scholarly journals Endoscopic ultrasound-guided placement of coils and cyanoacrylate embolization in refractory gastric variceal bleeding: a pediatric case report

2019 ◽  
Vol 07 (09) ◽  
pp. E1061-E1063 ◽  
Author(s):  
Juan I. Olmos ◽  
Roberto Oleas ◽  
Juan A. Alcívar ◽  
Jorge Baquerizo-Burgos ◽  
Carlos Robles-Medranda
Keyword(s):  
Endoscopic Ultrasound ◽  
Variceal Bleeding ◽  
Pediatric Patients ◽  
Rescue Therapy ◽  
Pediatric Population ◽  
Gastric Varices ◽  
Variceal Hemorrhage ◽  
Cyanoacrylate Glue ◽  
Bleeding Management ◽  
Rebleeding Rate

Abstract Background and study aims Gastric variceal bleeding management is challenging, especially in the pediatric population. Endoscopic cyanoacrylate glue injection is considered the standard for management of gastric varices but it is associated with a high rebleeding rate. Endoscopic ultrasound (EUS)-guided placement of coils with cyanoacrylate is a newly available technique with a lower rebleeding rate but there are no reported cases using this technique in pediatric patients. We report on a 12-year-old child with liver cirrhosis and gastric variceal hemorrhage who was refractory to the endoscopic cyanoacrylate injection and in whom hemostasis was achieved without rebleeding following EUS-guided coiling and cyanoacrylate injection. Neither rebleeding nor varix reappearance was noted on 12-month follow-up. EUS-guided coiling and cyanoacrylate injection is safe and feasible in pediatric patients and could be considered as rescue therapy for treatment of refractory gastric variceal bleeding.

scholarly journals Endoscopic variceal ligation combined with sclerotherapy for management of gastroesophageal variceal bleeding in pediatric patients

2021 ◽  
Author(s):  
Ming-Ming Li ◽  
Fang Sun ◽  
Man-Xiu Huai ◽  
Chun-Ying Qu ◽  
Feng Shen ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Pediatric Patients ◽  
Median Number ◽  
Gastric Varices ◽  
Secondary Prophylaxis ◽  
Endoscopic Management ◽  
Endoscopic Variceal Ligation ◽  
Variceal Hemorrhage ◽  
Clinical Center ◽  
The Mean

Abstract Background Portal hypertension (PH) frequently gives rise to severe and life-threatening complications, including hemorrhage accompanied by the rupture of esophageal and gastric varices. In contrast to the widely studied guidelines for the management of PH in adults, there remains controversial about the optimal endoscopic management of variceal bleeding in children for secondary prophylaxis. The study aims to determine the efficacy and safety of endoscopic variceal ligation (EVL) and sclerotherapy (EST) to control bleeding in children in our clinical center. Methods The retrospective study included 21 children with gastroesophageal variceal bleeding who were treated by endoscopic variceal ligation or sclerotherapy at Xinhua Hospital, Shanghai Jiaotong University School of Medicine between January 2007 and July 2020. The treatment outcome involving short-term hemostatic rate and long-term rebleeding rate were investigated. Adverse events related to the procedures, such as esophageal ulcer, esophageal stricture, abnormal embolization, pneumonia and perforation were also observed. Results The 21 pediatric patients who were diagnosed as moderate to severe esophageal varices concurrent with gastric varices experienced EVL or EST successfully. Hemostasis was achieved in 45 of 47 (95.7%) episodes of upper gastrointestinal bleeding. The mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 mL (range: 0.1–0.5 mL). Twenty-four patients (75%) reach varices eradication in the EVL group with a median number of procedures before eradication of 2 (1–4) and a median time to eradication of 3.40 months (1.10-13.33). Eleven patients (52.4%) developed rebleeding events, with the mean duration of hemostasis being 11.1 ± 11.6 mo (range: 1.0-39.2 mo). No treatment-related complications, for example, distal embolism, were noted with the exception of abdominal pain in one patient (4.8%). Conclusions Endoscopic variceal sclerotherapy or in combination with EVL turns out to be an effective and safe approach to treat variceal hemorrhage in children for secondary prophylaxis.

scholarly journals Can the Computed Tomographic Aspect of Porto-Systemic Circulation in Cirrhotic Patients Be Associated with the Presence of Variceal Hemorrhage?

