalence of co-morbidities. Conclusions: Embolization is effective in this very difficult cohort of patients with outcomes similar to surgery.

  20. Severe hyponatraemia after terlipressin treatment in the patient with surgically untreatable bleeding into gastrointestinal system

    International Nuclear Information System (INIS)

    Vojtko, M.; Smolar, M.; Laca, L.; Danova, I.; Strelka, L.; Hulo, E.; Mikolajcik, A.; Kicina, R.; Laca, L.; Zelenak, K.

    2014-01-01

    The authors present the case report of a 46 year old woman. In personal history, she was operated for congenital duodenal stenosis at the age 2 days, later reoperated due to restenosis. The patient had congenital vascular malformations of gastrointestinal tract (GIT) and was recurrently hospitalized for recidivous bleeding into GIT with concurrent development of portal hypertension. In 2012 she was admitted to our department because of relapsing bleeding into GIT which was impossible surgically treated so the patient was treated conservatively. In the course of terlipressin use, sharp decline of natremia developed with subsequent altered consciousness with CT verified brain edema. Further management included discontinuation of terlipressin, slow correction of hyponatraemia, embolization of arterial lienalis, hemosubstitution and recombinant factor VIIa. This treatment led to stop bleeding and improvement of state of consciousness however mild form of organic psycho syndrome persists. (author)

  1. Bevacizumab for Refractory Gastrointestinal Bleeding in Rendu-Osler-Weber Disease

    Science.gov (United States)

    Bernardes, Carlos; Santos, Sara; Loureiro, Rafaela; Borges, Verónica; Ramos, Gonçalo

    2018-01-01

    Rendu-Osler-Weber disease, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder which is often characterized by recurrent epistaxis, mucocutaneous and gastrointestinal telangiectasias, and visceral arteriovenous malformations. Patients with gastrointestinal involvement can present with a wide spectrum of severity, which may vary from uncomplicated iron deficiency anemia to continuous and refractory bleeding. We present the case of a 62-year-old female, who was admitted with anemia following several episodes of melena, and whose endoscopic examination revealed multiple angiodysplasias in the stomach and small bowel. Despite endoscopic and medical treatment attempts with hormonal agents and octreotide, she developed persistent hemorrhage and severe anemia, requiring frequent red blood cell transfusions. Immediately after initiating bevacizumab (7.5 mg/kg, every 3 weeks), complete cessation of bleeding episodes was observed. Currently, after 1 year of follow-up, she maintained sustained remission without the occurrence of adverse events. PMID:29662934

  2. Bleeding after dilatation and curettage: the efficacy of transcatheter uterine artery embolisation

    International Nuclear Information System (INIS)

    Song, Y.; Shin, J.H.; Yoon, H.-K.; Kim, J.W.; Ko, G.-Y.; Won, H.-S.

    2015-01-01

    Aim: To evaluate safety and clinical outcomes of uterine artery embolisation (UAE) for bleeding after dilatation and curettage (D&C) performed for abortion or termination. Materials and methods: The outcomes were analysed in 11 patients who underwent UAE for bleeding after D&C for missed abortions (n=8), caesarean scar pregnancies (n=2), or planned termination (n=1) between October 2001 and December 2013. Angiograms and medical records were retrospectively reviewed in order to obtain the patients' baseline characteristics, technical/clinical success rate, complications, and follow-up data regarding menstruation. Results: Technical success, defined as successful catheterisation of both uterine arteries with embolisation to haemostasis, was 100%, whereas clinical success, defined as cessation of bleeding after the initial session of UAE and without the need for additional UAE or surgery for the purpose of haemostasis, was 81.8% (nine of 11). In the two patients with clinical failure due to recurrent vaginal bleeding after UAE, one patient underwent repeat UAE and showed a successful outcome, whilst the other patient required hysterectomy with pathological results of placenta increta. Two other patients underwent hysterectomy for placenta percreta or hydatidiform mole-mimicking remnant placenta. None of the patients included in the present series had procedure-related complications. Menstruation resumed in all eight patients with an intact uterus during the mean follow-up period. Conclusion: UAE may be a safe and effective treatment for bleeding after D&C, especially for women who wish to preserve their fertility; however, hysterectomy may be indicated for patients with a placental abnormality. - Highlights: • We evaluate outcomes of uterine artery embolization for bleeding after D&C. • UAE may be a safe and effective treatment for bleeding after D&C. • Hysterectomy may be indicated for patients with a placental abnormality.

