scholarly journals Outcome of Endoscopic Variceal Band Ligation

2017 ◽  
Vol 56 (206) ◽  
Author(s):  
Barun Shrestha ◽  
Sudhamshu KC ◽  
Sita Ram Chaudhary ◽  
Bhupendra Kumar Basnet ◽  
Amrendra Kumar Mandal ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Endoscopic Examination ◽  
Endoscopic Variceal Ligation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Acute Variceal Bleeding ◽  
Red Color ◽  
Pugh Class

Introduction: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices.Methods: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017. Consecutive cases who presented in emergency room with acute variceal bleeding due to liver cirrhosis and cases of liver cirrhosis with large varices and red color signs on endoscopic examination were enrolled. They underwent EVL and subsequent re-endoscope at one month interval till the eradication of varices was achieved. Results: Among 83 patients, 15 (18.1%) were of Child Pugh class A, 29 (34.9%) B and 39 (47%) were of C. In 20 (24.1%) cases varices could be eradicated in one session of EVL while 57 (68.7%) required two sessions and in 6 (7.2%) cases it took three sessions. Total average EVL session required for obliteration of esophageal varices was 1.84±0.53. There was only one (1.2%) of early re-bleeding post EVL.Conclusions: EVL is an effective modality of treatment in controlling acute esophageal variceal bleeding, in preventing future variceal bleeding as well as in eradicating esophageal varices, with very few complications.Keywords: acute variceal bleeding; cirrhosis; endoscopic variceal ligation; large varices; red color sign. [PubMed]

Sclerotherapy of esophageal varices in hemophilia patients with liver cirrhosis – a prospective, controlled clinical study

2018 ◽  
Vol 90 (1) ◽  
pp. 29-34
Author(s):  
Andrzej B. Szczepanik ◽  
Konrad Pielaciński ◽  
Anna M. Oses-Szczepanik ◽  
Sławomir Huszcza ◽  
Andrzej Misiak ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Hemophilia A ◽  
Secondary Prophylaxis ◽  
Severe Form ◽  
Control Group ◽  
Endoscopic Sclerotherapy ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Introduction: Bleeding from esophageal varices is a serious clinical condition in hemophilia patients due to congenital deficiency or lack of clotting factors VIII (in hemophilia A) and IX (in hemophilia B), decreased clotting factor II, VII, IX, X synthesis in the course of chronic liver disease and hipersplenic thrombocytopenia. The aim of this study was to assess the efficacy and safety of endoscopic sclerotherapy in acute esophageal variceal bleeding and in secondary prophylaxis of hemorrhage. The aim was also to investigate the optimal activity of deficiency factors VIII or IX and duration of replacement therapy required to ensure proper hemostasis after sclerotherapy procedures. Material and methods: 22 hemophilia patients (A-19, B-4) with coexistent liver cirrhosis and active esophageal variceal bleeding treated with endoscopic sclerotherapy were subjected to prospective analysis. The patients who survived were qualified to repeated sclerotherapy procedures every 3 weeks within secondary prophylaxis of bleeding (investigated group). A 3-day substitution therapy enhanced the infusion of the deficient or lacking factor in doses allowing to reach 80-100% of normal value activity of factor VIII on the 1st day and 60-80% in the next two days. The desired activity of factor IX was 60- 80% and 40-60% respectively. The control group consisted of 20 non-hemophiliac patients with liver cirrhosis comparable in terms of age, sex, stage of advancement of liver cirrhosis, who underwent the same medical proceedings as the investigated group. Results: Active esophageal bleeding was stopped in 21 of 22 (95%) hemophilia patients. Complications were observed in 3 patients; 2 patients died. The rate of hemostasis, complications and deaths in the control group were comparable and no statistical differences were found. In hemophilia patients subjected to secondary prophylaxis of hemorrhage, in 18 of 20 (80%), complete eradication of esophageal varices was achieved after 4 to 7 sclerotherapy procedures in 1 patient (average 5.4). Recurrent bleeding was observed in 15% of patients, complication in 20%; 1 patient died. Time lapse from bleeding to eradication was 12-21 weeks (average 15.2). In the control group the rate of variceal eradication, complication and deaths was comparable and no statistical differences were found. The usage of factor VIII concentrates was as follows: in hemophilia A, in a severe form - 80.9 U/kg b.w./day, in hemophilia A in a severe form with an inhibitor <5 BU – 95.2 U/kg b.w./day, in mild form – 64.2 U/kg b.w./day and in severe hemophilia B – 91.6 U/kg b.w./day. Conclusions: Sclerotherapy is an effective method in the management of esophageal variceal bleeding in hemophilia patients. It is also effective for total eradication of varices when applied as a secondary prophylaxis of hemorrhage. In our opinion, a 3-day replacement therapy at the applied doses is sufficient to ensure hemostasis and avoid bleeding complications.

