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Clinical-radiomics nomogram for predicting esophagogastric variceal bleeding risk noninvasively in patients with cirrhosis

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World Journal of Gastroenterology 2023年第6期29卷 1076-1089页

作者： Rui Luo Jian Gao Wei Gan Wei-Bo Xie Department of Gastroenterology and Hepatology The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010ChongqingChina Department of Radiology The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010ChongqingChina

BACKGROUND Esophagogastric variceal bleeding(EGVB)is a serious complication of patients with decompensated cirrhosis and is associated with high mortality and morbidity.Early diagnosis and screening of cirrhotic patients at risk for EGVB is crucial.Currently,there is a lack of noninvasive predictive models widely available in clinical practice.AIM To develop a nomogram based on clinical variables and radiomics to facilitate the noninvasive prediction of EGVB in cirrhotic patients.METHODS A total of 211 cirrhotic patients hospitalized between September 2017 and December 2021 were included in this retrospective study.Patients were divided into training(n=149)and validation(n=62)groups at a 7:3 ratio.Participants underwent three-phase computed tomography(CT)scans before endoscopy,and radiomic features were extracted from portal venous phase CT images.The independent sample t-test and least absolute shrinkage and selection operator logistic regression were used to screen out the best features and establish a radiomics signature(RadScore).Univariate and multivariate analyses were performed to determine the independent predictors of EGVB in clinical settings.A noninvasive predictive nomogram for the risk of EGVB was built using independent clinical predictors and RadScore.Receiver operating characteristic,calibration,clinical decision,and clinical impact curves were applied to evaluate the model’s performance.RESULTS Albumin(P=0.001),fibrinogen(P=0.001),portal vein thrombosis(P=0.002),aspartate aminotransferase(P=0.001),and spleen thickness(P=0.025)were selected as independent clinical predictors of EGVB.RadScore,constructed with five CT features of the liver region and three of the spleen regions,performed well in training(area under the receiver operating characteristic curve(AUC)=0.817)as well as in validation(AUC=0.741)cohorts.There was excellent predictive performance in both the training and validation cohorts for the clinical-radiomics model(AUC=0.925 and 0.912,respectively).Compared with the existing noninvasiv

关键词： Liver cirrhosis variceal bleeding Radiomics Nomogram Diagnosis

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Position statement of Hepatology Society, Dhaka, Bangladesh, on the management of acute variceal bleeding in a resource-limited setting

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iLIVER 2022年第4期1卷 205-208页

作者： Tanvir Ahmad Shahinul Alam Saiful Islam Golam Azam Mahabubul Alam SKM Nazmul Hasan Golam Mustafa Motahar Hossain MdAkmat Ali Mobin Khan Kurmitola General Hospital DhakaBangladesh Department of Hepatology BSMMU General SecretaryHepatology SocietyDhakaBangladesh Department of Hepatology BSMMUBangladesh Department of Gastrointestinal-Hepatobiliary and Pancreatic Disorders(GHPD) BIRDEM HospitalBangladesh Department of Hepatology Shahid Syed Nazrul Islam Medical CollegeKishoregonjBangladesh Square Hospital Bangladesh Addin Medical College DhakaBangladesh

variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleeding worldwide.The outcome depends on bleeding and its complications as well as the severity of the underlying liver disease.Careful volume resuscitation,administration of antibiotics and vasoactive drugs,and early endoscopic therapy prevent rebleeding and death.People living in rural areas are first referred to a district hospital from the Upazila health complex for any medical emergency.So,commencing the resuscitation process as well as administration of the vasoactive drug(terlipressin)at the first attending hospital before being referred to a higher center will decrease the mortality in patients presenting with acute variceal bleeding.