  3. Recurrent life-threatening haemoptysis from a bleeding vertebral artery pseudoaneurysm: A diagnostic dilemma.

    Science.gov (United States)

    Chandran, Arun; Biswas, Shubhabrata; Hartley, James Leon; Nahser, Hans Christean; Lancaster, Jeffrey; Puthuran, Mani

    2016-10-01

    A bleeding vertebral artery pseudoaneurysm is a rare cause of haemoptysis. Pseudoaneurysm can arise due to radionecrosis from previous radiotherapy in the base of skull and neck region and may present with haemoptysis many years later. It is important to be aware of this entity in the work-up of haemoptysis, particularly in patients with previous base of skull and neck radiotherapy. Our patient was successfully treated with endovascular occlusion. © The Author(s) 2016.

  4. Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry-independent, double-blind, double-dummy, randomised trial.

    Science.gov (United States)

    Chan, Francis K L; Ching, Jessica Y L; Tse, Yee Kit; Lam, Kelvin; Wong, Grace L H; Ng, Siew C; Lee, Vivian; Au, Kim W L; Cheong, Pui Kuan; Suen, Bing Y; Chan, Heyson; Kee, Ka Man; Lo, Angeline; Wong, Vincent W S; Wu, Justin C Y; Kyaw, Moe H

    2017-06-17

    Present guidelines are conflicting for patients at high risk of both cardiovascular and gastrointestinal events who continue to require non-steroidal anti-inflammatory drugs (NSAIDs). We hypothesised that a cyclooxygenase-2-selective NSAID plus proton-pump inhibitor is superior to a non-selective NSAID plus proton-pump inhibitor for prevention of recurrent ulcer bleeding in concomitant users of aspirin with previous ulcer bleeding. For this industry-independent, double-blind, double-dummy, randomised trial done in one academic hospital in Hong Kong, we screened patients with arthritis and cardiothrombotic diseases who were presenting with upper gastrointestinal bleeding, were on NSAIDs, and require concomitant aspirin. After ulcer healing, an independent staff member randomly assigned (1:1) patients who were negative for Helicobacter pylori with a computer-generated list of random numbers to receive oral administrations of either celecoxib 100 mg twice per day plus esomeprazole 20 mg once per day or naproxen 500 mg twice per day plus esomeprazole 20 mg once per day for 18 months. All patients resumed aspirin 80 mg once per day. Both patients and investigators were masked to their treatments. The primary endpoint was recurrent upper gastrointestinal bleeding within 18 months. The primary endpoint and secondary safety endpoints were analysed in the modified intention-to-treat population. This study was registered with ClinicalTrials.gov, number NCT00153660. Between May 24, 2005, and Nov 28, 2012, we enrolled 514 patients, assigning 257 patients to each study group, all of whom were included in the intention-to-treat population. Recurrent upper gastrointestinal bleeding occurred in 14 patients in the celecoxib group (nine gastric ulcers and five duodenal ulcers) and 31 patients in the naproxen group (25 gastric ulcers, three duodenal ulcers, one gastric ulcer and duodenal ulcer, and two bleeding erosions). The cumulative incidence of recurrent bleeding in 18 months

  5. Upper gastrointestinal bleeding: risk factors for mortality in two urban centers in Latin America Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina

    Directory of Open Access Journals (Sweden)

