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Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

World Journal of Gastrointestinal Oncology 2024年第3期16卷 699-715页

作者： Ankit Agarwal Sagnik Biswas Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar Mishra Shivanand Gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar Department of Gastroenterology and Human Nutrition All India Institute of Medical SciencesNew Delhi 110029DelhiIndia Department of Gastroenterology Seth Gordhandas Sunderdas Medical College and KEM HospitalMumbai 400012MaharashtraIndia Department of Gastroenterology Sir HN Reliance Foundation HospitalMumbai 400004India Department of Liver Transplant and HPB Sir HN Reliance Foundation HospitalMumbai 400004India Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Professor of Biostatistics National Drug Dependence Treatment Centre(NDDTC)All India Institute of Medical SciencesNew Delhi 110029India Department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in BCS-HCC.METHODS A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were included.The prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were evaluated.RESULTS In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular obstruction.The median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic Liver Cancer C and D],and 2 patients underwent liver transplantation.CONCLUSION HCC is not uncommon in patients with BCS.Radiological interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

关键词： Budd chiari syndrome Cancer Cirrhosis Thrombosis Liver varices Transarterial chemoembolization Hepatic venous outflow tract obstruction

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Role of serotonin in development of esophageal and gastric fundal varices

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World Journal of Gastroenterology 2010年第48期16卷 6135-6138页

作者： Jelena S Rudi Dorde M ulafi Duko S Mirkovi Rada S Jei Miodrag N Krsti Clinic of Gastroenterology Clinical Center of SerbiaFaculty of MedicineUniversity of Belgrade Centre of Medical Biochemistry Clinical Center of SerbiaSchool of PharmacyUniversity of Belgrade

AIM:To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices. METHODS:This prospective study included 33 patients with liver cirrhosis and 24 healthy controls. Ultrasonography and measurement of serotonin concentration in plasma were carried out in both groups of subjects. The upper fiber panendoscopy was performed only in patients with liver cirrhosis. RESULTS:The mean plasma free serotonin levels were much higher in liver cirrhosis patients than in healthy controls (219.0 ± 24.2 nmol/L vs 65.4 ± 18.7 nmol/L,P varices according to Spearman coefficient of correlation (rs =-0.217,P > 0.05). However,the correlation of plasma serotonin concentration and gastric fundal varices was highly significant (rs =-0.601,P varices,indicating the clinical value of serotonergic receptor blockers in these patients.

关键词： Serotonin Portal hypertension Esophageal varices Fundal varices Platelets

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Elastography-based screening for esophageal varices in patients with advanced chronic liver disease

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World Journal of Gastroenterology 2019年第3期25卷 308-329页

作者： Rafael Paternostro Thomas Reiberger Theresa Bucsics Department of Medicine Ⅲ Division of Gastroenterology and Hepatology Medical University of Vienna

Elastography-based liver stiffness measurement(LSM) is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease(ACLD). The presence of varices and especially of varices needing treatment(VNT) indicates distinct prognostic stages in patients with compensated ACLD(cACLD). The Baveno VI guidelines suggested a simple algorithm based on LSM 150 G/L for ruling-out VNT in patients with cACLD. These(and other) TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies. Novel point shear-wave elastography(pSWE) and two-dimensional shear wave elastography(2D-SWE) methodologies for LSM have also been evaluated for their ability to screen for "any" varices and for VNT. Finally, the measurement of spleen stiffness(SSM) by elastography(mainly by pSWE and 2D-SWE) may represent another valuable screening tool for varices. Here, we summarize the current literature on elastography-based prediction of "any" varices and VNT. Finally,we have summarized the published LSM and SSM cut-offs in clinically useful scale cards.

关键词： Elastography Liver stiffness Spleen stiffness Shear wave Magnetic resonance elastography varices Portal hypertension Cirrhosis Advanced chronic liver disease

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Liver stiffness and serum markers for excluding high-risk varices in patients who do not meet Baveno VI criteria

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World Journal of Gastroenterology 2019年第35期25卷 5323-5333页

作者： Hong Zhou Jun Long Han Hu Cai-Yun Tian Shi-De Lin Department of Infectious Diseases Affiliated Hospital of Zunyi Medical University Zunyi 563003 Guizhou Province China Department of Infectious Diseases Suining Central Hospital Suining 629000 Sichuan Province China

