Clinical correlation between Child Pugh’s score and oesophageal varices in upper gastrointestinal endoscopy in cirrhotic patient

Background: Bleeding oesophageal varices are a major complication of portal hypertension following liver cirrhosis. Child Pugh’s score has been used as a prognostic tool while managing a patient with liver cirrhosis.Objective: To clinically correlate Child Pugh’s score and oesophageal varices in upper gastrointestinal endoscopy in cirrhotic patient.Methods: This is a prospective descriptive study done from January 2014 to January 2015. Cirrhotic patients who were referred for upper gastrointestinal endoscopy with or without history of upper GI bleeding were included. Patients were categorized according to Child Pugh’s score into A, B, C and correlated with their endoscopic finding of grading of varices.Results: A total of 50 cirrhotic patients underwent upper gastrointestinal endoscopy during one year. Out of which 60% were in Child Pugh’s category A, 30 % in category B and 10 % in category C. Among them 62% had grade I varices, 20% had grade II varices and 18 % had grade III varices. Those who presented with history of hematemesis had higher grades of oesophageal varices in comparison to those without hematemesis.Conclusion: Cirrhotic patients with higher Child Pugh’s score had higher grades of oesophageal varices leading presentation with hematemesis. Hence, routine screening of cirrhotic patient is necessary before the development of varices.

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CIRRHOTIC PATIENTS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.09.1705 ◽

2016 ◽

Vol 23 (09) ◽

pp. 1099-1103

Author(s):

Abdul Aziz Sahto ◽

Amir Shahzad ◽

Mahnaz Faiz Sahito

Keyword(s):

Liver Cirrhosis ◽

Gastrointestinal Endoscopy ◽

Lateral Position ◽

Outcome Variable ◽

Upper Gastrointestinal Endoscopy ◽

Care Hospital ◽

Left Lateral Position ◽

History Of ◽

Cirrhotic Patients ◽

Upper Gastrointestinal

Objectives: The aim behind this study was to determine the prevalence of portalhypertensive gastropathy in cirrhotic patients undergoing upper gastrointestinal endoscopy at atertiary care hospital in Shaheed Benazeerabad. Study Design: Hospital based cross sectionalstudy. Setting: Medicine Department of People’s Medical University, Shaheed Benazeerabad.Period: Six months from 20th August 2014 to 21st February 2015. Material and Methods: Atotal of 115 patients presenting with variceal bleeding (having history of liver cirrhosis since>2 years) and who further was undergoing diagnostic Endoscopic gastrodudenoscopy wereenrolled in the study. All endoscopies were performed by the endoscopists using a GIFQ 160Gastroscope (Olympus, Tokyo, Japan) in the left lateral position. The presence or absenceof PH gastropathy (outcome variable) was noted at each endoscopy. SPSS version 17.0 wasused to analyze the collected data. Results: The average age of the patients was 39.98±11.02years and mean duration of liver cirrhosis was 4.62±1.5 years. There were 70 (60.87%) maleand 45 (39.13%) were female. Regarding socioeconomic status, most of the cases were inlower and middle class. Frequency of portal hypertensive gastropathy (PHG) in patients of livercirrhosis undergoing upper gastrointestinal endoscopy was observed in 60% (69/115) cases.Conclusion: The frequency of PHG was 60% in the studied group of cirrhotic patients. Thisconcludes that if in the liver cirrhosis patients early identification and appropriate therapeuticmeasures of PHG is taken the morbidity in these patients can be decreased.

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Endoscopic variceal sclerotherapy in patients with Symmers periportal fibroses

Tropical Doctor ◽

10.1258/004947507781524719 ◽

2007 ◽

Vol 37 (3) ◽

pp. 179-181 ◽

Cited By ~ 8

Author(s):

H M Y Mudawi ◽

K B Ibrahim

Keyword(s):

