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.

Portal hypertension and variceal bleeding

2020 ◽  
pp. 3068-3080
Author(s):  
Marcus Robertson ◽  
Peter Hayes
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Developed Countries ◽  
Gastric Varices ◽  
Secondary Prophylaxis ◽  
Medical Emergency ◽  
Endoscopic Management ◽  
Recurrent Bleeding ◽  
Endoscopic Variceal Ligation ◽  
Complications Of Cirrhosis

Portal hypertension refers to a pathological elevation of pressure in the veins that carry blood from the splanchnic organs to the liver which, in developed countries, most commonly results from increased intrahepatic resistance to portal flow as a result of liver cirrhosis. Portal hypertension is associated with development of many of the complications of cirrhosis and confers a poor prognosis. Acute variceal bleeding is a life-threatening medical emergency which remains a leading cause of death in patients with cirrhosis. Endoscopic variceal ligation and endoscopic variceal obturation remain the treatments of choice for bleeding oesophageal and gastric varices respectively. Advances in care including prophylactic antibiotics, vasoactive drugs, and transjugular intrahepatic portosystemic shunt in patients with bleeding refractory to early endoscopic management has improved the mortality rate, which is now estimated at 15 to 20%. Secondary prophylaxis of variceal bleeding with nonselective β‎-blockers and/or endoscopic variceal ligation reduces recurrent bleeding and has been demonstrated to improve survival.

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 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 Surgical treatment of gastroduodenal ulcer bleeding: Our experience

2007 ◽  
Vol 54 (1) ◽  
pp. 165-167
Author(s):  
S.N. Krstic ◽  
T. Alempijevic ◽  
M.N. Krstic ◽  
Z.D. Lausevic ◽  
A. Sijacki ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Gastroduodenal Ulcer ◽  
Treatment Options ◽  
Ulcer Bleeding ◽  
Endoscopic Management ◽  
Ulcer Disease ◽  
Endoscopic Techniques ◽  
Clinical Center ◽  
The Mean ◽  
Gastroduodenal Ulcer Bleeding

Introduction: Acute bleeding from the upper gastrointestinal tract remains the commonest emergency in gastroenterology, and is most often caused by gastroduodenal ulcer disease. Despite introduction of novel endoscopic techniques and pharmacological treatment, 6-15% patients have to be operated. The aim of our investigation is analyze data of patients treated for gastrointestinal ulcer bleeding in our institution, their treatment options and outcome. Patients and methods: We included 2237 patients admitted in the Department for Emergency medicine of Clinical center of Serbia during the period from January 1999 until December 2003. because of gastroduodenal ulcer bleeding. We analyzed age, gender treatment option, hospital stay and mortality. Results: The mean age of our patients was 61.58 years, 1346 male and 891 female. The majority of patients were conservatively treated (84.5%). Operated patients mostly undergo Billroth II resection (57.8%). The mean hospital stay was 7.3 days. Average mortality was 14.4% Conclusions: Despite adequate endoscopic management of bleeding gastroduodenal ulcer, surgeons will continue to treat this patients for emergency surgery.

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.

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 Management of variceal hemorrhage: current concepts

2014 ◽  
Vol 27 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Fabricio Ferreira COELHO ◽  
Marcos Vinícius PERINI ◽  
Jaime Arthur Pirola KRUGER ◽  
Gilton Marques FONSECA ◽  
Raphael Leonardo Cunha de ARAÚJO ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Surgical Treatment ◽  
Variceal Bleeding ◽  
Endoscopic Therapy ◽  
Beta Blockers ◽  
Primary Prophylaxis ◽  
Underlying Disease ◽  
Secondary Prophylaxis ◽  
Variceal Hemorrhage ◽  
Cirrhotic Patients

INTRODUCTION: The treatment of portal hypertension is complex and the the best strategy depends on the underlying disease (cirrhosis vs. schistosomiasis), patient's clinical condition and time on it is performed (during an acute episode of variceal bleeding or electively, as pre-primary, primary or secondary prophylaxis). With the advent of new pharmacological options and technical development of endoscopy and interventional radiology treatment of portal hypertension has changed in recent decades. AIM: To review the strategies employed in elective and emergency treatment of variceal bleeding in cirrhotic and schistosomotic patients. METHODS: Survey of publications in PubMed, Embase, Lilacs, SciELO and Cochrane databases through June 2013, using the headings: portal hypertension, esophageal and gastric varices, variceal bleeding, liver cirrhosis, schistosomiasis mansoni, surgical treatment, pharmacological treatment, secondary prophylaxis, primary prophylaxis, pre-primary prophylaxis. CONCLUSION: Pre-primary prophylaxis doesn't have specific treatment strategies; the best recommendation is treatment of the underlying disease. Primary prophylaxis should be performed in cirrhotic patients with beta-blockers or endoscopic variceal ligation. There is controversy regarding the effectiveness of primary prophylaxis in patients with schistosomiasis; when indicated, it is done with beta-blockers or endoscopic therapy in high-risk varices. Treatment of acute variceal bleeding is systematized in the literature, combination of vasoconstrictor drugs and endoscopic therapy, provided significant decline in mortality over the last decades. TIPS and surgical treatment are options as rescue therapy. Secondary prophylaxis plays a fundamental role in the reduction of recurrent bleeding, the best option in cirrhotic patients is the combination of pharmacological therapy with beta-blockers and endoscopic band ligation. TIPS or surgical treatment, are options for controlling rebleeding on failure of secondary prophylaxis. Despite the increasing evidence of the effectiveness of pharmacological and endoscopic treatment in schistosomotic patients, surgical therapy still plays an important role in secondary prophylaxis.

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