BACKGROUND The Baveno VI criteria for predicting esophageal varices, i.e., liver stiffness measurement (LSM) 150 × 109/L, identify patients who can safely avoid gastroscopy screening. However, they require further refinement. AIM To evaluate the utility of LSM and serum markers of liver fibrosis in ruling out high-risk varices (HRV) in patients who do not meet Baveno VI criteria. METHODS Data from 132 patients with hepatitis B virus (HBV)-related compensated liver cirrhosis who did not meet the Baveno VI criteria were retrospectively reviewed. MedCalc 15.8 was used to calculate receiver operating characteristic (ROC) curves, and the accuracy of LSM, PLT count, aspartate aminotransferase (AST)- to-PLT ratio index, Fibrosis-4, and the Lok index in predicting HRV were evaluated according to the area under each ROC curve (AUROC). The utility of LSM, PLT, and serum markers of liver fibrosis stratified by alanine transaminase (ALT) and total bilirubin (TBil) levels was evaluated for ruling out HRV. RESULTS In all patients who did not meet the Baveno VI criteria, the independent risk factors for HRV were LSM and ALT. Only the AUROC of Lok index was above 0.7 for predicting HRV, and at a cutoff value of 0.4531 it could further spare 24.2% of gastroscopies without missing HRVs. The prevalence of HRV was significantly lower in patients with ALT or TBil ≥ 2 upper limit of normal (ULN)(14.3%) than in patients with both ALT and TBil 100 × 109/L further spared 39.6% and 43.9% of gastroscopies, respectively, without missing HRVs. CONCLUSION In HBV-related compensated cirrhosis patients who do not meet Baveno VI criteria, the LSM, PLT, or Lok index cutoff stratified by ALT

关键词： Baveno VI Esophageal varices Liver cirrhosis Liver stiffness measurement Serum markers of liver fibrosis

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Update on management of gastric varices

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World Journal of Hepatology 2019年第3期11卷 250-260页

作者： Louisa J Vine Mohsan Subhani Juan G Acevedo South West Liver Unit University Hospitals Plymouth NHS Trust

Gastric varices(GV) have different physiology and clinical characteristics compared to oesophageal varices(OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies' recommendations are based are scrutinised in this review and areas of research are identified.

关键词： Gastric varices Oesophageal varices Portal hypertension Cirrhosis

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Treatment of colonic varices with a superior mesenteric venous stent:a case report describing a unique approach

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Gastroenterology Report 2021年第6期9卷 597-599页

作者： Sandra Naffouj Mustafa Al-Shammari Reena Salgia Department of Internal Medicine Henry Ford HospitalDetroitMIUSA Division of Gastroenterology and Hepatology Department of MedicineHenry Ford HospitalDetroitMIUSA

Introduction Ectopic varices are a rare cause of gastrointestinal(GI)bleeding that may occur in the GI tract outside the esophageal and gastric distribution[1].The majority of these cases are rectal varices in cirrhotic patients with portal hypertension.Colonic varices(CV)are less common than rectal,duodenal,and smallbowel varices[2].There are no clear guidelines for managing CV given the rarity of this finding[3].We report a case of massive lower-GI bleeding due to CV in a patient with non-alcoholic steatohepatitis(NASH)without cirrhosis or portal hypertension secondary to porto-mesenteric venous thrombosis that was successfully treated with superior mesenteric venous(SMV)stenting.Given the extent of the mesenteric thrombosis,treatment modalities like transjugular intrahepatic portosystemic shunt(TIPS)and balloon-occluded retrograde transvenous obliteration(BRTO)were not possible.

关键词： venous varices balloon

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Transjugular intrahepatic portosystemic shunt plus embolization for bleeding esophagojejunal varices after total gastrectomy

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Journal of Interventional Medicine 2019年第4期2卷 181-183页

作者： Shaojie Wu Yicheng Wu Yanfu Shen Senlin Cai Yanfeng Zhou Haotian Zheng Zhuting Fang Department of Interventional Radiology Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityNo.134Dongjie RoadFuzhou350001China Department of Geriatrics Fujian Provincial HospitalFujian Provincial Center for GeriatricsShengli Clinical Medical College of Fujian Medical UniversityNo.134Dongjie RoadFuzhou350001China Department of Radiology Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityNo.134Dongjie RoadFuzhou350001China

A 64-year-old man was admitted to our hospital with hematemesis and melena.Six years ago,he had undergone total gastrectomy with Roux-en-Y esophagojejunostomy for gastric cancer.Endoscopic examination revealed varicose veins at the anastomotic sites with cherry-red spots and hemorrhage.Abdominal computed tomography showed that the varices were supplied by a dilated jejunal vein.Transjugular intrahepatic portosystemic shunt(TIPS)and variceal embolization were performed.There were no major complications or episodes of bleeding during the three-month follow-up.We conclude that TIPS in combination with varices obliteration is an effective alternative method for treatment of ruptured esophagojejunal varices after total gastrectomy.