Gastrointestinal Endoscopy ◽

Gastric Varices ◽

Oesophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

Predictive Risk Factor ◽

Predictive Risk ◽

One Year ◽

A Prospective Study ◽

Upper Gastrointestinal

This is a prospective study, carried out in patients with portal hypertension and bleeding oesophageal varices secondary to Symmers (Schistosomal) periportal fibroses, to determine the efficacy of sclerotherapy, the number of sessions needed to achieve full sclerosis, the complications associated with sclerotherapy and the incidence and risk factors for rebleeding. In total, 85 patients were studied with a mean age of 38 years, 76.5% were males. All underwent upper gastrointestinal endoscopy, had different grades of oesophageal varices and underwent intravariceal injection with 5% ethanolamine oleate until they achieved full sclerosis or were referred to surgery. Complications of sclerotherapy included oesophageal strictures, deep oesophageal ulcers, pleural effusion and ascites. Following obliteration of oesophageal varices, 3.5% and 20% developed new gastric varices and portal gastropathy, respectively. Rebleeding occurred in 32% - the only significant predictive risk factor for which was patients with GIII varices following the first sclerotherapy session. Varices recurred in 6% of patients after a mean follow-up period of one year. In total, 93% of our patients achieved full sclerosis after an average of four sessions, and 3.5% were referred for surgery. Three patients (3.5%) died, all from massive rebleeding. In conclusion, sclerotherapy is a safe effective method for treating patients with oesophageal varices due to periportal fibroses.

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Safety of balanced propofol and midazolam in upper gastrointestinal endoscopy for sedation in cirrhotic patients

Journal of the Pakistan Medical Association ◽

10.47391/jpma.526 ◽

2020 ◽

pp. 1-13

Author(s):

Laima Alam ◽

Mohammad Asif Khattak ◽

Mafaza Alam

Keyword(s):

Gastrointestinal Endoscopy ◽

Recovery Period ◽

Hepatic Clearance ◽

Upper Gastrointestinal Endoscopy ◽

Patient’S Satisfaction ◽

Dose Time ◽

Group I ◽

Significant Difference ◽

Cirrhotic Patients ◽

Upper Gastrointestinal

Abstract Objective: Sedation for upper gastrointestinal endoscopy (UGIE) in patients with cirrhosis is theoretically associated with high incidence of adverse events due to low levels of binding proteins and decreased hepatic clearance of drugs. The objective of the study was to assess the safety of combined propofol and midazolam sedation in cirrhotic patients undergoing UGIE. Methods: A total of 500 patients undergoing UGIE were divided in to two groups in a prospective observational study from Jan 1st 2018 to June 30th 2018. Group (I) consisted of cirrhotic patients who underwent the procedure with sedation and Group (II) consisted of non-cirrhotic patients who opted for sedation. The main outcome measurements included vitals monitoring before, during and after procedure, total sedation dose, time to initial and deep sedation, recovery time and complications. Results: There was no significant difference between sedation safety and rate of complications for the cirrhotic and non-cirrhotic patients except for the recovery period during initial 10 minutes. The Modified Aldrete score for the cirrhotic patients was 9.5±0.5 min as compared to 9.8±0.4 min for non-cirrhotic patients (p<0.001) at 10 minutes. Grade 2 hepatic encephalopathy was seen in 0.8% of the cirrhotic patients who required hospitalization for 24 hours. Also balanced sedation was acceptable by the patients and the endoscopists equally with statistically significant scores on endoscopist’s assessment of co-operation and assessment of patient’s satisfaction scores. Continuous...

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Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2009/791627 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Salvatore Maria Antonio Campo ◽

Roberto Lorenzetti ◽

Marina de Matthaeis ◽

Cesare Hassan ◽

Angelo Zullo ◽

...

Keyword(s):

Old Age ◽

Iron Deficiency Anaemia ◽

Gastrointestinal Endoscopy ◽

Barium Swallow ◽

Upper Gastrointestinal Endoscopy ◽

Metal Stent ◽

History Of ◽

Upper Gastrointestinal ◽

Progressive Dysphagia

We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.

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A rare cause of abdominal pain with fever

BMJ Case Reports ◽

10.1136/bcr-2018-228401 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228401

Author(s):

Diana Martins Oliveira ◽

Catarina Correia ◽

Flávia Cunha ◽

Patrícia Dias

Keyword(s):

Gastrointestinal Endoscopy ◽

Acute Cholangitis ◽

Magnetic Resonance Cholangiopancreatography ◽

Upper Gastrointestinal Endoscopy ◽

Laboratory Findings ◽

Reactive Protein ◽

Elevated Liver Enzymes ◽

History Of ◽

Lemmel’S Syndrome ◽

Upper Gastrointestinal

An 89-year-old man presented to the emergency department with a 1-month history of upper right quadrant pain, worsened in the last 3 days and accompanied by fever and chills. On physical examination, he had scleral icterus and right upper quadrant tenderness. Laboratory findings showed hyperbilirubinemia, elevated liver enzymes and C reactive protein. The patient was admitted, suspecting of an acute cholangitis and started on antibiotics. An upper gastrointestinal endoscopy revealed the presence of a juxtapapillary diverticulum in the second portion of the duodenum, which was confirmed by a magnetic resonance cholangiopancreatography, along with upstream biliary tract ectasia. The imaging findings allowed us to diagnose a Lemmel’s syndrome. Due to potential surgical risk, we decided for a conservative approach. The patient had a favourable course and was discharged home.

