scholarly journals A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Hany El-Assaly ◽  
Lamiaa I. A. Metwally ◽  
Heba Azzam ◽  
Mohamed Ibrahim Seif-Elnasr
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Imaging Modality ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

scholarly journals AGREEMENT BETWEEN MULTIDETECTOR COMPUTED TOMOGRAPHY AND ENDOSCOPY FOR THE EVALUATION OF GASTRO-ESOPHAGEAL VARICES IN PATIENTS WITH PORTAL HYPERTENSION.

2021 ◽  
pp. 1-3
Author(s):  
Mehak Garg ◽  
Nirmal Kumar Prabhu ◽  
Shivane Garg ◽  
Saravanan S ◽  
Rubalakshmi S ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Gold Standard ◽  
Gastric Fundus ◽  
Observer Agreement ◽  
Gastroesophageal Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy

Aim: The aim is to study the agreement between MDCT and endoscopy in diagnosing gastroesophageal varices in patients of chronic liver disease with portal hypertension, keeping endoscopy as gold standard. Materials and Methods: The study included 29 cirrhotic patients with portal hypertension assessed between August 2018 to August 2020 who underwent upper gastrointestinal (GI) endoscopy and MDCT within 12 weeks. Two radiologists reviewed the scans, to determine the grade of esophageal varices. To evaluate the accuracy of MDCT findings by Radiologists 1 and 2 with respect to endoscopy findings (GOLD STANDARD), McNemar’s chi square test with validity parameters such as Sensitivity, Specificity, Positive predictive value, Negative predictive value and accuracy was computed. Cohens kappa was used to ascertain the inter-observer agreement for grading of varices between MDCT and endoscopy. Results: The sensitivity of MDCT for radiologist A was 76.7%, specificity 93%, Accuracy 89.7%, PPV 91.6%, NPV 93.9% and for radiologist B, 79%, 93.4%, 89.6%, 81.4% and 93.1% respectively. For the inter-rater agreement the kappa value between Radiologist A v/s upper GI endoscopy was 0.716, Radiologist B v/s upper GI endoscopy was 0.720 and Radiologist A v/s Radiologist B was 0.808. MDCT detected para esophageal varices in 16 cases, gastric fundus varices in 9 cases and splenorenal collaterals in 3 cases, palisade vein dilatation was positive in 9 cases, negative in 20 cases. 3 cases of HCC were incidentally found during examination. Conclusion: MDCT is a good replacement for endoscopy in the detection of gastroesophageal varices, especially those with high grade varices (grade 2 and 3). MDCT helps in detection of palisade vein and other extra-luminal findings like HCC, other portosystemic collaterals.

scholarly journals Correlation between Serum-Ascites Albumin Gradient and Esophageal Varices in Portal Hypertension due to Cirrhosis of Liver

2021 ◽  
Vol 4 (1) ◽  
pp. 1-6
Author(s):  
Dinesh Koirala ◽  
Krishna Chandra Devkota ◽  
Ugra Narayan Pathak ◽  
Prabin Adhikari ◽  
Nirmal Ghimire
Keyword(s):  
Portal Hypertension ◽  
Positive Predictive Value ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Cirrhosis Of The Liver ◽  
Gi Endoscopy ◽  
Positive Correlation ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Cirrhosis Of Liver

Introduction: Cirrhosis of the liver is a major health problem in our country.  Patients with cirrhosis are at risk of developing esophageal varices and variceal bleeding with high mortality. They must undergo routine upper gastrointestinal endoscopy to screen for the presence of varices. This poses an economic, social, and medical burden. Thus, this warrants a non-invasive predictor of esophageal varices in a cirrhotic patient. The aim of this study was to find the correlation between SAAG and esophageal varices in portal hypertension due to cirrhosis of liver. Methods: Patients (45 males and 35 females) above 18 years of age and with cirrhosis of the liver underwent cross sectional observational study at Nepal Medical College Teaching hospital between October 2015 and December 2017 AD. Serum albumin and ascitic fluid albumin were analyzed on the same day and serum-ascites albumin gradient (SAAG) was calculated. Upper GI endoscopy was done to evaluate for the presence of esophageal and gastric varices. Pearson's chi-square test was applied to see the relation between SAAG and esophageal varices.  Results: Among the 80 patients studied, 56.2% were male and  93.75%  had varices. Majority of the patients who had esophageal varices had SAAG of more than 1.1 g/dL. A positive correlation was found between serum-ascites-albumin gradient and esophageal varices but was statistically not significant. A cut-off of  >1.6 for SAAG to discriminate between presence and absence of varices yielded a sensitivity of 78.66% and a positive predictive value of 92.18%. Conclusion: This study highlighted that SAAG has a positive correlation with esophageal varices with high sensitivity and positive predictive value in estimating the presence of varices but without statistical significance. It has a low specificity. Due to statistically insignificant correlation and low specificity, SAAG cannot be used in place of upper GI endoscopy in diagnosing gastroesophageal varices

scholarly journals A73 PHARYNGEAL VARICES AS A COMPLICATION OF PORTAL HYPERTENSION: A CASE SERIES

