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gastroesophageal varices in a patient presenting with essential thrombocythemia:A case report

World Journal of Clinical Cases 2021年第8期9卷 1871-1876页

作者： Jian-Bo Wang Yang Gao Jun-Wei Liu Mu-Gen Dai Shang-Wen Yang Bin Ye Department of Gastroenterology Lishui Hospital of Zhejiang UniversityThe Fifth Affiliated Hospital of Wenzhou Medical UniversityLishui Central HospitalLishui 323000Zhejiang ProvinceChina Department of Radiology Lishui Hospital of Zhejiang UniversityThe Fifth Affiliated Hospital of Wenzhou Medical UniversityLishui Central HospitalLishui 323000Zhejiang ProvinceChina

BACKGROUND gastroesophageal varices are a rare complication of essential thrombocythemia(ET).ET is a chronic myeloproliferative neoplasm(MPN)characterized by an increased number of blood platelets.CASE SUMMARY A 46-year-old woman,who denied a history of liver disease,was admitted to our hospital on presentation of hematemesis.Laboratory examination revealed a hemoglobin level of 83 g/L,and a platelet count of 397×109/L.The appearance of gastric and esophageal varices with red colored signs as displayed by an urgent endoscopy was followed by endoscopic variceal ligation and endoscopic tissue adhesive.Abdominal computed tomography revealed cirrhosis,marked splenomegaly,portal vein thrombosis and portal hypertension.In addition,bone marrow biopsy and evidence of mutated Janus kinase 2,substantiated the onset of ET.The patient was asymptomatic with regular routine blood testing during the 6-mo follow-up period.Therefore,in this case,gastroesophageal varices were induced by ET.CONCLUSION MPN should be given considerable attention when performing differential diagnoses in patients with gastroesophageal varices.An integrated approach such as laboratory tests,radiological examination,and pathological biopsy,should be included to allow optimal decisions and management.

关键词： gastroesophageal varices Essential thrombocythemia Non-cirrhotic portal hypertension Endoscopic variceal ligation Endoscopic tissue adhesive Case report

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Reinforcing the management of type 1 gastric esophageal varices

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World Journal of Gastroenterology 2024年第19期30卷 2615-2617页

作者： Zain Majid Ghazi Abrar Department of Gastroenterology Sindh Institute of Urology and TransplantationKarachi 75500Pakistan

Variceal bleed represents an important complication of cirrhosis,with its presence reflecting the severity of liver disease.Gastric varices,though less frequently seen than esophageal varices,present a distinct clinical challenge due to its higher intensity of bleeding and associated mortality.Based upon the Sarin classification,GOV1 is the most common subtype of gastric varices seen in clinical practice.

关键词： Gastric varices Sarin classification gastroesophageal varices Cyanoacrylate Endoscopic variceal ligation Trans jugular intrahepatic portosystemic shunt

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Effects of proton pump inhibitor on gastroesophageal varices in patients with cirrhosis:A randomized controlled trial from China

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Portal Hypertension & Cirrhosis 2023年第1期2卷 1-8页

作者： Xiaoning Chen Tao Zhou Ting Zhou Yueyue Li Xin Sun Baoquan Cheng Ning Zhong Xuefeng Lu Yanjing Gao Department of Gastroenterology Qilu HospitalCheeloo College of MedicineShandong UniversityJinanShandongChina Department of Geriatric Medicine Qilu HospitalCheeloo College of MedicineShandong UniversityJinanShandongChina

Aims:Proton pump inhibitors(PPI)are widely used for gastroesophageal varices in patients with cirrhosis after endoscopic therapy,although the effect of PPI on these patients remains controversial.This study aimed to evaluate the effect of PPI on gastroesophageal varices in patients with cirrhosis after endoscopic therapy,including variceal bleeding and adverse events.Methods:Cirrhotic patients with endoscopically confirmed gastroesophageal varices were enrolled in this study between May 2017 and June 2019.Eligible patients were randomized into two groups:one group received PPI for 14 days and the other group did not receive PPI treatment(n=53 in each group).All patients were followed for 8 weeks.Results:During the follow‐up period,three patients(5.66%)in the PPI group experienced variceal bleeding on days 9,16,and 25 after endoscopic therapy,including two patients with acute bleeding and one with primary prophylaxis.In the non‐PPI group,three patients(5.66%)experienced variceal bleeding on days 7,42,and 56 after endoscopic therapy,including one patient with acute bleeding and two with secondary prophylaxis(p=0.990).The incidence of adverse events was similar between the two groups(37.74%vs.28.30%,p=0.30).Conclusions:PPI did not appear to reduce variceal bleeding and adverse events in patients with cirrhosis after endoscopic therapy.