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Portal hypertension and reactive hemophagocytosis in pediatric visceral leishmaniasis

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v14i4.25809 ◽

2015 ◽

Vol 14 (4) ◽

pp. 409-412 ◽

Cited By ~ 1

Author(s):

Suman Das ◽

Nirmalya Sarkar ◽

Kaushani Chatterjee ◽

Bholanath Aich ◽

Mala Bhattacharya

Keyword(s):

Portal Hypertension ◽

Hepatic Failure ◽

Gastrointestinal Endoscopy ◽

Medical Science ◽

Supportive Therapy ◽

Abdominal Ultrasound ◽

Upper Gastrointestinal Endoscopy ◽

Low Grade ◽

Grade Ii ◽

Upper Gastrointestinal

A 10 year old boy suffering from prolonged low grade fever, progressive pallor, one episode of haematemesis and melaena, was found to have hepatospenomegaly, features of portal hypertension on abdominal ultrasound, and grade II varices in upper gastrointestinal endoscopy. During hospital stay for diagnostic workup, he developed features of hepatic failure and pancytopenia. Bone marrow aspirate revealed hemophagocytosis and plenty of Leishman-Donovan bodies. The child received Injection Sodium Stibogluconate to treat leishmaniasis and received supportive therapy for hepatic failure and pancytopenia. The child responded well to treatment.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.409-412

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A Nine-Year Audit of Open-Access Upper Gastrointestinal Endoscopic Procedures: Results and Experience of a Single Centre

Canadian Journal of Gastroenterology ◽

10.1155/2011/379014 ◽

2011 ◽

Vol 25 (2) ◽

pp. 83-88 ◽

Cited By ~ 14

Author(s):

Dean Keren ◽

Tova Rainis ◽

Edy Stermer ◽

Alexandra Lavy

Keyword(s):

Open Access ◽

Gastrointestinal Endoscopy ◽

Case Series ◽

Major Complication ◽

Upper Gastrointestinal Endoscopy ◽

Complication Rates ◽

Diagnostic Efficacy ◽

Duodenal Ulcers ◽

American Society ◽

Upper Gastrointestinal

BACKGROUND: The appropriateness and safety of open-access endoscopy are very important issues as its use continues to increase.OBJECTIVE: To present a review of a nine-year experience with open-access upper gastrointestinal endoscopy with respect to indications, diagnostic efficacy, safety and diseases diagnosed.METHODS: A retrospective, observational case series of all patients who underwent open-access endoscopy between January 2000 and December 2008 was conducted. Indications were classified as appropriate or not appropriate according to American Society of Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic diagnoses were based on widely accepted criteria. Major complication rates were assessed.RESULTS: A total of 20,620 patients with a mean age of 58 years were assessed, of whom 11,589 (56.2%) were women and 9031 (43.8%) were men. Adherence to ASGE indications led to statistically significant, clinically relevant findings. The most common indications in patients older than age 45 years of age were dyspepsia (28.5%) and anemia (19.7%) in the ASGE-appropriate group, and dyspepsia in patients younger than 45 years of age without therapy trial (6.6%) in the nonappropriate group. Of the examinations, 38.57% were normal. Hiatal hernia and nonerosive gastritis were the most common findings. Important diagnoses such as malignancies and duodenal ulcers would have been missed if endoscopies were performed only according to appropriateness. There were only two major complications and no mortalities.CONCLUSIONS: Open-access upper gastrointestinal endoscopy is a safe and effective system. More relevant findings were found when adhering to the ASGE guidelines. However, using these guidelines as the sole determining factor in whether to perform an endoscopy is not advisable because many clinically relevant diagnoses may be overlooked.

