Experience With Endoscopic Management of High-Risk Gastroesophageal Varices, With and Without Bleeding, in Children With Biliary Atresia

Variceal hemorrhage is a common and devastating complication of portal hypertension and is a leading cause of death in patients with cirrhosis. The management of gastroesophageal varices has evolved over the last decade resulting in improved mortality and morbidity rates. Regarding the primary prevention of variceal hemorrhaging, nonselectiveβ-blockers should be the first-line therapy in all patients with medium to large varices and in patients with small varices associated with high-risk features such as red wale marks and/or advanced cirrhosis. EVL should be offered in cases of intolerance or side effects toβ-blockers, or for patients at high-risk for variceal bleeding who have medium or large varices with red wale marks or advanced liver cirrhosis. In acute bleeding, vasoactive agents should be initiated along with antibiotics followed by EVL or endoscopic sclerotherapy (if EVL is technically difficult) within the first 12 hours of presentation. Where available, terlipressin is the preferred agent because of its safety profile and it represents the only drug with a proven efficacy in improving survival. All patients surviving an episode of bleeding should undergo further prophylaxis to prevent rebleeding with EVL and nonselectiveβ-blockers.

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Endoscopic Management of Portal Hypertension

International Journal of Hepatology ◽

10.1155/2012/747095 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Said A. Al-Busafi ◽

Peter Ghali ◽

Philip Wong ◽

Marc Deschenes

Keyword(s):

Portal Hypertension ◽

Endoscopic Ultrasound ◽

Capsule Endoscopy ◽

Interventional Therapy ◽

Gastric Varices ◽

Active Management ◽

Endoscopic Management ◽

Diagnostic Modality ◽

Gastroesophageal Varices ◽

Life Threatening

Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.

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Endoscopic Management of Giant Walled-Off Pancreatic Necrosis With a High Risk of Bleeding

ACG Case Reports Journal ◽

10.14309/crj.0000000000000199 ◽

2019 ◽

Vol 6 (8) ◽

pp. e00199 ◽

Cited By ~ 1

Author(s):

Faysal Alhasan ◽

Gilles Jadd Hoilat ◽

Waddah Malas ◽

Syed K. Mahmood ◽

Jaroslav Zivny ◽

...

Keyword(s):

High Risk ◽

Pancreatic Necrosis ◽

Endoscopic Management ◽

Risk Of Bleeding

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Spleen stiffness by 2‐D shear wave elastography is the most accurate predictor of high‐risk esophagogastric varices in children with biliary atresia

Hepatology Research ◽

10.1111/hepr.13381 ◽

2019 ◽

Vol 49 (10) ◽

pp. 1162-1168 ◽

Cited By ~ 4

Author(s):

Shinya Yokoyama ◽

Masatoshi Ishigami ◽

Takashi Honda ◽

Teiji Kuzuya ◽

Yoji Ishizu ◽

...

Keyword(s):

High Risk ◽

Biliary Atresia ◽

Shear Wave ◽

Shear Wave Elastography ◽

Accurate Predictor ◽

Esophagogastric Varices ◽

Spleen Stiffness

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Development and validation of a radiomics signature as a non‐invasive complementary predictor of gastroesophageal varices and high‐risk varices in compensated advanced chronic liver disease: A multicenter study

Journal of Gastroenterology and Hepatology ◽

10.1111/jgh.15306 ◽

2020 ◽

Author(s):

Yifei Huang ◽

Fangze Huang ◽

Li Yang ◽

Weiling Hu ◽

Yanna Liu ◽

...

Keyword(s):

Liver Disease ◽

High Risk ◽

Chronic Liver Disease ◽

Multicenter Study ◽

Chronic Liver ◽

Gastroesophageal Varices ◽

Non Invasive ◽

Development And Validation ◽

Radiomics Signature

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Endoscopic management of duodenal fistula in a patient operated after abdominal injury

Polish Journal of Surgery ◽

10.5604/01.3001.0013.1029 ◽

2019 ◽

Vol 91 (3) ◽

pp. 1-4

Author(s):

Bartłomiej Jędrzejczak ◽

Piotr Bednarski ◽

Michał Spychalski ◽

Przemysław Lipiński ◽

Adam Dziki ◽

...

Keyword(s):

High Risk ◽

Conservative Treatment ◽

Endoscopic Management ◽

Duodenal Fistula ◽

Duodenal Injury ◽

Endoscopic Techniques ◽

Life Threatening ◽

Post Traumatic ◽

Duodenal Injuries ◽

Rare Group

Post-traumatic duodenal injuries constitute a relatively rare group among this type of lesions reported in the abdominal structures. In the vast majority of cases, a post-traumatic duodenal injury is accompanied by damage to other important organs. The surgical management of duodenum injuries poses a high risk of life-threatening complications with duodenal fistula among the most common. In some cases, the combination of basic and advanced surgical procedures and intensive conservative treatment is insufficient to treat the complication. The progress in endoscopic techniques and the application of modern instruments have allowed for the use of these procedures to manage gastrointestinal injuries of various aetiology. The aim of the study is to present an effective endoscopic occlusion of post-traumatic duodenal fistula.

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Endoscopic Management of Giant Pancreatic Pseudocyst at High Risk for Bleeding

The American Journal of Gastroenterology ◽

10.14309/00000434-201810001-01394 ◽

2018 ◽

Vol 113 (Supplement) ◽

pp. S800-S801

Author(s):

Muhammad Alsayid ◽

Syed K. Mahmood ◽

Jaroslav Zivny

Keyword(s):

High Risk ◽

Pancreatic Pseudocyst ◽

Endoscopic Management ◽

Risk For Bleeding

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Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

Endoscopy International Open ◽

10.1055/s-0043-104860 ◽

2017 ◽

Vol 05 (05) ◽

pp. E324-E330 ◽

Cited By ~ 17

Author(s):

Regina Lamberts ◽

Anna Koch ◽

Christian Binner ◽

Marcus Zachäus ◽

Ingrid Knigge ◽

...

Keyword(s):

High Risk ◽

Gastrointestinal Bleeding ◽

Anticoagulant Therapy ◽

Endoscopic Therapy ◽

High Risk Patient ◽

Antiplatelet Agents ◽

High Rate ◽

Endoscopic Management ◽

Success Rates ◽

Primary Hemostasis

Abstract Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

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