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Historical overview and review of current day treatment in the management of acute variceal haemorrhage

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World Journal of Gastroenterology 2014年第21期20卷 6481-6494页

作者： Neil Rajoriya Dhiraj Tripathi Department of Hepatology The New Queen Elizabeth HospitalBirmingham B15 2THUnited Kingdom

Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The major historical treatment landmarks in the management of variceal haemorrhage can be divided into surgical, medical, endoscopic and radiological breakthroughs. We sought to provide a historical overview of the management of variceal haemorrhage and how treatment modalities over time have impacted on clinical outcomes. A PubMed search of the following terms: portal hypertension, variceal haemorrhage, gastric varices, oesophageal varices, transjugular intrahepatic portosystemic shunt was performed. To complement this, Google™ was searched with the aforementioned terms. Other relevant references were identified after review of the reference lists of articles. The review of therapeutic advances was conducted divided into pre-1970s, 1970/80s, 1990s, 2000-2010 and post-2010. Also, a summary and review on the pathophysiology of portal hypertension and clinical outcomes in variceal haemorrhage was performed. Aided by the development of endoscopic therapies, medication and improved radiological interventions; the management of variceal haemorrhage has changed over recent decades with improved survival from an often-terminating event in recent past.

关键词： Variceal haemorrhage oesophageal varices Gastric varices Portal hypertension

New guidelines for screening,evaluation and management of hepatobiliary disease in cystic fibrosis

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 875-878页

作者： P.Aiden McCormick Emer Fitzpatrick Liver Unit St Vincent’s University HospitalDublinIreland Department of Medicine UCD School of MedicineUniversity College DublinDublinIreland Gastroenterology and Liver Department Children’s Health IrelandCrumlinDublinIreland

The recently published guidelines on screening,monitoring and treatment update previous guidelines published 25 years ago(1,2).This update is timely as much has happened in the *** fibrosis(CF)modulator therapy has dramatically improved prognosis for patients with CF,although it is not yet clear whether liver disease is *** understanding of the pathophysiology of CF liver disease has also changed with the recognition of the importance of non-cirrhotic portal hypertension(3,4).Non-invasive tests for fibrosis and elastography have changed the practice of hepatology and reduced the need for liver *** guideline committee was made up of experts from North America and Europe and included adult and paediatric hepatologists and pulmonologists together with allied health practitioners and representatives of the CF community.A systematic literature search was performed and a vote of 80%was required to adopt a *** guidelines contain 7 recommendations for screening,13 for disease monitoring and 14 for treatment.

关键词： Cirrhosis oesophageal varices non-cirrhotic portal hypertension porto-sinusoidal vascular disease hepatobiliary

Endoscopic findings in patients with upper gastrointestinal bleeding clinically classified into three risk groups prior to endoscopy

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World Journal of Gastroenterology 2008年第32期14卷 5046-5050页

作者： Leonardo Tammaro Maria Carla Di Paolo Angelo Zullo Cesare Hassan Sergio Morini SebastianoCaliendo Lorella Pallotta Gastroenterology and DigestiveEndoscopy Ⅱ "San Giovanni Addolorata" Hospital Gastroentero-logy and Digestive Endoscopy "Nuovo Regina Margherita"Hospital

AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were strati- fied according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haem-orrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; χ2 = 304.5309, P < 0.001). Older age (t=3.311; P < 0.01) and presence of comor-bidities (χ2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplifi ed clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.

关键词： Upper gastrointestinal bleeding Urgentendoscopy Timing score Endoscopic treatment oesophageal varices Peptic ulcer

Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis

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World Journal of Gastroenterology 2010年第47期16卷 5982-5992页

作者： Natalie Funakoshi Frédérique Ségalas-Largey Yohan Duny Frédéric Oberti Jean-Christophe Valats Michael Bismuth Jean-Pierre Daurès Pierre Blanc Department of Hepato-gastroenterology B Saint Eloi Hospital University Hospital of Montpellier Department of Statistics University Hospital of Nimes Department of Hepato-gastroenterology University Hospital of Angers

AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif *** outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment signif icantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% conf idence interval (CI): 1.69-2.85, Poesophageal variceal bleeding.

关键词： oesophageal varices Portal hypertension Cirrhosis Secondary prevention β-blockers Banding ligation

Endoscopic Ruler for varix size measurement:A multicenter pilot study

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World Journal of Gastrointestinal Endoscopy 2023年第9期15卷 564-573页