    C. H. Morales Uribe

    2011-01-01

    Full Text Available Objective: to describe the experience with upper gastrointestinal bleeding (UGIB in two major Latin American hospitals; its main cuses, treatment and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: We included 464 patients older than 15 years of age from two reference centers. We studied some demographic variables, history, clinical presentation, treatment and mortality. We explored the association betwen those variables and death. Results: The mean age was 57.9 years, and the male: female ratio was 1.4:1. Three hundred and fifty nine patients (77.4% were seen for gastrointestinal bleeding (outpatients bleeding and 105 patients (22.6% were inpatients seen for UGIB. A total of 71.6% of patients admitted with the diagnosis of upper GI bleeding underwent upper GI emdoscopy (EGD within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 40.9%, erosive disease (162 patients, 34.9% and variceal bleeding (47 patients, 10.1%. Forty four patients died (9.5%. Patient who presented with bleeding due to other causes during hospitalization has a higher mortality risk than those whose complaints were related to gastrointestinal bleeding (RR 2.4, 95% CI 1.2-4.6. An increasing number of comorbidities such as those described in the Rockall Score, were also associated with a higher risk of mortality (RR 2.5 95% CI 1.1-5.4. Conclusion: Intrahospital upper GI bleeding and the presence of comorbilities ares risk factors for a fatal outcome. Identifying patients with a higher risk would help improve the management of patients with UGIB.Objetivo: presentar la experiencia con la hemorragia de vías digestivas alta (HDA en dos hospitales centros de referencia de un país latinoamericano, las principales causas, tratamiento, pronóstico y explorar algunos factores de riesgo asociados con la mortalidad. Diseño: estudio de cohortes prospectivo. Pacientes y métodos: se

  6. Transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis.

    Science.gov (United States)

    Klinger, Christoph; Riecken, Bettina; Schmidt, Arthur; De Gottardi, Andrea; Meier, Benjamin; Bosch, Jaime; Caca, Karel

    2018-03-01

    To determine safety and efficacy of transjugular portal vein recanalization with creation of intrahepatic portosystemic shunt (PVR-TIPS) in patients with chronic non-cirrhotic, non-malignant portal vein thrombosis (PVT). This retrospective study includes 17 consecutive patients with chronic non-cirrhotic PVT (cavernous transformation n = 15). PVR-TIPS was indicated because of variceal bleeding (n = 13), refractory ascites (n = 2), portal biliopathy with recurrent cholangitis (n = 1), or abdominal pain (n = 1). Treatment consisted of a combination of transjugular balloon angioplasty, mechanical thrombectomy, and-depending on extent of residual thrombosis-transjugular intrahepatic portosystemic shunt and additional stenting of the portal venous system. Recanalization was successful in 76.5 % of patients despite cavernous transformation in 88.2 %. Both 1- and 2-year secondary PV and TIPS patency rates were 69.5 %. Procedure-related bleeding complications occurred in 2 patients (intraperitoneal bleeding due to capsule perforation, n = 1; liver hematoma, n = 1) and resolved spontaneously. However, 1 patient died due to subsequent nosocomial pneumonia. During follow-up, 3 patients with TIPS occlusion and PVT recurrence experienced portal hypertensive complications. PVR-TIPS is safe and effective in selected patients with chronic non-cirrhotic PVT. Due to technical complexity and possible complications, it should be performed only in specialized centers with high experience in TIPS procedures. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Evaluation of fluency stent-grafts in transjugular intrahepatic portosystemic shunts

    International Nuclear Information System (INIS)

    Zhao Jianbo; Li Yanhao; Chen Yong; He Xiaofeng; Zeng Qingle; Mei Quelin; Lu Wei

    2009-01-01

    Objective: To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahepatic portosystemic shunt (TIPS). Methods: The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed. All of them were recurrent variceal bleeding secondary to portal vein hypertension, 1 was bleeding secondary to primary hepatic carcinoma with port vein thrombus, and 1 was Budd-Chiari syndrome. They were followed-up after (10.1±4.6) months (2.0 to 24.0 months). Stent-grafts patancy, portal vein pressure and liver function were recorded and compared. Results: Twenty-five stent-grafts were successfully implanted in 21 patients, 23 stent grafts were 8 mm 2 were 10 mm in diameter. The covered length of the stents varied from 6 to 8 cm. The bleeding was stopped and the portal vein pressure decreased significantly from (25.4±3.5) mm Hg to (15.4±2.8) mm Hg (t= 12.495, P 0.05). Conclusion: The Fluency stent-grafts could increase the patency of the TIPS, but its efficacy on the long-term effect and hepatic encephalopathy need further investigation. (authors)

  8. Cerebro-retinal microangiopathy with calcifications and cysts due to recessive mutations in the CTC1 gene.

    Science.gov (United States)

    Bisserbe, A; Tertian, G; Buffet, C; Turhan, A; Lambotte, O; Nasser, G; Alvin, P; Tardieu, M; Riant, F; Bergametti, F; Tournier-Lasserve, E; Denier, C

