scholarly journals Variceal bleeding caused by oesophageal varices: A manifestation of hepatocellular carcinoma in a 17-year-old girl

2015 ◽  
Vol 3 ◽  
pp. 2050313X1561979
Author(s):  
Saadia Sasha Ali ◽  
Samuel N Sanmuganathan
Keyword(s):  
Hepatocellular Carcinoma ◽  
Variceal Bleeding ◽  
Oesophageal Varices

Endogenous Heparinoids Detected by anti-Xa Activity are Present in Blood during Acute Variceal Bleeding in Cirrhosis. A Prospective Study

2014 ◽  
Vol 23 (2) ◽  
pp. 187-194 ◽  
Author(s):  
Christos Triantos ◽  
Emmanuel Louvros ◽  
Maria Kalafateli ◽  
Anne Riddell ◽  
Ulrich Thalheimer ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Variceal Bleeding ◽  
Blood Cells ◽  
Venous Pressure ◽  
White Blood Cells ◽  
International Normalized Ratio ◽  
Ulcer Bleeding ◽  
Factor X ◽  
Packed Red Blood Cells ◽  
Bacterial Peritonitis

Background & Aims: Endogenous heparinoids have been detected by thromboelastography and quantified by clotting based anti-Xa activity assays in patients with cirrhosis, but their presence in variceal bleeding has not been established yet.Methods: Clotting based anti-Xa activity was measured in A) 30 cirrhotics with variceal bleeding, B) 15 noncirrhotics with peptic ulcer bleeding, C) 10 cirrhotics without infection or bleeding, and D) 10 cirrhotics with hepatocellular carcinoma (HCC).Results: Anti-Xa activity was not detected in ulcer bleeders or in cirrhotics without infection or bleedingbut was present in seven (23%) variceal bleeders (median levels: 0.03 u/mL (0.01-0.07)) and was quantifiable for 3 days in six of seven patients. Four of seven variceal bleeders with anti-Xa activity present had HCC (p=0.023). Age, creatinine, platelet count and total infections the second day from admission were significantly correlated with the presence of measureable anti-Xa levels (p=0.014, 0.032, 0.004 and 0.019, respectively). In the HCC group, anti-Xa activity was present in three patients (30%) [median levels: 0.05 u/mL (0.01-0.06)].Conclusions: In this study, variceal bleeders and 30% of the patients with HCC had endogenous heparinoids that were detected by a clotting based anti-Xa activity assay, whereas there was no anti Xa activity present in patients with cirrhosis without infection, or bleeding or HCC, nor in those with ulcer bleeding. Thus, the anti-Xa activity is likely to be a response to bacterial infection and/or presence of HCC in cirrhosis.List of abbreviations: AFP, alpha-fetoprotein; aPTT, activated partial thromboplastin time; CP, Child-Pugh; FXa, activated factor X; GAGS, glycosaminoglycans; Hb, hemoglobin; HCC, hepatocellular carcinoma; HVPG, hepatic venous pressure gradient; INR, International normalized ratio; LMWHs, low molecular weight heparins; MELD, Model for End-stage Liver Disease; PPP, platelet-poor plasma; PRBC, packed red blood cells; PT, prothrombin time; SBP, sponataneous bacterial peritonitis; TEG, thromboelastography; WBC, white blood cells.

EFFICACY OF CARVEDILOL COMBINED WITH ENDOSCOPIC VARICEAL LIGATION IN THE PREVENTION OF RECURRENT VARICEAL BLEEDING IN PATIENTS OF CIRRHOSIS

2016 ◽  
pp. 23-30
Author(s):  
Van Huy Tran ◽  
Thi Ngoc Diep Bui
Keyword(s):  
Side Effects ◽  
Beta Blocker ◽  
Variceal Bleeding ◽  
Poor Prognosis ◽  
Oesophageal Varices ◽  
Endoscopic Variceal Ligation ◽  
Efficacy And Safety ◽  
Orthostatic Hypertension ◽  
Key Words Carvedilol ◽  
Very High

