Esophageal and Gastric Varices ; etiology ; therapy ; Female ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Humans ; Liver Cirrhosis ; complications ; therapy ; Male

Esophageal and Gastric Varices ; etiology ; surgery ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; Humans ; Hypertension, Portal ; complications

Esophageal and Gastric Varices ; etiology ; therapy ; Hemodynamics ; Humans ; Hypertension, Portal ; complications ; therapy ; Liver Cirrhosis ; complications ; therapy ; Portal Vein ; physiopathology

BACKGROUND/AIMS: Gastric variceal bleeding is difficult to treat endoscopically because the hemodynamics of the gastric varix are different from that of the esophageal varix. Transjugular intrahepatic portosystemic shunt (TIPS), which has been used widely, does not always result in the regression of gastric varix and it may aggravate the hepatic encephalopathy. Balloon occluded retrograde transvenous obliteration (BRTO) was introduced as a new procedure for gastric variceal bleeding with minimal invasiveness. The purpose of this study was to evaluate the therapeutic effects and complications on follow-up of BRTO as a new treatment option for gastric variceal bleeding. METHODS: Patients with gastric variceal bleeding, who were treated with BRTO form September, 2001 to April, 2003, were included in the study. After the definite confirmation of the shunts with abdominal CT, the sclerosing agent, 5% ethanolamine oleate, was injected into the gastric varix during occlusion through gastrorenal shunts. The procedurre was deemed a technical success when the clotting of the sclerosing agent was observed without leakage, and a clinical success when bleeding stopped and the varix decreased in size or was eradicated during the follow-up period (6-23 months, mean: 17.7). RESULTS: Technical success was achieved in 12 of 13 patients (92%) with gastric variceal bleeding. There were no significant side effects. In the one case of failure, the bleeding was controlled with TIPS. Eleven of the 12 patients who had technical success were shown to be clinically successful. The follow-up endoscopic exam showed some aggravation of pre-existing esophageal varices in four patients and a new development of esophageal varices in two patients. Endoscopic variceal ligation was done on one patient in whom esophageal variceal bleeding was present during the follow-up period. CONCLUSIONS: BRTO was proven to be a feasible, safe and less invasive procedure than TIPS and found to be an effective treatment of a gastric variceal bleeding. Considering the possible aggravation of pre-existing esophageal varices or the new development of esophageal varices, regular endoscopic examinations might be needed during the follow-up period.
Adult ; Aged ; *Balloon Occlusion ; English Abstract ; Esophageal and Gastric Varices/complications/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the effect of enhanced nutritional therapy on wound healing after endoscopic therapy in patients with liver cirrhosis and esophageal varices.

METHODSFifty patients with liver cirrhosis and esophageal varices were randomly divided into an enhanced nutritional therapy group (n = 25) and a control group (n = 25). The enhanced nutritional therapy group received one week of enhanced nutritional supplementation, including liver nutritional elements, prior to routine endoscopic therapy. The routine without any change to their diet. The rate of transformation and status of wound healing of esophageal varices were compared between the two groups.

RESULTSThe ratio of ulcers occurring at the injection site was lower in the enhanced nutrition group than in the control group (16/25 vs. 23/25; x2 = 5.711, P = 0.017). The enhanced nutrition group had only one case of minimal bleeding occurring during endoscopy as compared to the seven cases of bleeding in the control group (x2 = 5.357, P = 0.021). On average, the enhanced nutrition group required less sessions of endoscopic treatment to achieve eradication of esophageal varices than the control group (3.8 vs. 4.1; t = 2.069, P = 0.044).

CONCLUSIONPre-endoscopic enhanced nutritional therapy may benefit patients with liver cirrhosis and esophageal varices by promoting recovery of procedure-related local tissue injury and occlusion of varices.

Adult ; Endoscopy ; Esophageal and Gastric Varices ; etiology ; therapy ; Female ; Humans ; Liver Cirrhosis ; complications ; therapy ; Male ; Middle Aged ; Nutritional Support ; Wound Healing

Adult ; Aged ; Embolization, Therapeutic ; Esophageal and Gastric Varices ; complications ; therapy ; Female ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Humans ; Male ; Middle Aged

Endoscopy, Digestive System ; Esophageal and Gastric Varices ; complications ; drug therapy ; surgery ; therapy ; Fibrosis ; complications ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; surgery ; therapy ; Humans ; Hypertension, Portal ; drug therapy ; etiology ; surgery ; therapy

OBJECTIVESTo observe the effects and safety of percutaneous transhepatic coronary vein occlusion under ultrasound type B and X-ray guiding to treat esophagogastric variceal hemorrhage in cirrhotic patients.

METHODSEighteen cirrhotic patients suffering from esophagogastric variceal hemorrhage were treated with percutaneous transhepatic coronary vein occlusion under ultrasound type B and X-ray guiding. Among them, 8 patients were treated during emergency bleeding and another 10 patients after hemorrhage.

RESULTSSeventeen patients were successfully treated with coronary vein occlusion. One patient rebled after 6 hours of the treatment and was treated successfully with transjugular intrahepatic portosystemic shunt. The emergency hemostatic treatment efficacy was 87.5%, and successful occlusion occurred in 94.4%. All patients were followed up for 1 to 24 months. There were 4 patients who suffered from rebleeding, 2 patients from hepatic failure and 2 patients from hepatocellular carcinoma. There were 12 patients survived during the follow-up.

CONCLUSIONPercutaneous transhepatic coronary vein occlusion under the type B ultrasonography and X-ray guiding is safe and efficient to treat esophagogastric variceal hemorrhage in cirrhotic patients

Esophageal and Gastric Varices ; etiology ; Female ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemorrhage ; therapy ; Humans ; Hypertension, Portal ; complications ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Portal Vein

Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis related complications has been recognized during recent years. This paper aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis related complications. Hepatobiliary Study Group of Chinese Society of Gastroenterology of Chinese Medical Association and Hepatology Committee of Chinese Research Hospital Association have invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts' clinical experiences. Overall, 10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction, and bacterial infections and in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin-related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis related complications.
Electrolytes ; Esophageal and Gastric Varices/drug therapy* ; Gastrointestinal Hemorrhage/etiology* ; Hepatorenal Syndrome/etiology* ; Humans ; Liver Cirrhosis/drug therapy* ; Lypressin/adverse effects* ; Terlipressin/adverse effects* ; Vasoconstrictor Agents/adverse effects*

Catheterization ; Endoscopy ; Esophageal and Gastric Varices ; complications ; drug therapy ; surgery ; therapy ; Gastrointestinal Hemorrhage ; drug therapy ; etiology ; surgery ; therapy ; Humans ; Octreotide ; therapeutic use ; Somatostatin ; therapeutic use ; Vasopressins ; therapeutic use