Introduction: Variceal bleeding (VB) is a serious complication in cirrhotic patients. Hepatic pressure venous gradient (HPVG) is the gold standard to assess high risk of VB, but, this is not always available and is an invasive method. Therefore is necessary to explore if non-invasive parameters are useful as predictive factors of high risk of VB. Objective: To evaluate if low platelet count, spleen size, platelet count/spleen size ratio, portal vein diameter, blood flow velocity of the portal vein, congestion index of the portal vein, and variceal size could be useful as non-invasive parameters for predicting high risk of VB in cirrhotic patients. Subjects and methods: Observational, cross sectional study, that includes 99 cirrhotic patients with esophageal varices. For predictive analysis we considered as the dependent variable ''presence of VB'' and the independent variables we tested were: Child-Pugh score, platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, blood flow velocity of the portal vein, congestion index of the portal vein, variceal size. Univariate and multivariate logistic regression were performed. Results: 99 cirrhotics with esophageal varices were included, 56 (56.6%) were female, the mean of age was 57.8 ± 12.2. About variceal size, 54 (54.5%) of patients had large varices. Regarding to occurrence of VB, 46 (46.5%) presented it. In the multivariate analysis, the presence of large varices in the endoscopic study was the best predictor of VB (OR = 11.1; 95% CI = 3.9 to 32.8, P < 0.0001). Portal vein diameter ≥ 13 mm results with an OR = 5.0; 95% CI = 1.1 to 21.7, P = 0.03 Conclusions: The presence of large esophageal varices is the most important predictive risk factor for the occurrence of VB, independently of the class of Child-Pugh. Additionally, the M.A. Peñaloza-Posada et al.portal vein diameter ≥ 13 mm is a non-invasive parameter related to high risk of VB. Therefore, these factors could be used as predictors of high risk of VB when the measure of HPVG is not available. Parámetros no invasivos como predictores de alto riesgo de hemorragia variceal en pacientes cirróticosResumen Introducción: La hemorragia variceal (HV) es una complicación grave en pacientes cirróticos. El gradiente de presión venosa hepática (GPVH) es el estándar de oro para clasificar pacientes con alto riesgo de HV, sin embargo, este no siempre está disponible y es un método invasivo. Por tanto, es necesario explorar si parámetros no invasivos son útiles como factores predictores de alto riesgo de HV. Objetivo: Evaluar si la baja cuenta plaquetaria, tamaño del bazo, cociente cuenta plaquetaria/tamaño del bazo, diámetro portal, velocidad del flujo portal, índice de congestión portal, y tamaño variceal podrían ser útiles como parámetros no invasivos para predecir alto riesgo de HV en pacientes cirróticos. Sujetos y métodos: Estudio observacional, transversal, que incluyó 99 pacientes cirróticos con varices esofágicas. Para el análisis predictivo consideramos como la variable dependiente ''pr...
El síndrome de Lemmel es una entidad poco frecuente que se caracteriza por la presencia de ictericia obstructiva secundaria a la presencia de un divertículo duodenal periampular. Los periampulares son los más comunes, se presentan en un 75%; de estos, los que se localizan a 2-3 cm del ámpula de Vater se conocen como divertículos yuxtapapilares y la mayoría son extraluminales y adquiridos. Actualmente el diagnóstico se realiza utilizando colangiopancreatografía retrógrada endoscópica o ultrasonografía endoscópica, ya que con ambas se logra confirmar el diagnóstico. La esfinterotomía endoscópica y colocación de prótesis biliar es el tratamiento de elección en caso de complicación biliar o pancreática. Reportamos el caso de una paciente de 67 años con síndrome de Lemmel.
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