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 86-88
Author(s):  
J Ghaith ◽  
P James ◽  
F Wong
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Splenic Vein ◽  
Case Series ◽  
Brachiocephalic Vein ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Ectopic Varices ◽  
Collateral Vessels

Abstract Background One of the complications of portal hypertension, with or without the presence of cirrhosis, is the development of varices along the length of the gastrointestinal tract. The commonest sites are along the esophagus or in the stomach. Ectopic varices in the small and large bowels can also be observed, but ectopic varices in the pharynx are extremely uncommon. Aims To present a case series and review the literature regarding pharyngeal varcies. Methods - Results Three elderly female patients presented for esophagogastric varices surveillance gastroscopy were diagnosed with pharyngeal varices. One patient has hepatitis C cirrhosis, while the other two non-cirrhotic patients have myeloproliferative neoplasm (MPN). None of the patients had thromboses of the portal vein or its tributaries. All three patient have concomitant esophageal varices, but only one required band ligation of her esophageal varices. All patients are asymptotic except for mild dysphagia. No patient has bled from their pharyngeal varices to date. Two patients have had prophylactic treatment of their portal hypertension with non-selective beta blocker (NSBB), while the third one has not received NSBB prophylaxis because of her age. Conclusions Pharyngeal varices are extremely rare. To date, there are three case reports in the literature, however, we have been able to identify three cases in our practice. The previous two cases reported possible left-sided portal hypertension with splenic vein thrombosis, leading to the development of collateral vessels including a gastrocaval shunt, which by some contiguous route connects to the brachiocephalic vein; and a third case was a complication of neck dissection surgery. In our case series, none of our patients had splenic vein thrombosis. However, none of them has had a careful CT angiogram to delineate the portal vein tributaries and the collateral vessels, which may further help to define their pathogenesis. It is unclear whether NSBB would be effective as primary prophylaxis against their bleeding, The plan is to continue to monitor these patients to learn about the natural history of these pharyngeal varices. Funding Agencies None

scholarly journals Upper GI Endoscopy in Children: An Experience from Bangabandhu Sheikh Mujib Medical University (BSMMU)

2017 ◽  
Vol 40 (1) ◽  
pp. 17-20
Author(s):  
Md Wahiduzzaman Mazumder ◽  
Md Rukunuzzaman ◽  
Atiar Rahman ◽  
SM Baqui Billah ◽  
Kaniz Sultana ◽  
...  
Keyword(s):  
Esophageal Varices ◽  
Common Finding ◽  
Gi Bleeding ◽  
Gi Endoscopy ◽  
Upper Gi Bleeding ◽  
Endoscopic Findings ◽  
Upper Gi ◽  
Post Procedure ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal (UGI) endoscopy is a safe and sensitive investigation in the diagnosis of upper gastrointestinal diseases. There is limited study on paediatric upper GI endoscopy in our country. This study was done only in BSMMU, a tertiary care health facility of Bangladesh.Objectives: The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children.Methods: This is a retrospective analysis of 100 patients from August 2013 to October 2014. The indications for UGI endoscopy, common endoscopic findings and immediate post procedure complications were collected from case recording &were analyzed.Results: The commonest indication was upper GI bleeding in the form of hematemesis with or without melenae (41%). The most common finding was esophageal varices (49%). Less common findings were esophagitis, gastritis & gastro-duodenal ulcer. There was no post procedure complication.Conclusion: In the study, the commonest indication for Pediatric UGI endoscopy was upper GI bleeding and the commonest endoscopic abnormality was esophageal varices. No immediate post procedure complication was noted in the study.Bangladesh J Child Health 2016; VOL 40 (1) :17-20

scholarly journals Correlation of portal vein diameter with the presence of oesophageal varices in chronic liver disease: a prospective study

2018 ◽  
Vol 5 (4) ◽  
pp. 859 ◽  
Author(s):  
Suraj Uppalapati ◽  
Lokesh S.
Keyword(s):  
Portal Vein ◽  
Esophageal Varices ◽  
Previous History ◽  
Oesophageal Varices ◽  
Upper Gastrointestinal Endoscopy ◽  
Non Invasive ◽  
Upper Gi ◽  
Vein Diameter ◽  
Cirrhosis Of Liver ◽  
A Prospective Study

