scholarly journals Gastroduodenal Lesions Associated with Portal Hypertension: An Extensive Review

2021 ◽  
Author(s):  
Vincenzo Neri ◽  
Nicola Tartaglia ◽  
Alberto Fersini ◽  
Pasquale Cianci ◽  
Mario Pacilli ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Blood Flow ◽  
Clinical Practice ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Gastric Varices ◽  
Gastric Antral Vascular Ectasia ◽  
Extensive Review ◽  
Vascular Ectasia ◽  
Isolated Gastric Varices

The block of the portal flow by obstacles in prehepatic, hepatic or posthepatic site and alterations of the splanchnic blood flow are the pathological conditions that lead to portal hypertension. The portal hypertension can cause also others gastroduodenal lesions, potentially hemorrhagic, in addition to esophageal varices commonly developed and habitual source of bleeding in these patients. The gastroduodenal lesions associated with portal hypertension, usually encountered in the clinical practice, are portal hypertensive gastropaty, gastric antral vascular ectasia, gastric and duodenal ulcer, isolated gastric varices. The pathophysiology and clinical, diagnostic and therapeutic features of these lesions are examined.

Portal Hypertension and Variceal Hemorrhage

2015 ◽  
Author(s):  
Amir Qamar
Keyword(s):  
Portal Hypertension ◽  
Natural History ◽  
Esophageal Varices ◽  
Variceal Hemorrhage ◽  
Portal Hypertensive Gastropathy ◽  
Gastric Antral Vascular Ectasia ◽  
Esophageal Variceal ◽  
Gastroesophageal Varices ◽  
Vascular Ectasia ◽  
History Of

Gastrointestinal bleeding in patients with cirrhosis can occur from a number of different causes, including portal hypertension, gastric antral vascular ectasia, and acute variceal hemorrhage. The management of these conditions involves a combined medical and endoscopic approach, with radiologic and surgical therapies restricted to refractory cases. This review covers the natural history of gastroesophageal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia; diagnostic principles; primary and secondary prophylaxis relating to esophageal variceal hemorrhage; and treatment overviews for gastric variceal hemorrhage, portal hypertensive gastropathy, and gastric antral vascular ectasia. Figures show the pathophysiology of complications of cirrhosis, esophageal varices as seen during an upper endoscopic procedure, natural history of esophageal varices in patients with cirrhosis, portal hypertensive gastropathy, gastric antral vascular ectasia, and management principles for acute variceal hemorrhage, esophageal variceal ligation, and gastric varices. Tables list the prevalence of various etiologies of hemorrhage in patients with cirrhosis, current recommendations for follow-up screening and surveillance of varices, sensitivities and specificities of some noninvasive markers, and principles of initial management of acute variceal hemorrhage. This review contains 8 highly rendered figures, 4 tables, and 44 references.

scholarly journals A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Hany El-Assaly ◽  
Lamiaa I. A. Metwally ◽  
Heba Azzam ◽  
Mohamed Ibrahim Seif-Elnasr
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Imaging Modality ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

scholarly journals Balloon-Assisted Percutaneous Transhepatic Antegrade Embolization with 2-Octyl Cyanoacrylate for the Treatment of Isolated Gastric Varices with Large Gastrorenal Shunts

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Guangchuan Wang ◽  
Dongxiao Meng ◽  
Guangjun Huang ◽  
Qingshan Pei ◽  
Lianhui Zhao ◽  
...  
Keyword(s):  
Esophageal Varices ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Survival Rates ◽  
Laboratory Data ◽  
International Normalized Ratio ◽  
Gastric Varices ◽  
Balloon Occlusion ◽  
Before And After ◽  
Isolated Gastric Varices