作者： Yi-Fei Huang Sheng-Juan Hu Yang Bu Yi-Ling Li Yan-Hong Deng Jian-Ping Hu Shao-Qi Yang Qian Shen Mark McAlindon Rui-Chun Shi Xiao-Qin Li Tie-Ying Song Hai-Long Qi Tai-Wei Jiao Meng-Yuan Liu Fang He Jun Zhu Bin Ma Xiao-Bin Yu Jian-Yang Guo Yue-Hua Yu Hai-Jiang Yong Wen-Tun Yao Ting Ye Hua Wang Wen-Fu Dong Jian-Guo Liu Qiang Wei Jing Tian Xiao-Guo Li Xavier Dray Xiao-Long Qi Institute of Portal Hypertension The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Department of Gastroenterology People's Hospital of Ningxia Hui Autonomous RegionNingxia Medical University Affiliated People's Hospital of Autonomous RegionYinchuan 750000Ningxia Hui Autonomous RegionChina Department of Gastroenterology The First Affiliated Hospital of China Medical UniversityShenyang 110000Liaoning ProvinceChina Department of Gastroenterology Yinchuan First People's HospitalYinchuan 750000Ningxia Hui Autonomous RegionChina Department of Gastroenterology Ningxia Medical University General HospitalYinchuan 750000Ningxia Hui Autonomous RegionChina Department of Gastroenterology Yinchuan Second People's HospitalYinchuan 750000Ningxia Hui Autonomous RegionChina Academic Department of Gastroenterology and Hepatology Sheffield Teaching Hospitals NHS TrustAL 35660SheffieldUnited Kingdom Department of Gastroenterology Wuzhong People's HospitalWuzhong 751100Ningxia Hui Autonomous RegionChina Department of Gastroenterology The Fifth People's Hospital of Ningxia Hui Autonomous RegionShizuishan 753000Ningxia Hui Autonomous RegionChina Department of Second Gastroenterology The Sixth People’s Hospital of ShenyangShenyang 110000Liaoning ProvinceChina Department of Gastroenterology Shizuishan Second People's HospitalShizuishan 753000Ningxia Hui Autonomous RegionChina Department of Gastroenterology Zhongwei People's HospitalZhongwei 755000Ningxia Hui Autonomous RegionChina Department of Hepato-Gastroenterology ETISENSEACNRSSorbonne Université&APHPHôpital Saint AntoineUniversitéParis-SeineUniversitéde Cergy-PontoiseParis 75012SélectionnerFrance Center of Portal Hypertension Department of RadiologyZhongda HospitalMedical SchoolSoutheast UniversityNanjing 210000Jiangsu ProvinceChina

BACKGROUND We invented Endoscopic Ruler,a new endoscopic device to measure the size of varices in patients with cirrhosis and portal *** To assess the feasibility and safety of Endoscopic Ruler,and evaluate the agreement on identifying large oesophageal varices(OV)between Endoscopic Ruler and the endoscopists,as well as the interobserver agreement on diagnosing large OV using Endoscopic *** We prospectively and consecutively enrolled patients with cirrhosis from 11 hospitals,all of whom got esophagogastroduodenoscopy(EGD)with Endoscopic *** primary study outcome was a successful measurement of the size of varices using Endoscopic *** secondary outcomes included adverse events,operation time,the agreement of identifying large OV between the objective measurement of Endoscopic Ruler and the empirical reading of endoscopists,together with the interobserver agreement on diagnosing large OV by Endoscopic *** From November 2020 to April 2022,a total of 120 eligible patients with cirrhosis were recruited and all of them underwent EGD examinations with Endoscopic Ruler successfully without any adverse *** median operation time of Endoscopic Ruler was 3.00 min[interquartile range(IQR):3.00 min].The kappa value between Endoscopic Ruler and the endoscopists while detecting large OV was 0.52,demonstrating a moderate *** kappa value for diagnosing large OV using Endoscopic Ruler among the six independent observers was 0.77,demonstrating a substantial *** The data demonstrates that Endoscopic Ruler is feasible and safe for measuring the size of varices in patients with cirrhosis and portal *** Ruler is potential to promote the clinical practice of the two-grade classification system of OV.

关键词： oesophageal varices Cirrhosis Portal hypertension Esophagogastroduodenoscopy Endoscopic ruler

Upper Gastrointestinal Bleeding at a Public Referal Hospital in Malawi

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Surgical Science 2014年第11期5卷 501-507页

作者： Gift Mulima Javeria S.Qureshi Carol Shores Salim Tamimi Helena Klackenberg Ake Andren-Sandberg Department of Surgery Kamuzu Central HospitalLilongweMalawi Department of Surgery University of North CarolinaChapel HillUSA Department of Otolaryngology/Head&Neck Surgery University of North CarolinaChapel HillUSA Department of Surgery Karolinska UniversityStockholmSweden

Background: Upper gastrointestinal bleeding (UGIB) is a medical emergency. Timely and appropriate treatment can be lifesaving. Where medical equipment and supplies are inadequate, management of upper gastrointestinal bleeding is challenging. Methods: A retrospective review of charts of patients who were admitted during the year 2010, with a diagnosis of Upper Gastrointestinal Bleeding (UGIB), was done at Kamuzu Central Hospital, Lilongwe, Malawi. A Rockall score was applied to determine mortality risk. Results: A total number of 187 records (119 men and 68 women, mean age of 40.7 ± 15.3 years) were reviewed. The mortality rate was 23.5%, with a non-significant gender difference. Bleeding oesophageal varices were the most common clinical cause of UGIB (42.8%), with more males (63.1%) than females affected. About 40% of patients had no cause of UGIB indicated in their records. 14 (7.5%) patients had a normal oesophagogastroduodenoscopy (OGD). oesophageal tumor was present in 2.7% of the subjects as a cause of UGIB. Access to endoscopy, for diagnosis and therapeutic intervention, and surgery (Hassab procedure) was available to less than 50% of the patients. Sixteen patients (9.5%) had surgery after endoscopy due to lack of variceal banding materials.?Conclusion:?Upper gastrointestinal bleeding is an important and common clinical problem at Kamuzu Central Hospital. oesophageal varices seem to be the commonest cause of UGIB. Inadequacy of resuscitation materials and perhaps timely diagnostic and therapeutic endoscopic and surgical interventions are important limiting factors to favourable patient outcome. Work towards regular provision and supply of interventional resources regarding UGIB management may improve patient outcome.

关键词： Upper Gastrointestinal Bleeding(UGIB) oesophageal varices oesophageal Tumor Endoscopy