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Evaluation of the quality of endoscopically obtained esophageal biopsies in the dog

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.1055/s-0038-1623733 ◽

2013 ◽

Vol 41 (06) ◽

pp. 375-382 ◽

Cited By ~ 3

Author(s):

M. Vieth ◽

A. Hörauf ◽

M. Münster

Keyword(s):

Basal Cell ◽

Gastrointestinal Endoscopy ◽

Squamous Epithelium ◽

Clinical Signs ◽

Upper Gastrointestinal Endoscopy ◽

Initial Learning ◽

Cell Layers ◽

Adequate Quality ◽

One Year ◽

Upper Gastrointestinal

Summary Objective: An important premise for obtaining diagnostically relevant histology specimens is an appropriate biopsy technique. Goal of this study was to determine if biopsies of adequate quality can be obtained from the canine esophagus at the gastro-esophageal junction (GEJ) during routine upper gastrointestinal endoscopy. Material and methods: Over the course of one year, 58 dogs undergoing upper gastrointestinal endoscopy because of the presence of esophageal (n = 22) or gastrointestinal (n = 36) clinical signs were prospectively included. Five biopsies were repeatedly collected from the same dorsal and ventral locations of the GEJ, fixated individually in 4% neutral buffered formaldehyde, and evaluated histopathologically after standard preparation and haematoxylin and eosin staining. The presence of esophageal squamous epithelium with a basal cell layer and lamina propria mucosae in conjunction with foveolar columnar epithelium and cardiac glands, and the absence of fundic glands in one specimen, respectively, was judged as an adequately sampled biopsy. Results: Adequately sampled biopsies were reported in 45 out of 58 dogs, with 31 samples originating from the dorsal GEJ, 36 samples originating from the ventral GEJ, and with 22 samples originating from both sites, respectively. The incidence of adequately sampled biopsies increased significantly over time (r = 0,22; p < 0,05), with these biopsies being reported significantly more often during the last 6 months compared to the first 6 months of the study (p = 0,03). Histopathological evaluation of the esophageal squamous epithelium showed fibrosis, inflammation, elongation of the stromal papillae, and increased thickness of the basal cell layers in 14 out of 58 dogs. Stromal papillae of the ventral esophageal epithelium were significantly elongated in dogs with esophageal clinical signs compared to dogs with gastrointestinal clinical signs (p = 0,03). Conclusion and clinical relevance: After an initial learning phase adequate esophageal biopsies from the GEJ can be obtained in canine patients undergoing upper gastrointestinal endoscopy, and histological lesions can be found in these biopsies.

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Repeat Upper Gastrointestinal Endoscopy in Patients with Functional Dyspepsia: Yield, Findings, and Predictors of Positive Findings

Gastroenterology Research and Practice ◽

10.1155/2015/904683 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Supot Pongprasobchai ◽

Natta Asanaleykha ◽

Pongchirat Tantayakom

Keyword(s):

Peptic Ulcer ◽

Functional Dyspepsia ◽

Reflux Esophagitis ◽

Gastrointestinal Endoscopy ◽

Multivariate Analyses ◽

Upper Gastrointestinal Endoscopy ◽

Erosive Gastritis ◽

History Of ◽

Alarm Features ◽

Upper Gastrointestinal

Background. No guideline on repeat esophagogastroduodenoscopy (EGD) in functional dyspepsia (FD) exists. This study aimed to define yield, findings, and predictors of positive findings on repeat EGD in FD.Methods. FD patients who underwent at least 2 EGDs during October 2005 to November 2011 were enrolled and reviewed. Yield and findings were analyzed and univariate and multivariate analyses were performed to identify predictors of positive repeat EGD.Results. The median time to repeat EGD was 34 months. Among 146 patients, 115 patients (79%) had negative and 31 (21%) had positive repeat EGD, including erosive gastritis (13.0%), peptic ulcer (7.5%), reflux esophagitis (1.4%), and Barrett’s esophagus (0.7%). Four independent predictors of positive repeat EGD were smoking (HR 3.88, 95% CI 1.31–11.51,P=0.015), hypertension (HR 2.96, 95% CI 1.38–6.36,P=0.050), history of malignancies (HR 3.65, 95% CI 1.16–11.46,P=0.027), and antiplatelets or NSAIDs used within 4 weeks (HR 4.10, 95% CI 1.13–14.90,P=0.032), while alarm features or failure to treatment did not predict positive repeat EGD. Conclusion. Yield of repeat EGD in FD was substantially low, all findings were acid-related disorders, and there was no malignancy. Smoking, hypertension, history of malignancies, and antiplatelets/NSAIDs use associated with positive repeat EGD.

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