关键词： Esophagojejunal varices Transjugular intrahepatic portosystemic shunt varices obliteration Total gastrectomy

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Carvedilol Versus Other Nonselective Beta Blockers for Variceal Bleeding Prophylaxis and Death: A Network Meta-analysis

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Journal of Clinical and Translational Hepatology 2023年第5期11卷 1143-1149页

作者： Ka-Shing Cheung Chiu-Hang Mok Lok-Ka Lam Xian-Hua Mao Lung-Yi Mak Wai-Kay Seto Man-Fung Yuen Department of Medicine School of Clinical MedicineThe University of Hong KongQueen Mary HospitalHong KongChina Department of Medicine The University of Hong Kong-Shenzhen HospitalShenzhenGuangdongChina School of Clinical Medicine The University of Hong KongHong KongChina State Key Laboratory of Liver Research The University of Hong KongHong KongChina

Background and Aims:We aimed to perform a network meta-analysis(NWM)to examine comparative effectiveness of non-selective beta blockers(NSBBs)on prophylaxis of gastroesophageal variceal bleeding(GVB)and mortality benefit.Methods:MEDLINE(OVID)and EMBASE databases were searched for eligible randomized clinical trials(RCTs)from inception to July 3,2021.Outcomes of interest included primary/secondary prophylaxis of GVB,failure to achieve hepatic venous pressure gradient(HVPG)decremental response,liver-related and all-cause mortality.A Bayesian NWM was performed to derive relative risk(RR)with 95%credible intervals(CrIs).The ranking probability of each NSBB was assessed by surface under cumulative ranking curve(SUCRA).Results:Thirty-three RCTs including 3,188 cirrhosis patients with gastroesophageal varices were included.Compared with placebo,nadolol ranked first for reducing variceal bleeding[RR:0.25,(95%CrI:0.11–0.51);SUCRA:0.898],followed by carvedilol[RR:0.33,(95%CrI:0.11–0.88);SUCRA:0.692]and propranolol[RR:0.52,(95%CrI:0.37–0.75);SUCRA:0.405].Carvedilol was more effective than propranolol in achieving HVPG decremental response[RR:0.43,(95%CrI:0.26–0.69)].Carvedilol ranked first for reducing all-cause mortality[RR:0.32,(95%CrI:0.17–0.57);SUCRA:0.963],followed by nadolol[RR:0.48,(95%CI:0.29–0.77);SUCRA:0.688],and propranolol[RR:0.77,(95%CI:0.58–1.02);SUCRA:0.337].Similar findings were observed for liver-related mortality.Carvedilol ranked the safest.The RR of adverse events was 4.38,(95%CrI:0.33–161.4);SUCRA:0.530,followed by propranolol[RR:7.54,(95%CrI:1.90–47.89);SUCRA:0.360],and nadolol[RR:18.24,(95%CrI:91.51–390.90);SUCRA:0.158].Conclusions:Carvedilol is the preferred NSBB with better survival benefit and lower occurrence of adverse events among patients with gastroesophageal varices.

关键词： NSBB Carvedilol Nadolol Propranolol varices Cirrhosis CPSH

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Vascular complications of chronic pancreatitis and its management

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1574-1590页

作者： Dinesh Walia Anoop Saraya Deepak Gunjan Gastroenterology and Human Nutrition Unit All India Institute of Medical SciencesNew Delhi 110029India

Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst formation,benign biliary stricture,gastric outlet obstruction;and vascular complications like venous thrombosis,variceal and pseudoaneurysmal bleed.Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy.Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration,or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations.Procedure-related bleed is usually venous and mostly managed conservatively.Procedure-related arterial bleed,however,may require radiological interventions.

关键词： Chronic pancreatitis Pseudoaneurysm Vascular complications varices Venous thrombosis

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Update on the management of gastrointestinal varices

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2019年第1期10卷 1-21页

作者： Umesha Boregowda Chandraprakash Umapathy Nasir Halim Madhav Desai Arpitha Nanjappa Subramanyeswara Arekapudi Thimmaiah Theethira Helen Wong Marina Roytman Shreyas Saligram Department of Gastroenterology and Hepatology University of California San Francisco Department of Gastroenterology and Hepatology Kansas University Medical Center Department of Medicine VA Central California Healthcare System Department of Gastroenterology and Hepatology VA Central California Healthcare System

Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality.

关键词： Portal hypertension Esophageal varices Gastric varices Ectopic varices Endoscopy

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