关键词： variceal bleeding Resource-limited setting Terlipressin Cirrhosis Primary care physician

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Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding

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Hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 128-136页

作者： Xiao-Yan Sun Guang-Chuan Wang Jing Wang Guang-Jun Huang Chun-Qing Zhang Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021China Department of Infectious Diseases Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021China

Background:Studies about treatment of patients with chronic portal vein thrombosis(CPVT)are still limited,especially in different types of CPVT.This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt(TIPS)in all types of CPVT with variceal bleeding.Methods:Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis.All patients had a history of variceal bleeding.The characteristics and clinical parameters were collected and recorded.Data on procedure success rate,variation in portal vein pressure,rebleeding,hepatic encephalopathy(HE),stent stenosis,and overall mortality were analyzed.Results:A total of 189 patients were included in this study(39 in type 1,84 in type 2,48 in type 3,18 in type 4).The TIPS procedure success rate was 86.2%.The success rate was significantly different among the four types(89.7%vs.88.1%vs.83.3%vs.77.8%,P=0.001).In the TIPS success group,portal vein pressure was significantly reduced from 27.15±6.59 to 19.74±6.73 mm Hg after the procedure(Pbleeding rate was significantly lower than that of the fail group(14.7%vs.30.8%,P=0.017).In addition,there were no significant differences in HE rate(30.7%vs.26.9%,P=0.912)or overall mortality(12.9%vs.19.2%,P=0.403)between the TIPS success group and the fail group.In the TIPS success group,we found that the occurrence of HE was significantly different(P=0.020)among the four types,while there were no significant differences in rebleeding rate(P=0.669),stent stenosis rate(P=0.056),or overall mortality(P=0.690).Conclusions:TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.

关键词： Chronic portal vein thrombosis Transjugular intrahepatic portosystemic shunt variceal bleeding Hepatic encephalopathy

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Terlipressin improves pulmonary pressures in cirrhotic patients with pulmonary hypertension and variceal bleeding or hepatorenal syndrome

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Hepatobiliary & Pancreatic Diseases International 2012年第4期11卷 434-437页

作者： George N Kalambokis Konstantinos Pappas Epameinondas V Tsianos 1st Division of Internal Medicine and Hepato Gastroenterology UnitUniversity Hospital of IoanninaIoannina 45500Greece Department of Cardiology University Hospital of IoanninaIoannina 45500Greece

Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We investigated the pulmonary and systemic hemodynamic effects of the first terlipressin dose(2 mg) in 7 cirrhotic patients with PH presenting with variceal bleeding(n=4) or hepatorenal syndrome(n=3).Terlipressin decreased pulmonary vascular resistance(158.8±8.9 vs 186.5±13.9 dynes sec cm-5 ;P=0.003) together with an increase in systemic vascular resistance(2143± 126 vs 1643±126 dynes sec cm-5 ;Pvariceal bleeding or HRS.

关键词： terlipressin pulmonary hypertension cirrhosis variceal bleeding hepatorenal syndrome

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Hepatobiliary & Pancreatic Diseases International 2009年第4期8卷 358-362页

作者： Mohammed Saied Hedaya Walid Mohamed El Moghazy Shinji Uemoto Department of Hepato-Biliary-Pancreatic and Transplant Surgery Kyoto UniversityJapan Department of General Surgery Theodore Bilharz Research InstituteGizaEgypt Department of Surgery Sohag UniversityEgypt

BACKGROUND:Liver transplantation currently represents the ultimate therapy for bleeding esophageal varices in patients with liver cirrhosis.It is the only therapy that cures both portal hypertension and the underlying liver disease.The outcome of liver transplantation is thought to be correlated with several factors.In this study,the clinical outcome of living-related liver transplantation(LRLT) was evaluated in patients with variceal bleeding,and the prognostic indicators of short-term survival in these patients were identified. METHODS:We reviewed retrospectively 121 patients with a history of variceal bleeding who had received LRLT from 1998 to 2006.The clinical outcomes were analyzed,and the risk factors for short-term survival were defined. RESULTS:The 3-month survival rate of patients with variceal bleeding was 83.4%,while that of non-bleeders was 87%.Sepsis was the commonest cause of death in both groups.Portal vein diameter and blood transfusion were the only independent prognostic factors for short-term survival among variceal bleeders. CONCLUSION:The outcome of LRLT in recipients with variceal bleeding is based on the improvement of portal hemodynamics,by minimizing intraoperative blood loss and subsequent blood transfusion.