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 301
Author(s):  
Cosmin Caraiani ◽  
Bianca Petresc ◽  
Anamaria Pop ◽  
Magda Rotaru ◽  
Lidia Ciobanu ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Gastric Varices ◽  
Systemic Circulation ◽  
Variceal Hemorrhage ◽  
Left Gastric Vein ◽  
Ct Examination ◽  
Contrast Enhanced Ct ◽  
Cirrhotic Patients

Background and objectives: Variceal bleeding is a serious complication caused by portal hypertension, frequently encountered among cirrhotic patients. The purpose of this study was to determine whether the aspect of the collateral, porto-systemic circulation, as detected by CT are associated with the presence variceal hemorrhage (VH). Materials and Methods: 81 cirrhotic patients who underwent a contrast-enhanced CT examination were retrospectively included in the study. Patients were divided into two groups: Cirrhotic patients with variceal hemorrhage during the hospital admission concomitant, with the CT examination (n = 33) and group 2-cirrhotic patients, without any variceal hemorrhage in their medical history (n = 48). The diameter of the left gastric vein, the presence or absence and dimensions of oesophageal and gastric varices, paraumbilical veins and splenorenal shunts were the indicators assessed on CT. Results: The univariate analysis showed a significant association between the presence of upper GI bleeding and the diameters of paraoesophageal veins, paragastric veins and left gastric vein respectively, all of these CT parameters being higher in patients with variceal bleeding. In the multivariate logistic regression analysis, only the diameter of the left gastric vein was independently associated with the presence of variceal hemorrhage (OR = 1.6 (95% CI: 1.17–2.19), p = 0.003). We found an optimal cut-off value of 3 mm for the diameter of the left gastric vein useful to discriminate among patients with variceal hemorrhage from the ones without it, with a good diagnostic performance (AUC = 0.78, Se = 97%, Sp = 45.8%, PPV = 55.2%, NPV = 95.7%). Conclusions: Our observations point out that an objective CT quantification of porto-systemic circulation can be correlated with the presence of variceal hemorrhage and the diameter of the left gastric vein can be a reliable parameter associated with this condition.

scholarly journals A174 RARE BUT DEADLY: AN APPROACH TO MANAGEMENT OF DUODENAL VARICEAL HEMORRHAGE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 39-41
Author(s):  
M Dahiya ◽  
M Tomaszewski ◽  
G Ou ◽  
A Ramji
Keyword(s):  
Interventional Radiology ◽  
Case Report ◽  
Portal Hypertension ◽  
Literature Review ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Variceal Hemorrhage ◽  
Cyanoacrylate Glue ◽  
Duodenal Varices ◽  
Ectopic Varices

Abstract Background Common etiologies of upper gastrointestinal bleeding (UGIB) in cirrhotic patients with portal hypertension include gastroesophageal varices (GOV), portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE). Less commonly, patients with portal hypertension develop varices in ectopic sites, including the rectum, biliary tree and duodenum. Ectopic varices are rare, contributing to 1–5% of all variceal bleeding, of which 17% is from duodenal varices. Aims To describe the management of duodenal variceal hemorrhage. Methods A case report and literature review was performed. Results Case report: We present a case of recurrent UGIB in a 59-year-old male with decompensated cirrhosis due to non-alcoholic steatohepatitis (CP-C; Meld 14). Initial endoscopy was negative for GOV, peptic ulcer, PHG, and GAVE, but an erosion over a mucosal bulge in the third segment of the duodenum was identified, raising possibility of vascular malformation versus ectopic varix. There was active bleeding after water provocation, so clips were deployed for hemostasis. CT imaging showed mesenteric venous collaterals abutting the duodenum, again raising possibility of duodenal varix, which was ultimately confirmed by endoscopic ultrasound (EUS). Patient had recurrent overt bleeding despite beta-blockage for prophylaxis, endoscopic clipping on four separate occasions, attempted angioembolization by interventional radiology, and cyanoacrylate glue. Transjugular intrahepatic porto-systemic shunt (TIPS) was not possible due to portal vein occlusion, so he underwent EUS-guided cyanoacrylate glue a second time. Literature review: Ectopic varices are rare, contributing to 1–5% of all variceal bleeding, of which 17% is from duodenal varices. Duodenal variceal hemorrhage can lead to hemorrhagic shock, and is potentially life threatening, with quoted mortality rates of 40%. Unfortunately, duodenal varices can be difficult to identify. Diagnosis is often delayed due to a combination of lower awareness and endoscopic challenges given the unusual serosal and submucosal location. Evidence-based guidelines for the management of ectopic varices are limited. For this reason, our current management strategies rely heavily on local expertise. Splanchnic vasoconstrictor medication, endoscopic ligation, EUS guided gluing, interventional radiology guided embolization, TIPS, balloon retrograde transvenous obliteration and surgical shunts are potential therapeutic options to manage the acutely bleeding varix. Following a variceal bleed, liver transplantation should be considered in eligible patients with no other contraindications. Conclusions Duodenal varices are a rare, potentially fatal, and underrecognized cause of gastrointestinal bleeding in patients with portal hypertension. Definitive therapy currently relies upon local expertise in the absence of clear guideline-based therapy. Funding Agencies None