Aims. To evaluate the safety and effectiveness of percutaneous transhepatic antegrade embolization (PTAE) with 2-octyl cyanoacrylate assisted with balloon occlusion of the left renal vein or gastrorenal shunts (GRSs) for the treatment of isolated gastric varices (IGVs) with large GRSs. Methods. Thirty patients with IGVs associated with large GRSs who had underwent PTAE assisted with a balloon to block the opening of the GRS in the left renal vein were retrospectively evaluated and followed up. Clinical and laboratory data were collected to evaluate the technical success of the procedure, complications, changes in the liver function using Child-Pugh scores, worsening of the esophageal varices, the rebleeding rate, and survival. Laboratory data obtained before and after PTAE were compared (paired-sample t-test). Results. PTAE was technically successful in all 30 patients. No serious complications were observed except for one nonsymptomatic pulmonary embolism. During a mean follow-up of 30 months, rebleeding was observed in 4/30 (13.3%) patients, worsening of esophageal varices was observed in 4/30 (13.3%) patients, and newly developed or aggravated ascites were observed on CT in 3/30 (10%) patients. Significant improvement was observed in Child-Pugh scores (p=0.009) and the international normalized ratio (INR) (p=0.004) at 3 months after PTAE. The cumulative survival rates at 1, 2, 3, and 5 years were 96.3%, 96.3%, 79.9%, and 79.9%, respectively. Conclusion. Balloon-assisted PTAE with 2-octyl cyanoacrylate is technically feasible, safe, and effective for the treatment of IGV associated with a large GRS.

scholarly journals Noninvasive diagnosis of portal hypertension and esophageal varices through the identification of liver blood flow markers

Hepatology ◽  
2014 ◽  
Vol 60 (2) ◽  
pp. 762-762 ◽  
Author(s):  
Andrea Lisotti ◽  
Francesco Azzaroli ◽  
Marco Montagnani ◽  
Giuseppe Mazzella
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Liver Blood Flow ◽  
Noninvasive Diagnosis

Gastric Antral Vascular Ectasia (GAVE) to Prevent Bleeding-Induced Anemia in Patients with Portal Hypertension

2008 ◽  
Vol 67 (5) ◽  
pp. AB257
Author(s):  
Tomohiro Kato ◽  
Hiroshi Araki ◽  
Akihiko Sugiyama ◽  
Hideki Hayashi ◽  
Youichi Nishigaki ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastric Antral Vascular Ectasia ◽  
Vascular Ectasia

scholarly journals SPLENIC ARTERY EMBOLIZATION IN OUR OWN MODIFICATION IN PATIENTS WITH SEGMENTAL PORTAL HYPERTENSION AND BLEEDING FROM VARICES OF THE GASTRIC FUNDUS

2021 ◽  
pp. 56-63
Author(s):  
E.V. Mahiliavets ◽  
P.V. Harelik ◽  
L.F. Vasilchuk ◽  
A.V. Cherniy
Keyword(s):  
Blood Flow ◽  
Portal Hypertension ◽  
Splenic Artery ◽  
Single Point ◽  
Gastric Varices ◽  
Gastric Fundus ◽  
Endovascular Embolization ◽  
Endoscopic Examination ◽  
Splenic Artery Embolization ◽  
Flow Through

There is still no single point of view regarding the choice of the most effective method for treating left-sided portal hypertension, due to the difficulties in organizing the recruitment of patient groups for controlled studies on this topic. Aim. Preliminary analysis of the results of performing endovascular embolization of the splenic artery in our own modification in patients with left-sided portal hypertension. Materials and methods. Endovascular embolization of the splenic artery in our own modification was performed in three patients with chronic recurrent pancreatitis and left-sided portal hypertension (all males) aged 46 to 59 years after a repeated episode of bleeding from varices of the gastric fundus (2 to 3 relapses). A distinctive feature of our modification of X-ray endovascular partial embolization of the proximal segment of the splenic artery was that the criterion for stopping the process of reducing blood flow through the splenic artery was endoscopic confirmation of the fact of achieving reliable hemostasis. Results and discussion. All patients underwent successful surgery. Two patients were transferred after surgery to the Department of Surgical Pancreatology, Hepatology and Transplantation. In one case, it was required to stay in the intensive care unit for four days after surgery due to the severity of preoperative blood loss. The time spent in hospital in the postoperative period was (Me [min; max]) - 7 [6; 7] days. During the postoperative observation of these patients for the period from 22 to 60 months, no recurrence of bleeding from gastric varices was noted. In all patients, endoscopic examination after a year showed regression of the degree of expansion of gastric varices. Сonclusions. The method of endovascular embolization of the splenic artery presented in the article makes it possible to effectively achieve reliable hemostasis in bleeding from varices of the fundus of the stomach in patients with left-sided portal hypertension while maintaining blood flow through the splenic artery sufficient to minimize the risk of developing total necrosis and abscess of the spleen, necrotic changes in the fundus of the stomach and pancreas The reproducibility of the surgical intervention, its effectiveness and safety should be noted. It is advisable carry out further studies of the effectiveness of the technique in randomized controlled trials.

