The Role of Endoscopic Ultrasound for Esophageal Varices

Esophageal varices are caused by the development of collateral circulation in the esophagus as a result of portal hypertension. It is important to administer appropriate preventive treatment because bleeding varices can be fatal. Esophageal varices have complex and diverse hemodynamics, and there are various variations for each case. Endoscopic ultrasound (EUS) can estimate the hemodynamics of each case. Therefore, observation by EUS in esophageal varices provides useful information, such as safe and effective treatment selection, prediction of recurrence, and appropriate follow-up after treatment. Although treatment for the esophagogastric varices can be performed without EUS imaging, understanding the local hemodynamics of the varices using EUS prior to treatment will lead to more safe and effective treatment. EUS observation is an indispensable tool for thorough variceal care.

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Follow-up of Patients with Portal Hypertension and Esophageal Varices Treated with Percutaneous Obliteration of Gastric Coronary Vein

Radiology ◽

10.1148/122.1.59 ◽

1977 ◽

Vol 122 (1) ◽

pp. 59-63 ◽

Cited By ~ 49

Author(s):

Anders Lunderquist ◽

Göran Simert ◽

Ulf Tylén ◽

Johannes Vang

Keyword(s):

Portal Hypertension ◽

Esophageal Varices ◽

Coronary Vein ◽

Percutaneous Obliteration

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Role of Endoscopic Ultrasound to Assess and Manage Portal Hypertension

Digestive Disease Interventions ◽

10.1055/s-0040-1713372 ◽

2020 ◽

Vol 04 (02) ◽

pp. 103-109

Author(s):

Sidhant Singh ◽

Saurabh Mukewar

Keyword(s):

Portal Hypertension ◽

Gastrointestinal Tract ◽

Endoscopic Ultrasound ◽

Portal Pressure ◽

Pressure Measurements ◽

Vascular Changes ◽

Ectopic Varices ◽

Portal Venography ◽

Intrahepatic Shunt

AbstractPortal hypertension leads to the development of varices along the gastrointestinal tract. Endoscopy plays an important role in the diagnosis and management of varices. Endosonography (EUS) enables visualization and permits access to varices and veins outside the gastrointestinal tract. EUS has emerged as an important tool, with the ability to identify vascular changes, treat gastric and ectopic varices, perform portal pressure measurements, portal venography, and intrahepatic shunt placement. This review discusses the role of endoscopy and the emerging role of EUS in evaluation and management of portal hypertension.

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Portal hypertension after prolonged use of trastuzumab emtansine: nodular regenerative hyperplasia with autoimmune features

Research Society and Development ◽

10.33448/rsd-v10i8.17005 ◽

2021 ◽

Vol 10 (8) ◽

pp. e10810817005

Author(s):

Gustavo Vargas Borgongino Monteiro ◽

Marcela Chagas Lima Mussi ◽

Mateus Jorge Nardelli ◽

Bruno Campos Santos ◽

Cláudia Alves Couto

Keyword(s):

Portal Hypertension ◽

Esophageal Varices ◽

Ductal Carcinoma ◽

Rare Complication ◽

Nodular Regenerative Hyperplasia ◽

Trastuzumab Emtansine ◽

Her2 Breast Cancer ◽

History Of ◽

The Right

We report a rare complication associated with prolonged use of trastuzumab emtansine (T-DM1) – a composed therapy for HER2+ breast cancer – presenting with laboratorial autoimmune features that could have delayed the diagnosis or led to misdiagnosis. A 55-year-old female was referred to the hepatologist with a computed tomography suggestive of portal hypertension for etiological investigation. History of invasive ductal carcinoma in the right breast undergoing treatment for 5 years. She had already undergone neoadjuvant chemotherapy, mastectomy, radiotherapy and adjuvant chemotherapy. By the time of metastatic diagnosis, she was in monotherapy with T-DM1 for 2.5 years. Upper endoscopy showed esophageal varices and portal hypertension gastropathy. Laboratorial tests revealed increased transaminases, hypergammaglobulinemia and positive antinuclear antibody. Liver biopsy was performed for autoimmune hepatitis differential diagnosis but revealed nodular regenerative hyperplasia. T-DM1 was discontinued. After a 2-year follow-up, the patient did not present any complications of portal hypertension, although persisted with esophageal varices.