Background: Guidelines recommends upper gastrointestinal endoscopy for all the patients with cirrhosis of liver to rule out portal hypertension. Many patients may not be willing to undergo this unpleasant procedure or resources may not be available. In this study, authors aim to identify the effectiveness of portal vein size as a non-invasive predictor of esophageal varices.Methods: In this prospective observational study of 30 patients, patients with liver cirrhosis without a previous history of upper GI bleeding were included between November 2012 and October 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of portal vein diameter.Results: Out of the study population 70% of the patients had Oesophageal varices. Ultrasonography abdomen showed portal vein dilatation(>13mm) in 66.6% cases. The mean portal vein diameter in our study group was 13.1mm and majority of patients had portal vein between 13-13.9 mm (43.3%). A cut-off point of more than 13 mm had strong significant relationship (p<0.01) with presence of esophageal varices (sensitivity of 100%, specificity of 90% and positive predictive value of 95.24%). Higher grades of esophageal varices exists with larger portal vein size.Conclusions: From present study, authors conclude that portal vein size and its dilatation detected ultrasonographically can determine the presence of esophageal varices and can hence identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being non-invasive, portal vein diameter is a relatively inexpensive and easily reproducible parameter.

scholarly journals Upper Gi Endoscopy-indications and Findings at Tertiary Care Hospital Hyderabad/Jamshoro

2021 ◽  
pp. 46-50
Author(s):  
Jalpa Devi ◽  
Muhammad Akram Bajwa ◽  
Nasrullah Aamer ◽  
Rabia Farooque ◽  
Hira Laghari ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Chronic Liver ◽  
Care Hospital ◽  
Gi Endoscopy ◽  
Endoscopic Findings ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Gi Bleed

Objective: To document different indications and findings of upper GI Endoscopy in our endoscopy suite. Methods: A descriptive study of 500 patients who underwent upper gastrointestinal (UGI) endoscopy was conducted in the Endoscopy Unit of PNS DRIGH LUMHS Jamshoro and Civil Hospital Hyderabad from April to September 2020. Included patients underwent UGI endoscopy. Demographic data including indications and endoscopic findings of the patients was collected via study proforma. Results: Total five hundred patients were studied; their mean age was 42.4±16.8 years. Out of all 52.8% were males. Upper GI bleed was the commonest indication (33.2%) followed by dysphagia (21.6%), epigastrium pain (10%), surveillance and screening of varices (9% and 8.2% respectively).  The most common endoscopic findings were esophageal varices (32.2 %), gastritis (18.8%), and normal (11.4%). In patients with esophageal varices, 77.4% had chronic liver disease with positive serology for HCV and HBV in 63.4% and 23% respectively. Conclusion: The most common indication was upper GI bleed with esophageal varices for upper GI endoscopy. The underlying etiology of varices reflects the high burden of chronic liver disease due to viral hepatitis.

scholarly journals Portal Hypertensive Polyps as Gastroscopic Finding in Liver Cirrhosis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Firdevs Topal ◽  
Sabiye Akbulut ◽  
Cengiz Karahanlı ◽  
Süleyman Günay ◽  
Elif Sarıtaş Yüksel ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Polypoid Lesion ◽  
Healthy Control Group ◽  
Control Group ◽  
Esophageal Variceal ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Healthy Control ◽  
Upper Gi Endoscopy

Background. Portal hypertensive polyps in patients with portal hypertension are described. Aims. The most significant and serious complication in liver cirrhosis proves to be portal hypertension. Polypoid lesions, which can be seen in the stomach as endoscopic finding in patients with portal hypertension, have not quite been defined in the literature. The aim of this study, therefore, was to define polypoid lesion formation due to portal hypertension in the upper gastrointestinal system in patients with portal hypertension. Study Design. Cross-sectional study. Methods. The study covered a group of patients with liver cirrhosis and a healthy control group that did not have portal hypertension. All individuals covered by the study received upper GI endoscopy, while the endoscopic features and pathological characteristics of the identified polypoid lesions were defined. Standard histological criteria were used in polyp diagnosis. Results. A total of 400 individuals were included in the study. Upper GI endoscopy was performed for 200 patients with liver cirrhosis and another 200 healthy individuals with no portal hypertension in the control group. When the cases were gastroscopically assessed with regard to polypoid lesion presence, it was seen that a total of 87 (21.8%) individuals had polyps. While 67 (33.5%) cirrhotic patients were identified to have polyps, 20 (10%) individuals in the healthy control group had polyps. When the results of those with liver cirrhosis who received esophageal variceal endoscopic band ligation (EVL) and who did not were compared, it was observed that a higher number of individuals in the group with EVL had polypoid lesions. When the patient and control groups were compared as to Helicobacter pylori presence, the results showed that it was slightly higher in the dyspepsia group but the difference was not statistically significant (p>0.05). Conclusion. Portal hypertension-associated polypoid lesions are common in advanced liver cirrhosis cases. The pathological analyses of these polyps pointed out that they were all benign and no malignant cases were detected. It was argued that these polypoid lesions, referred to as portal hypertensive polyps, were associated with elevated angiogenesis in the gastric mucosa.