关键词： living-related liver transplantation outcome prognostic factors variceal bleeding

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Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States

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World Journal of Hepatology 2020年第6期12卷 288-297页

作者： Pavan Patel Laura Rotundo Evan Orosz Faiz Afridi Nikolaos Pyrsopoulos Division of Gastroenterology and Hepatology Rutgers-New Jersey Medical SchoolNewarkNJ 07101-1709United States Department of Medicine Rutgers-New Jersey Medical SchoolNewarkNJ 07101-1709United States

BACKGROUND Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis.There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals.Because esophageal variceal bleeding requires complex management,it may be hypothesized that teaching hospitals have lower mortality.AIM To assess the differences in mortality,hospital length of stay(LOS)and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.METHODS The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20%of all inpatient admissions to nonfederal hospitals in the United States.We collected data from the years 2008 to 2014.Cases of variceal bleeding were identified using the International Classification of Diseases,Ninth Edition,Clinical Modification codes.Differences in mortality,LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.RESULTS Between 2008 and 2014,there were 58362 cases of esophageal variceal bleeding identified.Compared with teaching hospitals,mortality was lower in nonteaching hospitals(8.0%vs 5.3%,Pvariceal bleeding,mort

关键词： variceal bleeding Teaching hospital Mortality National Inpatient Sample Length of stay bleeding Cirrhosis

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Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

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World Journal of Gastrointestinal Endoscopy 2020年第10期12卷 365-377页

作者： Jake Krige Eduard Jonas Urda Kotze Christo Kloppers Karan Gandhi Hisham Allam Marc Bernon Sean Burmeister Mashiko Setshedi Departments of Surgery and Medicine University of Cape Town Health Sciences FacultyCape Town 7925South Africa Department of Surgery University of Cape Town Health Sciences FacultyCape Town 7925South Africa

BACKGROUND bleeding esophageal varices(BEV)is a potentially life-threatening complication in patients with portal hypertension with mortality rates as high as 25%within six weeks of the index variceal bleed.After control of the initial bleeding episode patients should enter a long-term surveillance program with endoscopic intervention combined with non-selectiveβ-blockers to prevent further bleeding and eradicate EV.AIM To assess the efficacy of endoscopic variceal ligation(EVL)in controlling acute variceal bleeding,preventing variceal recurrence and rebleeding and achieving complete eradication of esophageal varices(EV)in patients who present with BEV.METHODS A prospectively documented single-center database was used to retrospectively identify all patients with BEV who were treated with EVL between 2000 and 2018.Control of acute bleeding,variceal recurrence,rebleeding,eradication and survival were analyzed using Baveno assessment criteria.RESULTS One hundred and forty patients(100 men,40 women;mean age 50 years;range,21-84 years;Child-Pugh grade A=32;B=48;C=60)underwent 160 emergency and 298 elective EVL interventions during a total of 928 endoscopy sessions.One hundred and fourteen(81%)of the 140 patients had variceal bleeding that was effectively controlled during the index banding procedure and never bled again from EV,while 26(19%)patients had complicated and refractory variceal bleeding.EVL controlled the acute sentinel variceal bleed during the first endoscopic intervention in 134 of 140 patients(95.7%).Six patients required balloon tamponade for control and 4 other patients rebled in hospital.Overall 5-d endoscopic failure to control variceal bleeding was 7.1%(n=10)and four patients required a salvage transjugular intrahepatic portosystemic shunt.Index admission mortality was 14.2%(n=20).EV were completely eradicated in 50 of 111 patients(45%)who survived>3 mo of whom 31 recurred and 3 rebled.Sixteen(13.3%)of 120 surviving patients subsequently had 21 EV rebleeding episodes and 10 patients bled from othe

关键词： Endoscopy variceal ligation variceal bleeding Secondary prophylaxis Esophageal varices variceal recurrence