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Transjugular Portosystemic Shunting in Refractory Cirrhotic Ascites

Russian Journal of Gastroenterology Hepatology Coloproctology ◽

10.22416/1382-4376-2021-31-1-39-46 ◽

2021 ◽

Vol 31 (1) ◽

pp. 39-46

Author(s):

Yu. V. Khoronko ◽

M. A. Kozyrevskiy ◽

A. V. Dmitriev ◽

A. A. Volokhova ◽

G. Yu. Spiridenko ◽

...

Keyword(s):

Portal Hypertension ◽

Variceal Bleeding ◽

Refractory Ascites ◽

Esophagogastric Varices ◽

Portosystemic Shunting ◽

Shunt Dysfunction ◽

Grade 3 ◽

One Year ◽

Medical University

Aim. Improvement of refractory ascites (RA) outcomes in underlying cirrhotic portal hypertension (PH) through optimising the transjugular intrahepatic portosystemic shunting (TIPS) procedure among therapy measures.Materials and methods. The survey included 107 patients with RA admitted to portal hypertension units of the Rostov State Medical University Surgical Clinic during 2007—2020. The patients were randomly assigned to two cohorts similar by gender, age, cirrhosis aetiology and condition severity. The control cohort had conventional paracentesis and albumin infusion. In cohort 2, 57 patients had minimally invasive endovascular TIPS surgery in a recommended setting.Results. TIPS eliminated PH in all 57 patients of cohort 2. Cohort 1 was reported with progressive esophagogastric varices (EGV), their enlargement in 37 and rupture in 11 patients during the first 12 months. Cohort 2 revealed the grade 3—2 and 2—1 EGV reduction in 24 (41.1%) patients with shunt surgery and in 39 (68.4%) patients in one year. Esophagogastric variceal bleeding (EGVB) developed in 9 patients in cohort 1, with 7 lethal outcomes. No variceal bleeding was observed in cohort 2, with 7 patients having the portosystemic shunt dysfunction.Conclusion. The TIPS procedure is justified in cirrhotic PH patients with RA for reducing the mortality rate in a one year follow-up.

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The Role of Endoscopic Ultrasound in the Diagnosis and Management of Primary Gastric Lymphoma

Gastroenterology Research and Practice ◽

10.1155/2017/2397430 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Dimitrios Schizas ◽

Ioannis Ntanasis-Stathopoulos ◽

Diamantis I. Tsilimigras ◽

Athanasios D. Sioulas ◽

Demetrios Moris ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Gastric Lymphoma ◽

Gastric Lesions ◽

First Line ◽

Prediction Of Response ◽

Multiple Biopsies ◽

Disease Staging ◽

First Line Treatment

Endoscopic ultrasound (EUS) is considered a valuable diagnostic tool during the workup of malignant gastric lesions, including primary gastric lymphomas (PGL). Although endoscopy combined with multiple biopsies remains essential in the establishment of PGL diagnosis, EUS utilization in locoregional disease staging has been well documented in the literature. Data also support the possible role of EUS in prediction of response to first-line treatment, that is,Helicobacter pylorieradication. However, its application in the posttreatment setting remains problematic, since concordance rates between endosonography and histology findings during follow-up seem to vary substantially. The aim of the present review is to summarize all available data regarding the role of EUS in the management of PGL.

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The Role of Controlled Anticoagulation in Balloon Occluding Vertebral Arteries to Treat Giant Fusiform Aneurysms of the Basilar Artery

Interventional Neuroradiology ◽

10.1177/159101999900500206 ◽

1999 ◽

Vol 5 (2) ◽

pp. 145-150

Author(s):

F. Ling ◽

H. Zhang ◽

D. Wang ◽

M. Li ◽

Z. Miao ◽

...