STUDY ON ENDOSCOPIC FEATURES OF GASTROESOPHAGEAL MUCOSA IN PATIENTS WITH CIRRHOSIS

2011 ◽  
pp. 45-51
Author(s):  
Van Huy Tran ◽  
Anh Hien Ho
Keyword(s):  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Varicose Veins ◽  
University Hospital ◽  
Esophageal Variceal ◽  
Cross Sectional ◽  
Esophageal Variceal Bleeding ◽  
Endoscopic Images ◽  
Red Color ◽  
Grade 3

Background: 1. To evaluate endoscopic images of gastroesophageal mucosa in patients with cirrhosis. 2. To evaluate the relationship between endoscopic images of the gastroesophageal and some clinical, subclinical features. Subjects and Methods: A cross- sectional descriptive study. From May 2010 to April 2011, the study sample includes 88 cirrhotic patients hospitalized at Hue Central Hospital and at Hue University Hospital. Results 1. 95.5% of patients with cirrhosis have esophageal varices. The presence of red color signs on esophageal varices accounts for 48.8% of the cases. The esophageal varices with bleeding accounts for 39.3%. The most common images of gastric mucosa in patients with cirrhosis observed was gastritis (58.0%), mucosal mosiac-like pattern (52.3%) and the lesser common signs seen were gastric ulcer (19.3%) and fundal varices (12.5%). 2. Among the esophageal varices cases at grade 3, 58.3% patients had moderate and large ascites. Among the esophageal variceal bleeding cases at grade 3, the rate of esophageal variceal bleeding is 84.9%, and among the grade 2 cases, the rate is 15.1%. The prevalence of platelet counts <100 Kμ / L in patients with varicose veins in the esophagus accounts for 75% among the grade 3. Among the grade 3 cases, The prevalence of major spleen with width>13 cm accounted for 66.7%. The rate of bleeding from esophageal varices in patients with red color signs is 84.9%. Conclusion: 1. The common endoscopic images of gastroesophageal mucosa in patients with cirrhosis is esophageal varices, gastritis and mucosal mosiac-like pattern. 2. Esophageal varices is related with ascites, bleeding, low platelet count and spleen diameter >13cm. Bleeding from esophageal varices is related with red color signs and is not related to mucosal mosaic-like pattern. Key words: esophageal varices, gastric endoscopy, cirrhosis

scholarly journals Esophageal Variceal Bleeding as the First Manifestation of COVID-19 Infection: A Case Report

2022 ◽  
Vol 7 (01) ◽  
pp. 41-45
Author(s):  
Christos Sotiropoulos, MD, MSc ◽  
Eftichia Sakka, MD ◽  
Georgios Theocharis, MD, PhD ◽  
Konstantinos Thomopoulos, MD, PhD
Keyword(s):  
Liver Cirrhosis ◽  
Case Report ◽  
Variceal Bleeding ◽  
Clinical Manifestations ◽  
Polymerase Chain Reaction Test ◽  
Variceal Hemorrhage ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Wide Range ◽  
Upper Gastrointestinal

Liver cirrhosis is a defined liver disease with a wide range of clinical manifestations. Variceal bleeding is the main source of gastrointestinal hemorrhage among cirrhotic patients induced by several factors, such as alcohol consumption or infections. This is a report of a cirrhotic patient presenting with esophageal variceal bleeding in the context of COVID-19 infection. We report the case of a 53-year-old patient with liver cirrhosis and multifocal hepatocellular carcinoma presenting with upper gastrointestinal bleeding as the first manifestation of COVID-19 infection. Upon admission, the patient had no symptoms suggestive of a respiratory tract infection or any contact with positive SARS-CoV-2 individual and upper gastrointestinal endoscopy revealed variceal hemorrhage. After a few hours the patient manifested with fever, cough and dyspnea and a SARS-CoV-2 polymerase chain reaction test obtained was positive. The patient was initially treated with endoscopic band ligation and transferred in the COVID-19 infection clinic, where after a few days of hospitalization he passed away. The devastating pandemic of coronavirus disease 2019 had altered the pathophysiology and clinical presentation of several chronic diseases. This case report suggests that coronavirus disease as a potential triggering factor of variceal bleeding.

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