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Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications

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World Journal of Gastroenterology 2023年第15期29卷 2336-2348页

作者： Shi-Hua Luo Mi-Mi Zhou Ming-Jin Cai Shao-Lei Han Xue-Qiang Zhang Jian-Guo Chu Department of Interventional Radiology The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510150Guangdong ProvinceChina Department of Liver Disease Jinan Infectious Disease HospitalShandong University School of MedicineJinan 250021Shandong ProvinceChina Department of Gastroenterology The Second Hospital of Hebei Medical UniversityShijiazhuang 050000Hebei ProvinceChina Department of Gastroenterology Air Force Medical Center of PLABeijing 100142China

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is placed important role in the therapy of complications of portal hypertension,there is still no suitable criterion for a reduction in portosystemic gradient(PSG),which can both reduce PSG and maximize clinical results and minimize hepatic encephalopathy(HE).AIM To compare the clinical outcomes and incidence of HE after one-third PSG reduction during TIPS in patients with variceal bleeding and refractory ascites.METHODS A total of 1280 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2016 to January 2019 were analyzed retrospectively.Patients were divided into group A(variceal hemorrhage and PSG reduced by one third,n=479);group B(variceal hemorrhage and PSG reduced tobleeding was no different between groups A and B(χ^(2)=7.062,P=0.374),but recurrent ascites did differ significantly between groups C and D(χ^(2)=14.493,P=0.006).The probability of total hepatic impairment within 3 years was significantly different between groups A and B(χ^(2)=11.352,P=0.005)and groups C and D(χ^(2)=13.758,P=0.002).The total incidence of HE differed significantly between groups A and B(χ^(2)=7.932,P=0.016),groups C and D(χ^(2)=13.637,P=0.007).There were no differences of survival rate between groups A and B(χ^(2)=3.376,P=0.369,log-rank test),but did differ significantly between groups C and D(χ^(2)=13.582,P=0.014,log-rank test).CONCLUSION The PSG reduction by one third may reduce the risk of HE,hepatic function damage and achieve good clinical results.

关键词： Portal hypertension Transjugular intrahepatic portosystemic shunt Portosystemic gradient Liver cirrhosis variceal bleeding Refractory ascites

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β-arrestin-2 predicts the clinical response to β-blockers in cirrhotic portal hypertension patients: A prospective study

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World Journal of Hepatology 2022年第2期14卷 429-441页

作者： Sameh A Lashen Mohammed M Shamseya Marwa A Madkour Radwa M Abdel Salam Sanaa S Mostafa Division of Hepatology and Gastroenterology Faculty of MedicineAlexandria UniversityAlexandria 21521Egypt Department of Experimental and Clinical Internal Medicine Medical Research InstituteAlexandria 21561Egypt Department of Pathology Medical Research InstituteAlexandria UniversityAlexandria 21561Egypt

BACKGROUND Portal hypertension,a common complication associated with liver cirrhosis,can result in variceal bleeding,which greatly impacts patient survival.Recently,β-arrestin-2 has been shown to predict the acute hemodynamic response to nonselectiveβ-blocker therapy for cirrhotic portal hypertension.However,more data is needed on the long-term effects of and changes inβ-arrestin-2 following nonselectiveβ-blocker therapy.AIM To investigate the expression and role ofβ-Arrestin-2 in predicting the long-term response to nonselectiveβ-blockers in cirrhotic portal hypertensive patients.METHODS We prospectively enrolled 91 treatment-naïve patients with cirrhotic portal hypertension.Baseline clinical and laboratory data were obtained.Gastroscopy was performed for grading and treating varices and obtaining gastric antral biopsies.We measured the serum and antral expression ofβ-arrestin-2 and obtained Doppler measurement of the portal vein congestion index.Treatment with nonselectiveβ-blockers was then started.The patients were followed up for 18 mo,after which they have undergone a repeat antral biopsy and re-evaluation of the portal vein congestion index.RESULTS A higher serum level and antral expression ofβ-arrestin-2 was associated with longer bleedingfree intervals,greater reduction in the portal vein congestion index,and improved grade of varices.Among patients with a lowβ-arrestin-2 expression,17.6%were nonselectiveβ-blocker responders,whereas,among those with high expression,95.1%were responders(Pvariceal bleeding(90%sensitivity and 71%specificity).β-arrestin-2 expression significantly decreased after nonselectiveβ-blocker therapy.CONCLUSIONβ-arrestin-2 expression in cirrhotic portal hypertension predicts the clinical response to long-term nonselectiveβ-blocker treatment.Serumβ-arrestin-2 is a potential noninvasive biomarker for selecting the candidate patients for nonselectiveβ-blockers.