    2015-05-01

    Cerebro-retinal microangiopathy with calcifications and cysts (CRMCC) or Coats plus syndrome is a pleiotropic disorder affecting the eyes, brain, bone and gastrointestinal tract. Its primary pathogenesis involves small vessel obliterative microangiopathy. Recently, autosomal recessively inherited mutations in CTC1 have been reported in CRMCC patients. We herein report an adolescent referred to our hospital following new seizures in a context of an undefined multisystem disorder. Cerebral imaging disclosed asymmetrical leukopathy, intracranial calcifications and cysts. In addition, he presented other typical CRMCC features i.e. a history of intrauterine growth retardation, skeletal demineralization and osteopenia, bilateral exudative vitreo-retinopathy reminiscent of Coats disease, recurrent gastrointestinal hemorrhages secondary to watermelon stomach and variceal bleeding of the esophagus due to idiopathic portal hypertension and telangiectatic and angiodysplasic changes in the small intestine and colon, and anemia due to recurrent bleeding and bone marrow abnormalities. The patient was diagnosed with Coats plus syndrome. CTC1 gene screening confirmed the diagnosis with the identification of heterozygous deleterious mutations. CRMCC due to CTC1 mutations has a broad clinical expressivity. Our case report illustrates the main possible associated phenotypes and their complications, demonstrating the need for a careful etiological search in order to initiate appropriate therapeutic and preventive measures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. A rare case of important and recurrent abnormal uterine bleeding in a post partum woman caused by cavernous hemangioma: a case report and review of literature.

    Science.gov (United States)

    Aka, Kacou Edele; Apollinaire Horo, Gninlgninrin; Fomba, Minata; Kouyate, Salif; Koffi, Abdoul Koffi; Konan, Seni; Fanny, Mohamed; Effi, Benjamin; Kone, Mamourou

    2017-01-01

    The cavernous hemangioma is a rare benign vascular tumor. About 50 cases of this disease were found in the literature over the last century and only 9 cases of cavernous hemangioma on the pregnant uterus were published it comes into cavernous or capillary form. The symptomatology is not unequivocal and when it occurs during pregnancy or postpartum, it causes life-threatening cataclysmic hemorrhage. Antenatal diagnosis is difficult and requires a multidisciplinary approach with pathologists, radiologists and gynecologists to avoid these complications or unnecessary hysterectomies. The diagnosis is histological. Hysterectomy is possible after failure of conservative treatment means. We report a rare case, a novel mixed cavernous hemangioma of the body associated with a capillary hemangioma of the cervix in a patient of 28 years 5th visors with recurrent genital bleeding in the postpartum period leading to a hysterectomy.

  10. The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

    International Nuclear Information System (INIS)

    Kwak, Hyo Sung; Han, Young Min; Lee, Soo Teik

    2009-01-01

    To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography

  11. Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke.

    Science.gov (United States)

    Gonzalez-Valcarcel, Jaime; Sissani, Leila; Labreuche, Julien; Bousser, Marie-Germaine; Chamorro, Angel; Fisher, Marc; Ford, Ian; Fox, Kim M; Hennerici, Michael G; Mattle, Heinrich P; Rothwell, Peter M; Steg, Philippe Gabriel; Vicaut, Eric; Amarenco, Pierre

    2016-04-01

    The presumed safety of paracetamol in high-cardiovascular risk patients has been questioned. We determined whether paracetamol or ibuprofen use is associated with major cardiovascular events (MACE) or major bleeding in 19 120 patients with recent ischemic stroke or transient ischemic attack of mainly atherothrombotic origin included in the Prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) trial. We performed 2 nested case-control analysis (2153 cases with MACE during trial follow-up and 4306 controls matched on Essen stroke risk score; 809 cases with major bleeding matched with 1616 controls) and a separate time-varying analysis. 12.3% were prescribed paracetamol and 2.5% ibuprofen. Median duration of treatment was 14 (interquartile range 5-145) days for paracetamol and 9 (5-30) days for ibuprofen. Paracetamol, but not ibuprofen, was associated with increased risk of MACE (odds ratio 1.21, 95% confidence interval [CI] 1.04-1.42) or a major bleeding (odds ratio 1.60, 95% CI 1.26-2.03), with no impact of daily dose and duration of paracetamol treatment. Time-varying analysis found an increased risk of MACE with both paracetamol (hazard ratio 1.22, 95% CI 1.05-1.43) and ibuprofen (hazard ratio 1.47, 95% CI 1.06-2.03) and of major bleeding with paracetamol (hazard ratio 1.95, 95% CI 1.45-2.62). There was a weak and inconsistent signal for association between paracetamol or ibuprofen and MACE or major bleeding, which may be related to either a genuine but modest effect of these drugs or to residual confounding. http://www.isrctn.com. Unique identifier: ISRCTN66157730. © 2016 American Heart Association, Inc.