Correlation of Portal and Splenic Vein Diameter with Presence and Size of Esophageal and Gastric Varices in Liver Cirrhosis Patients on MDCT

2020 ◽  
Vol 10 (2) ◽  
pp. 2-8
Author(s):  
Anamika Jha ◽  
Yusra Ali ◽  
Ghanshyam Gurung ◽  
Ranjit Kumar Chaudhary ◽  
Akhilesh Kumar Kasyap
Keyword(s):  
Computed Tomography ◽  
Portal Hypertension ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Inclusion Criteria ◽  
Left Gastric Vein ◽  
Gastroesophageal Varices ◽  
Non Invasive ◽  
Vein Diameter ◽  
Ethical Clearance

Introduction: Variceal formation depends upon the pattern of dilatation of the portal and various splanchnic veins in patients with cirrhotic liver and portal hypertension. Multidetector Computed Tomography (MDCT) may be helpful in the evaluation of such gastroesophageal varices and predicting their risk of haemorrhage.Methods: After obtaining ethical clearance and consent, 50 patients meeting the inclusion criteria were included and MDCT obtained. The diameters of the portal vein (PV), splenic vein (SV) and left gastric vein (LGV) were measured and originating vein of LGV determined. Pattern, location and diameter of varix was evaluated. Association between the diameters of the originating vein and the grade and pattern of the esophagael and gastric fundic varices was determined.Results: Of the 50 patients, 41 had gastroesophageal (GE) varices equal to or larger than 1mm with 34% having high-risk varices. The SV was predominantly the originating vein of the LGV. Cutoff SV diameter of 7.75mm and LGV diameter of 5.75mm had a sensitivity of 77.8% with a specificity of 73.2% and 75.6% respectively for the presence of varices.Conclusions: In our study, EV and GEV was more common and mostly supplied by LGV while isolated gastric fundic varices were supplied by non LGV veins only. The diameters of SV and LGV were associated with the presence and grade of esophageal and gastric fundic varices. MDCT is an important non-invasive modality in patients with portal hypertension and should be used for diagnosis, risk stratification and monitoring of varices.

scholarly journals Relationship between hemodynamic parameters and portal venous pressure in cirrhosis patients with portal hypertension

2020 ◽  
Vol 15 (1) ◽  
pp. 981-987
Author(s):  
Hongjuan Yao ◽  
Yongliang Wang
Keyword(s):  
Portal Hypertension ◽  
Liver Function ◽  
Portal Vein ◽  
Doppler Ultrasound ◽  
Venous Pressure ◽  
Splenic Vein ◽  
Portal Venous Pressure ◽  
Control Group ◽  
Hemodynamic Parameters ◽  
Vein Diameter

AbstractCirrhosis caused by viral and alcoholic hepatitis is an essential cause of portal hypertension (PHT). The incidence of PHT complication is directly proportional to portal venous pressure (PVP), and the clinical research of PVP and its hemodynamic indexes is of great significance for deciding the treatment strategy of PHT. Various techniques are currently being developed to decrease portal pressure but hemodynamic side effects may occur. In this article, the hemodynamic indexes of cirrhotic PHT patients were studied to explore the correlation between the index and PVP and to evaluate the clinical value of Doppler ultrasound in measuring PVP in patients with PHT. This was achieved by selecting 90 cirrhotic PHT patients who underwent transjugular intrahepatic portosystemic shunt in our hospital from June 2015 to September 2019. Fifty healthy people who had a physical examination in the hospital in the same period were selected as the control group. The liver hemodynamic parameters of two groups were measured by Doppler ultrasound, and the cirrhotic PHT patients were graded by the Child–Pugh grading method to evaluate the liver function and measure the PVP value. The results showed that both the central portal vein velocity (PVV) and splenic vein velocity (SVV) of the PHT group were lower than those of the control group. Also, the portal vein diameter (PVD), portal venous flow and splenic vein diameter (SVD) were higher than those of the control group (all Ps < 0.05). Among liver function graded PHT patients, the PVD, PVV, SVD and SVV were significantly different (all Ps < 0.05). Furthermore, the PVP of patients with liver function grades A, B and C was 38.9 ± 1.4, 40.6 ± 5.1 and 42.5 ± 4.8 cmH2O, respectively, with a significant difference. It can be concluded from this study that Doppler ultrasound can be used as a tool for clinical assessment of PHT in cirrhosis patients. Doppler ultrasound showed a good prospect in noninvasive detection of PHT in cirrhosis; however, this technique needs application on large sample population study to validate the results.

USE OF ROADMAP FLUOROSCOPY IN UPPER GI ENDOSCOPY

2020 ◽  
Author(s):  
J Weigt ◽  
W Elhossary ◽  
W Obst ◽  
P Maciej
Keyword(s):  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy
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