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A creatinine-based model for predicting recurrent bleeding after modified percutaneous transhepatic variceal embolization in patients with cirrhosis

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Journal of Interventional Medicine 2022年第2期5卷 95-102页

作者： Kun Ji Xin Li Hanlong Zhu Si Zhao Pengchao Zhan Yang Shi Shuwen Ye Bingcan Xie Yuyuan Zhang Peng Yu Zhigang Ren Juan Ding Xinwei Han Zhen Li Hepaobilary and Pancreatic Ientionod Treatment Center Divston of Heptbiliay and Pancreatic SurgenyThe Pirst fliated HospitalZhejiang University School of MedicineHangzhouZhejiang ProvinceChina Deprtnent of Inteventional Radiology The First Aftlated Hospital of Zhengzhou UntversityZhengzhouHenan ProvinceChina Department of Gastroenterology and Hpatology Jinling HopitalMedical School of Nanjing UneversiyNanjing210002Jiangsu ProvinceChina Deparment of Gastroenterology filiated Drum Tower Hospitadl of Nanying University Medical SchooNajin 210008Jiangsu ProvinceChina Department of Infecious Diseases The Frst Afilated Hosital of Zhengzhou UniversityZhengzhouHenan ProvinceChina Department of Qualiy Conurol The Pirnt Afllated Hospital of Zhengzhou UnivesiyZhenghouHenarn ProwinceChina

Background:Patients who survive initial esophagogastric variceal bleeding(EVB)are at an increased risk of recurrent bleeding and death;however,a reliable predictive model is lacking.We aimed to develop a model for rebleeding prediction in patients with EVB after modified percutaneous transhepatic variceal embolization(PTVE)with cyanoacrylate.Methods:A total of 122 patients with EVB who underwent PTVE from January 2015 to November 2020 were enrolled.Multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction.The discrimination,calibration,and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease score(MELD)and the Child–Pugh model.Risk stratification was performed according to the nomogram.Results:Rebleeding within 3 months of PTVE occurred in 32 patients(26.2%).Independent rebleeding indicators included prior history of endoscopic therapy,Child–Pugh score,partial splenic embolization,and creatinine level.The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities,with a concordance index of 0.85,which was confirmed to be 0.83 through bootstrapping validation.The nomogram demonstrated superior discrimination and clinical applicability than the MELD and Child–Pugh models.As shown in the Kaplan–Meier curves,high-risk patients had a high probability of rebleeding(P<0.001).Conclusions:The creatinine-based nomogram had a superior ability to predict rebleeding after PTVE in patients with EVB.Risk stratification may help identify high-risk patients and lead to the earlier implementation of aggressive treatments and formulation of intensive follow-up plans.

关键词： esophagogastric varices Percutaneous transhepatic variceal embolization Nomogram Prediction

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Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt

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World Journal of Gastroenterology 2010年第25期16卷 3211-3214页

作者： Hiromichi Ishii Teruhisa Sonoyama Shingo Nakashima Hiroyuki Nagata Atsushi Shiozaki Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Hitoshi Fujiwara Kazuma Okamoto Toshiya Ochiai Yukihito Kokuba Chohei Sakakura Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan

We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). He was then referred to our hospital. Abdominal computed tomography revealed a lowdensity lesion in the posterior segment of the liver and an intratumoral APS, which caused portal hypertension. Although the patient underwent EVL, EIS, Hassab’s operation, and transcatheter arterial embolization for APS, he vomited blood due to rupture of esophagogastric varices. Right hepatectomy was performed for the treatment of HCC and APS, although the indocyanine green retention value at 15 min after intravenous injection was poor (30%). The patient’s postoperative course was uneventful. Eventually, APS disappeared and the esophagogastric varices improved.

关键词： Arterioportal shunt Hepatocellular carcinoma esophagogastric varices

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Embolization combined with endoscopic variceal ligation for the treatment of esophagogastric variceal bleeding in patients with cirrhosis

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Chinese Medical Journal 2007年第1期120卷 36-40页

作者： HUANG Liu-ye CUI Jun WU Cheng-rong LIU Yun-xiang Department of Gastroenterology Yuhuangding Hospital MedicalCollege of Qingdao University Yantai 264000 China

Background esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fundus vadces combined with endoscopic variceal ligation （EVL） of esophageal varices for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis. Methods Totally 172 patients were diagnosed by endoscopic examination within 24 hours of hospitalization with active gastric fundus variceal bleeding and grade II above esophageal varices caused by cirrhosis. Other causes leading to upper digestive tract bleeding were excluded. Patients were randomly divided into a control group （n=82） and a therapy group （n=-90） following a random number table method. For the former, embolization for gastric fundus varices was performed, then an EVL for esophageal varices was performed 2 months later. For the therapy group, embolization for gastric fundus varices and EVL for esophageal varices were performed at the same time. Results The rate of emergency hemostasis in the therapy group was 100.0%, higher than that in the control group （87.8%, P〈0.05）. The rate of early rebleeding in the therapy group was 6.7% while the rate in the control group was 23.6% （P〈0.05）. No complications related to treatment occurred in both groups. Conclusion Embolization for gastric fundus varices combined with EVL for esophageal varices is a safe and effective method for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis.

关键词： esophagogastric varices embolization endoscopic variceal ligation cirrhosis

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