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

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hongjie Guo ◽  
Fabao Hao ◽  
Chunbao Guo ◽  
Yang Yu
Keyword(s):  
Logistic Regression ◽  
Variceal Bleeding ◽  
Collateral Circulation ◽  
Pediatric Patients ◽  
Venous Pressure ◽  
Multivariate Logistic Regression Analysis ◽  
Portal Venous Pressure ◽  
Endoscopic Sclerotherapy ◽  
Variceal Hemorrhage ◽  
Portal Cavernoma

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.

scholarly journals Non-cirrhotic portal hypertension: current concepts and modern management

2016 ◽  
Vol 43 (3) ◽  
pp. 170-176
Author(s):  
Md Ismail Patwary ◽  
Matiur Rahman ◽  
Kaushik Mojumder
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Gastric Varices ◽  
Idiopathic Portal Hypertension ◽  
Endoscopic Sclerotherapy ◽  
Cyanoacrylate Glue ◽  
Portal Fibrosis ◽  
Vascular Origin ◽  
Glue Injection

Non-cirrhotic portal hypertension (NCPH) is a heterogeneous group of liver disorders of vascular origin, leading to portal hypertension (PHTN) in the absence of cirrhosis.The lesions are generallyvascular, either in the portal vein, its branches or in the peri-sinusoidal area. The majority of diseases included in the category of NCPH are well-characterized disease entities where PHTN is a late manifestation. Two diseases that present only with features of PHTN and are common in developing countries are non-cirrhotic portal fibrosis (NCPF) and extrahepatic portal vein obstruction (EHPVO). Non-cirrhotic portal fibrosis is a syndrome of obscure etiology, characterized by ‘obliterative-portovenopathy’ leading to PHT, massive splenomegaly and well-tolerated episodes of variceal bleeding in young adults from low socioeconomic backgrounds, having near normal hepatic functions. In some parts of the world, NCPFis called idiopathic portal hypertension in Japan or ‘hepatoportalsclerosis’in USA. Because 85–95% of patient with NCPF and EHPVO present with variceal bleeding, treatment involves management with endoscopic sclerotherapy (EST) or variceal ligation (EVL). These therapies are effective in approximately 90–95% of patients. Gastric varices are another common cause of upper gastrointestinal bleeding in these patients and these can be managed with cyanoacrylate glue injection or surgery. The prognosis of patients with NCPF is good and 5 years survival in patients in whom variceal bleeding can be controlled has been reported to be approximately 95–100%.Bangladesh Med J. 2014 Sep; 43 (3): 170-176

TIPS in the Treatment of Variceal Bleeding

2017 ◽  
Vol 01 (04) ◽  
pp. 265-271
Author(s):  
Joseph Morrison ◽  
Andrew Lipnik ◽  
Ron Gaba
Keyword(s):  
Variceal Bleeding ◽  
Selection Criteria ◽  
Gastric Varices ◽  
Portosystemic Shunt ◽  
Variceal Hemorrhage ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Patient Selection Criteria ◽  
Early Tips