关键词： endoscopic therapy gastroesophageal varices liver cirrhosis proton pump inhibitor

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Sequential therapy for patients with cirrhosis complicated by common bile duct stones and moderate to severe gastroesophageal varices

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Chinese Medical Journal 2012年第23期125卷 4312-4314页

作者： HUANG Liu-ye ZHANG Bo CUI Jun LIU Yun-xiang WU Cheng-rong LIN Shu-juan Department of Gastroenterology Yantai Yuhuangding HospitalYantaiShandong 264000China

Cirrhosis complicated by common bile duct stones is a common clinical finding.1 Currently, good therapeutic results occur in patients with cirrhosis complicated by moderate to severe gastroesophageal varices and common bile duct stones using endoscopic variceal ligation （EVL） and/or embolization followed two weeks later by calculus removal with endoscopic retrograde cholangiopancreatography （ERCP）.

关键词： cirrhosis common bile duct stone gastroesophageal varices endoscopic retrograde cholangiopancreatography endoscopic variceal ligation embolization

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Endoscopic submucosal tunnel dissection for early esophageal squamous cell carcinoma in patients with cirrhosis:A propensity score analysis

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World Journal of Clinical Cases 2022年第31期10卷 11325-11337页

作者： Lin-Lin Zhu Li-Xia Liu Jun-Chao Wu Tao Gan Jin-Lin Yang Department of General Practice General Practice Medical CenterWest China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Gastroenterology and Hepatology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the feasibility,safety,efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection(ESTD)for treating EESCC in patients with cirrhosis.METHODS This was a single-center retrospective cohort study.We examined 590 EESCC patients who underwent ESTD between July 14,2014,and May 26,2021,from a large-scale tertiary hospital.After excluding 25 patients with unclear lesion areas or pathological results,the remaining 565 patients were matched at a ratio of 1:3 by using propensity score matching.A total of 25 EESCC patients with comorbid liver cirrhosis and 75 matched EESCC patients were ultimately included in the analysis.Parametric and nonparametric statistical methods were used to compare the differences between the two groups.The Kaplan–Meier method was used to create survival curves,and differences in survival curves were compared by the log-rank test.RESULTS Among 25 patients with liver cirrhosis and 75 matched noncirrhotic patients,there were no significant differences in intraoperative bleeding(P=0.234),30-d post-ESTD bleeding(P=0.099),disease-specific survival(P=0.075),or recurrence-free survival(P=0.8196).The mean hospitalization time and costs were significantly longer(P=0.007)and higher(P=0.023)in the cirrhosis group than in the noncirrhosis group.The overall survival rate was significantly lower in the cirrhosis group(P=0.001).CONCLUSION ESTD is technically feasible,safe,and effective for patients with EESCC and liver cirrhosis.EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.

关键词： Endoscopic submucosal tunnel dissection Early esophageal cancer Liver cirrhosis gastroesophageal varices Survival Propensity score matching

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Impact of endoscopic ultrasound examination for deep esophageal collateral veins evaluation in liver cirrhosis patients prior to endoscopic treatment:A case series

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Portal Hypertension & Cirrhosis 2022年第1期1卷 76-81页

作者： Cosmas Rinaldi A.Lesmana Saut H.Nababan Kemal F.Kalista Juferdy Kurniawan Chyntia O.M.Jasirwan Andri S.Sulaiman Irsan Hasan Rino A.Gani Department of Internal Medicine Hepatobiliary DivisionDr.Cipto Mangunkusumo National General HospitalJakartaIndonesia Digestive Disease and GI Oncology Center Medistra HospitalJakartaIndonesia

Aim:The presence of esophageal collateral veins(ECV)has been reported to be associated with the recurrence of esophageal varices(EV)and bleeding in liver cirrhotic(LC)patients.This study aimed to see the potential clinical value of deep collateral veins assessment using endoscopic ultrasound(EUS)in liver cirrhotic patients with EV.Methods:During 6 months period,a prospective study is conducted,where we identified LC patients who were admitted for esophagogastroduodenoscopy(EGD)screening at the Department of Internal Medicine,Dr.Cipto Mangunkusumo National General Hospital,Jakarta.ECV was examined using EUS.Patients were excluded if they had(1)liver malignancy,(2)history of ligation or glue injection,or(3)portal or splenic vein thrombus.We collected demographic data,medical history,data pertaining to use of nonselective beta blocker(NSBB),and laboratory,imaging,and endoscopy results.EGD was performed using a gastroscope(EG29‐i10,3.2 mm Pentax Medical)while EUS was performed using a linear array echoendoscope(EG‐3870UTK,3.8 mm,Pentax Medical)before band ligation or glue injection.Results:There were 20 LC patients included in this study,where 15(75%)of patients were classified with Child-Pugh(CP)‐A and five(25%)of patients with CP‐B.The most common aetiologies were hepatitis B in seven(35%)patients and hepatitis C in nine(45%)patients.The EV with peri‐or para‐esophageal veins(PEEV or PAEV)were detected in 65%of patients.None of the LC patients with no EV showed the presence of ECV.PEEV or PAEV were detected in grades 1-3 EV.Conclusion:EUS examination can give a better evaluation before managing gastroesophageal varices through deep ECV detection in LC patients.

