Endoscopic injection sclerotherapy improves liver function compared with endoscopic variceal ligation

Liver function is a most important prognostic factor in patients with liver cirrhosis. Also, portal hypertension is a fatal complication of liver cirrhosis and variceal treatment is indispensable. However, changes of liver functions after endoscopic variceal treatments are unknown. The aim of this study was to evaluate prognosis and liver functions after endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). A total of liver cirrhotic 103 patients who underwent prophylactic EIS and EVL were enrolled. Overall survival rate was higher in EIS group than EVL group (p = 0.03). Multivariate analysis showed that EIS was a negative factor for death (HR: 0.46, 95% confidence interval: 0.24–0.88, p = 0.02). Liver functions were assessed by blood test taken at before and 3 months after treatment. In EIS group, albumin and prothrombin time improved (p < 0.01), leading to improvement of Child–Pugh score, ALBI score and MELD score (p < 0.05). However, these did not improve in EVL group. EIS was a significant factor related to the elevated value of albumin after treatment in linear regression analysis (estimated regression coefficient: 0.17, 95% confidence interval: 0.05–0.29, p = 0.005). These results revealed that EIS could improve liver functions and prognosis.

Bladder Dysfunction and Re-Absorbable Bulking Agent Affect Success Rate in Children Underwent Endoscopic Treatment for Vesicoureteral Reflux: A Long-Term Follow-Up Study

This paper is designed to evaluate the results (at long-term follow-up of) children affected by dilating VUR. Our attention was focused on how VUR grade, laterality, bladder dysfunction (BD), the double renal system, and the type of bulking substance may affect VUR resolution in the long-term period. The charts of 93 children with dilating VUR who underwent endoscopic treatment (ET) and with a minimum post-operative follow-up of 7 years were reviewed (mean follow-up time was 9.6 + 1.4). The majority of patients had severe and bilateral VUR. Polydimetilsiloxane or hyaluronic acid/dextranomer (PDS or Ha/Dx) were used as bulking agents. VUR persistence following endoscopic injection was independent with respect to grade, laterality, duplex renal system, and BD. However, the rate of VUR persistence was significantly higher in children with BD. Children treated with Ha/Dx had a higher rate of VUR persistence. This research demonstrated that ET of VUR is also effective at very long term follow up (and without the development of significant complications). We also showed that patients treated with absorbable bulking agents such as Ha/Dx may experience a higher recurrence rate at the long-term follow-up). We also confirm that the only preoperative condition affecting VUR recurrence was bladder dysfunction.

Outcome of patients treated with N-Butyl-2-cyanoacrylate in gastric variceal bleeding.

Objective: Aim of study was to determine outcomes of patients treated with N-butyl-2-cyanoacrylate. Study Design: Retrospective study. Setting: Department of Gastroenterology at Liaquat University of Medical and Health Sciences, Jamshoro. Period: December 2019 to March 2020. Material & Methods: A Retrospective study was conducted between by viewing medical records and endoscopy reports. Total 31 patients were enrolled with gastric variceal bleed that underwent endoscopic injection of N-butyl-2-cyanoacrylate we examined the mortality rate, hemostasis, Hospital stay, need of blood transfusion, and effectiveness of procedure. Results: A Total of 31 patients, out of which 18 (58.1 %) were male; the mean age was 55.23±8.778 years. Of these patients 23 (74.2 %), had concomitant esophageal varices, Child-Pugh class-A, B, C were seen in 4, 20 & 7 patients (12.9, 64.5 % & 22.6) respectively. Average duration of hospital stay was 5 to 8 days in 22 cases (71.0 %). Less than 3 pints of PRBC were transfused in 17 cases (54.8 %). Hemostasis was achieved in 27 patients (87%). Overall mortality rate was 3 out of 31(9.7%). one patient was referred for TIPSS. No complications from cyanoacrylate injection were observed. Conclusion: Standardized injection technique and regimen ensures the success and safety of N-butyl-2-cyanoacrylate injection for the treatment of gastric fundal varices in experienced hands.

PREDICTORS OF MORTALITY WITHIN 8 WEEKS AFTER ENDOSCOPIC TREATMENT OF GASTRIC VARICEAL BLEED WITH N-BUTYL 2-CYANOACRYLATE IN CIRRHOTIC PATIENTS

Objective: To assess the predictors associated with mortality within 8 weeks in patients undergoing endoscopic N-butyl-2- cyanoacrylate treatment. Study Design: Prospective comparative study. Place and Duration of Study: Department of Gastroenterology, Services Institute of Medical Sciences, Lahore Pakistan, from Mar 2018 to Mar 2019. Methodology: A total of 106 patients of gastric variceal bleed were enrolled in the study. Tissue glue was injected into the varix endoscopically and mortality within 8 weeks after endoscopic intervention was noted. Results: Among the enrolled patients, 65 (61.3%) were male and 41(38.7%) were female. Mortality was noted in 19 (17.9%) patients within 8 weeks after endoscopic therapy. Chi-square analysis showed creatinine >1.5, Child Pugh score >9, MELD score >18, re-bleeding within 7 days, low blood pressure <90/60 at presentation and hepatic encephalopathy as significant predictors of mortality (p<0.005). Conclusion: Cirrhotic patients undergoing endoscopic injection of gastric varix with N-butyl 2-cyanoacrylate after gastric variceal bleed have high risk of death within 8 weeks.

Predicting the outcomes of a single endoscopic correction of vesicoureteral reflux using a dextranomer/hyaluronic acid copolymer: selection of the optimal predictive model

Introduction. Endoscopic dextranomer/hyaluronic acid copolymer (DxHA) injection is the most commonly used minimally invasive method of surgical treatment of vesicoureteral reflux (VUR) in children.Purpose of the study. To estimate the accuracy of logistic prognostic models and artificial neural network for prediction a single endoscopic injection DxHA in VUR.Materials and methods. We used endoscopic DxHA in 582 patients (783 ureteric units) of all grades reflux (I - 20, II - 133, III - 443, IV - 187), 53 ureters had complete duplication. A total effectiveness of surgery was 53.2%. A binary logistic regression model and an artificial neural network (multilayer perceptron) were created, taking the following as independent variables: grade of reflux, the patient's age and sex, the ureteral duplication and ureteral dilatation index.Results. The univariate logistic regression showed that the selected predictors were strongly related to the outcome of the treatment. Binary logistic regression and neural network developed high accuracy of the predictions, area under ROC-curve was 0,7 for logistic regression model (a sensitivity of 70.7%, and a specificity of 66.3%) and 0.74 for artificial neural network (a sensitivity of 85.5%, a specificity of 65.3%). Synaptic neural network weights and logistic regression parameters were used in a scoring model to predict the outcome of a single endoscopic injection of DxHA in 2 independent hospitals. An outcomes analysis using predictive models in independent clinics showed a good quality of prediction both with the use of logistic regression (75% and 90% of the correct prognosis) and using a neural network (89.7% and 77% of the correct prediction).Conclusion. An artificial neural network and a binary logistic regression model are an effective tool to assist urologists in identifying and applying endoscopic treatments for VUR in children.