AbstractVariceal bleeding is a life-threatening complication of portal hypertension. In recent years, transjugular intrahepatic portosystemic shunt (TIPS) creation has cemented a role in the management of acute refractory bleeding and recurrent variceal hemorrhage. This article aims to review the use of TIPS in patients with variceal bleeding, with a focus on accepted procedure indications, patient selection criteria, TIPS technique, clinical outcomes, and contemporary issues, such as early TIPS in acute variceal hemorrhage, the role of adjuvant embolotherapy, and TIPS utility for gastric varices.

scholarly journals Endoscopic ultrasound coil placement of gastric varices: Emerging modality for recurrent bleeding gastric varices

2014 ◽  
Vol 05 (01) ◽  
pp. 024-026
Author(s):  
Yogesh Harwani ◽  
Mahesh Kumar Goenka ◽  
Vijay Rai ◽  
Usha Goenka
Keyword(s):  
Case Report ◽  
Endoscopic Ultrasound ◽  
Standard Of Care ◽  
Gastric Varices ◽  
Recurrent Bleeding ◽  
High Complication Rate ◽  
Cyanoacrylate Glue ◽  
Acute Variceal Bleeding ◽  
Probable Source ◽  
Glue Injection

AbstractGastric 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.

scholarly journals A META-ANALYSIS COMPARING THE EFFICACY AND SAFETY OF TERLIPRESSIN AND OCTREOTIDE IN THE MANAGEMENT OF ACUTE VARICEAL BLEEDING

2019 ◽  
pp. 73-76
Author(s):  
AKANKSHA MATHUR ◽  
ACHAL SHARMA
Keyword(s):  
Mortality Rate ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Variceal Hemorrhage ◽  
Randomized Control Trials ◽  
Efficacy And Safety ◽  
Acute Variceal Bleeding ◽  
Rebleeding Rate ◽  
Randomized Control ◽  
Overall Mortality

Objective: Various clinical trials have compared terlipressin and octreotide in the management of acute variceal bleed, but their results have been inconsistent. Therefore, the present meta-analysis was performed to compare the clinical efficacy and safety of terlipressin and octreotide and gather the strength of evidence regarding their use in variceal hemorrhage. Methods: Randomized control trials were identified using PubMed search engine and Cochrane clinical trial register (from 1994 to 2019). Initial hemostasis rate, rebleeding rate on the 5th day, and overall mortality rate during the study period were studied. The extracted data were analyzed using review manager 5.3 software. Odds ratio with 95% confidence intervals (CI) was estimated for the dichotomous outcomes. Results: A total of six randomized control trials were identified. Through comparisons of data for terlipressin and octreotide groups, we found no statistically significant differences in the initial hemostasis rate, rebleeding rate on the 5th day, and overall mortality rate between the different treatment approaches. Conclusion: The comparison of terlipressin and octreotide showed them to be equally effective and safe therapeutic agents in patients of acute variceal bleeding. Further, evidence from the future randomized controlled trials with higher quality and larger sample sizes is needed to confirm these findings.

scholarly journals Gastric Variceal Obliteration By Cyanoacrylate Glue Injection

2012 ◽  
Vol 7 (2) ◽  
pp. 44-46
Author(s):  
SMB Hussain ◽  
MR Hossain ◽  
MM Rahman ◽  
S Parvin ◽  
MD Hossain
Keyword(s):  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Gastric Varices ◽  
Oesophageal Varices ◽  
Cyanoacrylate Glue ◽  
Back Ground ◽  
Successful Control ◽  
Glue Injection

Introduction: Rupture Gastric varices (GVs) can lead to catastrophic gastrointestinal bleeding, though it is much less in number than that of rupture oesophageal varices (OVs). Successful haemostasis of such bleeding is difficult specially in the back ground of non availability of appropriate drugs and instruments. Case Report: Introduction of intra-variceal injection of cyanoacrylate glue since 1980s has changed the scenario, it is cheaper and effective in controlling GVs related bleeding. A case of successful control of gastric variceal bleeding is reported. DOI: http://dx.doi.org/10.3329/jafmc.v7i2.10397 JAFMC 2011; 7(2): 44-46

Sign in / Sign up

Export Citation Format

Share Document