Keyword(s):

Brain Stem ◽

Basilar Artery ◽

Collateral Circulation ◽

Anticoagulation Therapy ◽

Balloon Occlusion ◽

Vertebral Arteries ◽

Aneurysm Wall ◽

The Brain

We suggest and discuss the role of controlled anticoagulation therapy after the balloon occlusion of vertebral arteries to treat giant fusiform aneurysms in the basilar trunk. Two cases of giant fusiform aneurysms were treated with balloon occlusion of vertebral arteries. Both of these patients suffered severe brain stem ischaemia. Anticoagulants were used to adjust the PTT to 1.5–2.5 times the normal level to control the formation speed of thrombosis inside the aneurysms. Case 1 was obliged to suspend the anticoagulation therapy one week after occlusion because of digestive tract haemorrhage, and died of severe brain stem ischaemia. On autopsy, the sac of the aneurysm was totally occupied by the thrombus. Two perforating arteries feeding the brain stem arising from the wall of the aneurysm and infarction in the brain stem were found. Case 2 was anticoagulated strictly and progressively improved after three weeks. Anticoagulation was terminated after one month. Follow-up MRI showed the aneurysm had disappeared six months later. Giant fusiform aneurysms in the basilar artery trunk can be treated with the balloon occlusion of vertebral arteries which induces thrombosis in the sac of aneurysm. Controlled anticoagulation should be given to slow down the thrombotic obliteration in the perforators arising from the aneurysm wall to the brain stem and give the brain stem have enough time to establish the sufficient collateral circulation.

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The Role of Endoscopic Ultrasound for Evaluating Portal Hypertension in Children Being Assessed for Intestinal Transplantation

Transplantation Journal ◽

10.1097/tp.0b013e3181891d63 ◽

2008 ◽

Vol 86 (10) ◽

pp. 1470-1473 ◽

Cited By ~ 16

Author(s):

Patrick J. McKiernan ◽

Khalid Sharif ◽

Girish L. Gupte

Keyword(s):

Portal Hypertension ◽

Endoscopic Ultrasound ◽

Intestinal Transplantation ◽

Hypertension In Children

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Role of plasma von Willebrand factor antigen in prediction of esophageal varices in pediatric and adolescent patients with portal hypertension

Egyptian Liver Journal ◽

10.1186/s43066-021-00159-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lerine B. El Shazli ◽

Dina A. Ragab ◽

Karim A. Abdelhady ◽

Asmaa W. Abdelaziz

Keyword(s):

Portal Hypertension ◽

Von Willebrand Factor ◽

Esophageal Varices ◽

Cross Sectional ◽

Non Invasive ◽

Von Willebrand Factor Antigen ◽

Von Willebrand ◽

Willebrand Factor ◽

Factor Antigen

Abstract Background Ruptured esophageal varices (EVs) are a leading cause of death in Portal hypertension (PHT), it has been a big concern of research to screen EVs through non-invasive approaches. This study aimed to evaluate the role of plasma von Willebrand factor antigen (VWF-Ag) assay for early detection of EVs in patients with portal hypertension. This was a cross-sectional study, done on 47 portal hypertensive children and adolescents who were collected from the Pediatrics Hepatology Clinic, Children Hospital, Ain Shams University. All patients were subjected to comprehensive history taking, thorough clinical examination, routine investigations, abdominal ultrasound, upper GI endoscopy, and measurement of plasma VWF-Ag level. The patients were divided based on their endoscopic findings into two groups; a varices group which included 37 patients, and a non-varices group which included 10 patients. Results VWF-Ag rise significantly in patients with EVs, revealing a direct positive association with the degree of EVs. Conclusion The plasma VWF-Ag can be applied as a non-invasive evidence of the presence and grading of EVs.

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