  12. Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

    OpenAIRE

    Antonenko, Kateryna; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H

    2016-01-01

    Introduction: Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes.\\ud Methods Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibril...

  13. Risk factors for recurrent spontaneous epistaxis.

    Science.gov (United States)

    Abrich, Victor; Brozek, Annabelle; Boyle, Timothy R; Chyou, Po-Huang; Yale, Steven H

    2014-12-01

    To identify risk factors associated with spontaneous recurrent epistaxis. This was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having epistaxis between January 1, 1991, and January 1, 2011. There were 461 cases with at least 2 episodes of spontaneous epistaxis within 3 years and 912 controls with only 1 episode in the same time frame. More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of epistaxis recurrence. Traditional risk factors for epistaxis, including nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrence, independent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence. Few major adverse cardiovascular events were observed within 30 days of the first epistaxis event. Congestive heart failure is an underappreciated risk factor for recurrent epistaxis. Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent epistaxis to prevent major adverse cardiovascular events. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  14. Bleeding during Pregnancy

    Science.gov (United States)

    ... in pregnancy? • What problems with the placenta can cause bleeding during pregnancy? • Can bleeding be a sign of preterm labor? • ... the hospital. What problems with the placenta can cause bleeding during pregnancy? Several problems with the placenta later in pregnancy ...

  15. Ectasias and varices of the vocal fold: clearing the striking zone.

    Science.gov (United States)

    Hochman, I; Sataloff, R T; Hillman, R E; Zeitels, S M

    1999-01-01

    Vascular malformations such as ectasias and varices (Es and Vs) are frequently encountered in patients who present with recurrent vocal fold hemorrhage and/or other traumatic vocal fold lesions. This study examined Es and Vs with regard to their anatomic presentation, phonomicrosurgical management, and treatment outcome. Forty-two patients (39 of them singers) were treated for a total of 87 Es and Vs: 67 of 87 (77%) were on the superior surface of the vocal fold and 20 of 87 (23%) were on the medial surface of the vocal fold. Eighty-three percent were located in the middle musculomembranous region (the striking zone), where the greatest aerodynamically induced shearing stresses occur during phonation. Treatment was performed with carbon dioxide laser cauterization (13 patients), or a new technique utilizing cold instrument excision by means of epithelial cordotomies (23 patients), while a combined approach was employed in 6 patients. Comparisons of preoperative and postoperative stroboscopy revealed improvement or no significant change in all patients in whom the cold instrument technique was used, and increased epithelial stiffness was noted in 4 of 19 patients in whom the carbon dioxide laser was used. Clearing the striking zone appears to have halted further hemorrhages by removing the the fragile Es and Vs from this injury-prone region of the vocal fold. Interpretations of stroboscopic examinations were directed at providing new insights into the biomechanical forces of vocal fold vibration that probably contribute to the genesis of Es and Vs in the vocal folds.

  16. Interventional treatment of upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting

    International Nuclear Information System (INIS)

    Li Jijun; Shang Jianqiang; Liu Zuoqin; Tang Jun; Sun Zengtao; Chen Jie; Zhang Lei; Liu Hongjun; Zhou Zhaohai

    2011-01-01

    Objective: To explore the diagnostic and therapeutic efficacy of interventional procedure for upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting (HAPVS). Methods: Clinical data of 27 patients of hepatic carcinoma accompanied with HAPVS were retrospectively analyzed. All patients underwent hepatic arterial angiography and transcatheter arterial embolization. Shunts were embolized with coils, Gelfoam particles or PVA particles. Results: Of 27 patients with upper gastrointestinal bleeding, central type HAPVS was seen in 16 and peripheral type HAPVS in 11. Reversed portal venous flow was detected in 20 cases and ascites was found in 23 cases. The abnormal shunts were successfully occluded in all patients and the bleeding ceased within 2 days after embolization. No recurrent bleeding occurred in one month after the treatment. Ascites disappeared in 16 cases and subsided in 7 cases. Conclusion: HAPVS is an important cause for upper gastrointestinal bleeding in patients of hepatic carcinoma, and the arteriovenous fistula can be confirmed with hepatic artery DSA. Embolization of fistulous orifice is the most effective therapy for such patients. (authors)