Background: The recurrent variceal bleeding is still very high with a very poor prognosis. The combination of a non-selective beta-blocker and endoscopic variceal ligation (EVL) is still a standard therapy for the prevention, but many patients showed no response to propranolol. Carvedilol is a new, non-selective beta-blocker having intrinsic alpha-blocker activity, but the data about the efficacy and safety of carvedilol is still very limited. This study is aimed at assessing the efficacy and safety of carvedilol combined with EVL in the prevention of recurrent variceal bleeding. Patients and methods: 33 patients having variceal bleeding were enrolled. All patients received carvedilol and were performed the EVL until variceal eradication. All the patients were followed after 9 months. Results: rate of variceal eradication of oesophageal varices was 87.88%; the recurrence rate of variceal bleeding was 12.12% after 9 months. The side effects of carvedilol were rare and not severe, including vertiges, headache, and orthostatic hypertension. Conclusion: Carvedilol combined with EVL appeared as a relatively safe and effective in the prevention of recurrent variceal bleeding in patients of cirrhosis. Key words: carvedilol, variceal bleeding, EVL

scholarly journals Does sclerotherapy of remnant little oesophageal varices after endoscopic ligation have impact on the reduction of recurrent varices?: Prospective study

2011 ◽  
Vol 139 (5-6) ◽  
pp. 328-332 ◽  
Author(s):  
Sasa Grgov ◽  
Perica Stamenkovic
Keyword(s):  
Variceal Bleeding ◽  
Injection Sclerotherapy ◽  
Oesophageal Varices ◽  
Endoscopic Injection ◽  
Band Ligation ◽  
Significant Difference ◽  
Endoscopic Band Ligation ◽  
The Difference ◽  
Variceal Recurrence ◽  
Endoscopic Ligation

Introduction. Endoscopic band ligation (EBL) is superior to endoscopic injection sclerotherapy (EIS) of oesophageal varices, however, EBL is associated with a higher rate of variceal recurrences. Objective. To examine whether the reduction of recurrent varices can be achieved by additional sclerotherapy of remnant little varices after ligation. Methods. Forty-eight patients with liver cirrhosis who had previously bled from oesophageal varices were examined. Endoscopic therapy was performed in order to prevent recurrent variceal bleeding. I group: in 23 patients ligation of oesophageal varices with multi band ligation device was applied (EBL group). II group: in 25 patients sclerotherapy using polydocanol or absolute alcohol was applied after reducing the size of varices using ligation (EBL and EIS group). Results. There was no statistically significant difference between the examined groups of patients in relation to the number of sessions for variceal eradication, recurrence of variceal bleeding, deterioration of portal gastropathy and mortality in the observed period from 18.8?18.6 months (EBL group) and 22.2?26.2 months (EBL and EIS group). Variceal recurrence was verified in 21.7% of patients of the EBL group and 16% of the EBL and EIS group, but the difference was not statistically important. Several complications, such as dysphagia and chest pain, were statistically more frequent in the EBL and EIS group of patients. Conclusion. The combined method of ligation and extra sclerosing of remnant small oesophageal varices after ligation does not have advantage in relation to the ligation alone.

scholarly journals Prophylactic Endoscopic Therapy for Variceal Bleeding in Patients with Hepatocellular Carcinoma

2019 ◽  
Vol 10 (14) ◽  
pp. 3087-3093
Author(s):  
Jie Chen ◽  
Yujen Tseng ◽  
Tiancheng Luo ◽  
Na Li ◽  
Lili Ma ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Variceal Bleeding ◽  
Endoscopic Therapy

Surgery for hepatocellular carcinoma presenting with variceal bleeding: The eastern experience

2015 ◽  
Vol 113 (2) ◽  
pp. 165-174 ◽  
Author(s):  
Tian Yang ◽  
Haiguan He ◽  
Jianyong Yuan ◽  
Jin Zhang ◽  
Junhua Lu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Variceal Bleeding

Treatment of Acute Oesophageal Variceal Bleeding by Transgastric Ligation

1987 ◽  
Vol 17 (3) ◽  
pp. 113-116
Author(s):  
H P Dass ◽  
S J Wilson ◽  
P R S Kurup
Keyword(s):  
Liver Failure ◽  
Variceal Bleeding ◽  
Effective Control ◽  
Oesophageal Varices

This paper presents the results of transgastric ligation of oesophageal varices (Ong's operation), performed on 7 patients at Khoula Hospital between June 1983 and July 1985. Effective control of bleeding was obtained in every case. There were three deaths due to liver failure. Four patients are symptom-free after a period of 12–18 months follow up.

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