关键词： β-arrestin-2 Portal hypertension variceal bleeding Nonselective beta-blockers Portal congestion index variceal ligation

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Superiority of urgent vs early endoscopic hemostasis in patients with upper gastrointestinal bleeding with high-risk stigmata

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Gastroenterology Report 2021年第6期9卷 543-551页

作者： Masayasu Horibe Eisuke Iwasaki Juntaro Matsuzaki Fateh Bazerbachi Tetsuji Kaneko Kazuhiro Minami Seiichiro Fukuhara Tatsuhiro Masaoka Naoki Hosoe Yuki Ogura Shin Namiki Yasuo Hosoda Haruhiko Ogata Takanori Kanai Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineTokyoJapan Division of Gastroenterology and Hepatology Mayo ClinicMNUSA Interventional Endoscopy Program CentraCareSt Cloud HospitalMNUSA Department of Clinical Trial Tokyo Metropolitan Children’s Medical CenterTokyoJapan Teikyo Academic Research Center Teikyo UniversityTokyoJapan Center for Diagnostic and Therapeutic Endoscopy Keio University HospitalTokyoJapan Department of Gastroenterology and Hepatology Tokyo Metropolitan Tama Medical CenterTokyoJapan Division of Gastroenterology Department of Internal MedicineNational Hospital Organization Saitama National HospitalSaitamaJapan

Background Guidelines recommend that all patients with upper gastrointestinal bleeding(UGIB)undergo endoscopy within 24 h.It is unclear whether a subgroup may benefit from an urgent intervention.We aimed to evaluate the influence of endoscopic hemostasis and urgent endoscopy on mortality in UGIB patients with high-risk stigmata(HRS).Methods Consecutive patients with suspected UGIB were enrolled in three Japanese hospitals with a policy to perform endoscopy within 24 h.The primary outcome was 30-day mortality.Endoscopic hemostasis and endoscopy timing(urgent,6h;early,>6h)were evaluated in a regression model adjusting for age,systolic pressure,heart rate,hemoglobin,creatinine,and variceal bleeding in multivariate analysis.A propensity score of 1:1 matched sensitivity analysis was also performed.Results HRS were present in 886 of 1966 patients,and 35 of 886(3.95%)patients perished.Median urgent-endoscopy time(n=769)was 3.0h(interquartile range[IQR],2.0–4.0 h)and early endoscopy(n紏117)was 12.0h(IQR,8.5–19.0 h).Successful endoscopic hemostasis and urgent endoscopy were significantly associated with reduced mortality in multivariable analysis(odds ratio[OR],0.22;95%confidence interval[CI],0.09–0.52;P=0.0006,and OR,0.37;95%CI,0.16–0.87;P=0.023,respectively).In a propensity-score-matched analysis of 115 pairs,adjusted comparisons showed significantly lower mortality of urgent vs early endoscopy(2.61%vs 7.83%,P<0.001).Conclusions A subgroup of UGIB patients,namely those harboring HRS,may benefit from endoscopic hemostasis and urgent endoscopy rather than early endoscopy in reducing mortality.Implementing triage scores that predict the presence of such lesions is important.

关键词： UGIB urgent endoscopy non-variceal bleeding variceal bleeding HARBINGER GBS upper gastrointestinal bleeding

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