  17. Correlation study of spleen stiffness measured by FibroTouch with esophageal and gastric varices in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    WEI Yutong

    2015-03-01

    Full Text Available ObjectiveTo explore the correlation of spleen stiffness measured by FibroScan with esophageal and gastric varices in patients with liver cirrhosis. MethodsSpleen and liver stiffness was measured by FibroScan in 72 patients with liver cirrhosis who received gastroscopy in our hospital from December 2012 to December 2013. Categorical data were analyzed by χ2 test, and continuous data were analyzed by t test. Pearson's correlation analysis was used to investigate the correlation between the degree of esophageal varices and spleen stiffness. ResultsWith the increase in the Child-Pugh score in patients, the measurements of liver and spleen stiffness showed a rising trend. Correlation was found between the measurements of spleen and liver stiffness (r=0.367, P<0.05. The differences in measurements of spleen stiffness between patients with Child-Pugh classes A, B, and C were all significant (t=5.149, 7.231, and 6.119, respectively; P=0031, 0.025, and 0.037, respectively. The measurements of spleen and liver stiffness showed marked increases in patients with moderate and severe esophageal and gastric varices. The receiver operating characteristic (ROC curve analysis showed that the area under the ROC curve, sensitivity, and specificity for spleen stiffness were significantly higher than those for liver stiffness and platelet count/spleen thickness. ConclusionThe spleen stiffness measurement by FibroScan shows a good correlation with the esophageal and gastric varices in patients with liver cirrhosis. FibroScan is safe and noninvasive, and especially useful for those who are not suitable for gastroscopy.

  18. Spleen Stiffness Correlates with the Presence of Ascites but Not Esophageal Varices in Chronic Hepatitis C Patients

    Directory of Open Access Journals (Sweden)

    Kazuyo Mori

    2013-01-01

    Full Text Available Although spleen stiffness has recently been identified as potential surrogate marker for portal hypertension, the relationship between spleen stiffness and portal hypertension has not been fully elucidated. We attempted to determine the relationship between the liver or spleen stiffness and the presence of ascites or esophageal varices by acoustic radiation force impulse (ARFI imaging. A total of 33 chronic hepatitis C (CHC patients (median age 68; range 51–84 were enrolled. We evaluated the relationship between the liver or spleen stiffness and indicators of portal hypertension as well as clinical and biochemical parameters. Fourteen healthy volunteers were used for validating the accuracy of AFRI imaging. The liver and spleen stiffness increased significantly with progression of liver disease. A significant positive correlation was observed between the liver and spleen stiffness. However, spleen stiffness, but not liver stiffness, was significantly associated with the presence of ascites (, while there was no significant association between the spleen stiffness and spleen index/presence of esophageal varices in CHC patients. The area under the receiver operating characteristic curve based on the spleen stiffness was 0.80. In conclusion, spleen stiffness significantly correlates with the presence of ascites but not esophageal varices in CHC patients.

  19. Internal Bleeding

    Science.gov (United States)

    ... Fractures (Part II) Additional Content Medical News Internal Bleeding By Amy H. Kaji, MD, PhD, Associate Professor, ... Emergency First Aid Priorities Cardiac Arrest Choking Internal Bleeding Severed or Constricted Limbs or Digits Soft-Tissue ...

  20. Localization of hemorrhage in a recurrent hemothorax using Tc-99m-sulfur colloid

    International Nuclear Information System (INIS)

    Taillefer, R.; Essiambre, R.; Lemieux, R.

    1981-01-01

    Tc99m-sulfur colloid scintigraphy has proven clinically useful in identifying gastrointestinal hemorrhages. The authors describe a patient with recurrent hemothorax under oral anticoagulation therapy in which Tc-99m-sulfur colloid imaging was used to determine the site of bleeding