关键词： endoscopic ultrasound esophageal collateral vein gastroesophageal varices liver cirrhosis portal hypertension

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Esophagogastric variceal bleeding in cirrhotic portal hypertension： onsensus on prevention and management （2008）

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Chinese Medical Journal 2009年第7期122卷 766-775页

作者： LiuFang Cheng Jidong Jia Xiaoyuan Xu Enqiang Linghu Yulan Liu Xisheng Leng Maoqiang Wang Task Force for the Prevention and Management of Esophagogastric Variceal Bleeding of the Chinese Society ofGastroenterology Chinese Society of Hepatology and Chinese Society of Digestive Endoscopy

Portal hypertension is a clinical syndrome which is a consequence of a pathological increase in portal vein pressure due to various causes, liver cirrhosis being the most common. The basic pathophysiological characteristic of portal hypertension is resistance to portal vein flow or an increase in portal vein flow, which results in elevation of pressure in the portal vein and its tributaries and the formation of collateral circulation.

关键词： gastroesophageal varices PHARMACOLOGICAL-TREATMENT EMERGENCY SCLEROTHERAPY GASTRIC varices PROPHYLAXIS OBLITERATION METHODOLOGY EXPERIENCE HEMORRHAGE OCTREOTIDE

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Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

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World Journal of Hepatology 2020年第11期12卷 908-918页

作者： Saroja Bangaru Jihane N Benhammou James H Tabibian Internal Medicine GastroenterologyUniversity of California at Los AngelesLos AngelesCA 90025United States The Vatche and Tamar Manoukian Division of Digestive Diseases University of California at Los AngelesLos AngelesCA 90095United States Department of Medicine Olive View-University of California at Los Angeles Medical CenterSylmarCA 91342United States David Geffen School of Medicine at UCLA Los AngelesCA 90095United States

The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s).It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper endoscopy.However,there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper endoscopy.Because the population of patients with compensated advanced chronic liver disease continues to grow,it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all patients.Therefore,there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal screening.This is particularly important and timely in light of increasing healthcare reform and barriers to healthcare.In this review,we discuss and compare,with respect to test characteristics and clinical applicability,the available methods used to noninvasively predict the presence of esophageal varices.

关键词： gastroesophageal varices Variceal screening Advanced chronic liver disease Cirrhosis Non-invasive screening Upper endoscopy

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Gastrointestinal endoscopy in cirrhotic patient:Issues on the table

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World Journal of Gastrointestinal Endoscopy 2021年第7期13卷 210-220页

作者： Giuseppe Grassi Ilaria Lenci Alessandro Signorello Martina Milana Leonardo Baiocchi Hepatology Unit University of Tor VergataRome 00100Italy

Patients with liver cirrhosis are fragile and present specific clinical hallmarks.When undergoing to gastrointestinal(GI)endoscopy,these subjects require an individual pre evaluation,taking into account:Level of haemostasis impairment,the individual risk of infection,the impact of sedation on hepatic encephalopathy and other factors.The overall assessment of liver function,employing common scoring systems,should be also assessed in the preprocedural phase.Beside some common general problems,regarding GI endoscopy in cirrhotic subjects,also specific issues are present for some frequent indications or procedures.For instance,despite an increased incidence of adenomas in cirrhosis,colon cancer screening remains suboptimal in subjects with this disease.Several studies in fact demonstrated liver cirrhosis as a negative factor for an adequate colon cleansing before colonoscopy.On the other hand,also the routine assessment of gastroesophageal varices during upper GI endoscopy presents some concern,since important inter-observer variability or incomplete description of endoscopic findings has been reported in some studies.In this review we discussed in details the most relevant issues that may be considered while performing general GI endoscopic practice,in patient with cirrhosis.For most of these issues there are no guidelines or clear indications.Moreover until now,few studies focused on these aspects.We believe that targeting these issues with corrective measures may be helpful to develop a tailored endoscopic approach for cirrhosis,in the future.

关键词： Gastrointestinal endoscopy Cirrhosis Sedation Infection gastroesophageal varices Colonoscopy Bowel cleansing Liver transplantation

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