scholarly journals Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension

Gut ◽  
1999 ◽  
Vol 44 (5) ◽  
pp. 739-742 ◽  
Author(s):  
L Spahr ◽  
J-P Villeneuve ◽  
M-P Dufresne ◽  
D Tassé ◽  
B Bui ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Therapeutic Option ◽  
Multiorgan Failure ◽  
Postoperative Mortality ◽  
Portacaval Shunt ◽  
Low Grade ◽  
Gastric Antral Vascular Ectasia ◽  
Vascular Ectasia ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

BACKGROUNDPortal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) are increasingly recognised as separate entities. The pathogenic role of portal hypertension for the development of GAVE is still controversial.AIMSTo evaluate the effects of portal decompression on chronic bleeding related to GAVE in cirrhotic patients.METHODSEight patients with cirrhosis and chronic blood loss related to GAVE were included. GAVE was defined endoscopically and histologically.RESULTSAll patients had severe portal hypertension (mean portocaval gradient (PCG) 26 mm Hg) and chronic low grade bleeding. Seven patients underwent transjugular intrahepatic portosystemic shunt (TIPS) and one had an end to side portacaval shunt. Rebleeding occurred in seven patients. In these, TIPS was found to be occluded after 15 days in one patient; in the other six, the shunt was patent and the PCG was below 12 mm Hg in five. In the responder, PCG was 16 mm Hg. Antrectomy was performed in four non-responders; surgery was uneventful, and they did not rebleed after surgery, but two died 11 and 30 days postoperatively from multiorgan failure. In one patient, TIPS did not control GAVE related bleeding despite a notable decrease in PCG. This patient underwent liver transplantation 14 months after TIPS; two months after transplantation, bleeding had stopped and the endoscopic appearance of the antrum had normalised.CONCLUSIONSResults suggest that GAVE is not directly related to portal hypertension, but is influenced by the presence of liver dysfunction. Antrectomy is a therapeutic option when chronic bleeding becomes a significant problem but carries a risk of postoperative mortality.

scholarly journals Outcome of Band Ligation in Esophageal Varices of Bangladeshi Children: A Tertiary Centre Experience

2017 ◽  
Vol 41 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Salahuddin Mahmud ◽  
Syed Shafi Ahmed ◽  
Jahida Gulshan ◽  
Farhana Tasneem ◽  
Madhabi Baidya
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Clinical Situation ◽  
Gastric Varices ◽  
Band Ligation ◽  
Tertiary Centre ◽  
Life Threatening ◽  
Common Etiology ◽  
One Year

Background: Variceal bleeding is often a life threatening clinical situation in infants and children. Band ligation is the main endoscopic treatment for esophageal varices.Objective: To see the outcome of band ligation of esophageal varices in extra-hepatic and hepatic cases of portal hypertension.Methods: This prospective study was done in the Department of Pediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh on 40 consecutive cases of esophageal varices enrolled from April, 2014 to March 2016. Every case was treated with band ligation followed by tab. propranolol. Cases were followed up for a minimum period of one year after the band ligation.Results: Age of the children was 2-12 years with mean age of 7.2±4.3 years and male:female ratio was 1.5:1. Out of 40 children, 32 (80%) were pre-hepatic and 8 (20%) hepatic (chronic liver disease with portal hypertension) causes. Only 1 session required in 50% pre-hepatic cases and multiple (2-3) sessions required in hepatic (100%) cases. Almost same number of band (average 2-3) required in every session of both cases. Grade-II esophageal varices with red sign were more common in prehepatic cases & severity of grading much more (grade-III & IV) in hepatic cases. Gastric varices were more common in hepatic (50%) cases than extra-hepatic (12.5%) cases. Recurrence of bleeding occurred in all hepatic (100%) cases and half (50%) of the pre-hepatic cases. Early re-bleeding was more common in hepatic (75%) cases & late re-bleeding in both pre-hepatic (43.7%) & hepatic (100%) cases. Minimal side effect like discomfort (10%) & Nausea (10%) were present after the procedure.Conclusion: Pre-hepatic was the most common etiology of portal hypertension in studied children. Fewer sessions were required in pre-hepatic cases than in hepatic cases. Severity of grading, re-bleeding & associated gastric varices were more common in hepatic cases. Band ligation was found to be the treatment of choice for the control of acute variceal bleeding and prevention of re-bleeding with less complications.Bangladesh J Child Health 2017; VOL 41 (1) :28-33

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