Transarterial embolization (TAE) is performed in patients with colonic diverticular bleeding after difficult endoscopic hemostasis or rebleeding. A total of 375 patients with hematochezia at our hospital from 1 April 2016 to 31 March 2020 were retrospectively analysed. Firstly, we compared the group in which hemostasis was achieved by endoscopy alone with the group that eventually underwent TAE. Secondly, we compared the group in which hemostasis was achieved by endoscopy alone, with the group switched to TAE after endoscopic hemostasis failed. The group that eventually underwent TAE had a higher shock index and lower Alb and PT% than the endoscopic hemostasis group. The shock index was correlated with Alb and PT%. When the cut-off value for the shock index was defined as more than 0.740, an OR of 9.500, a positive predictive value (PPV) of 40.0%, a negative predictive value (NPV) of 93.4%, and an accuracy of 80.3% were obtained for predicting a switch to TAE treatment. The greatest risk for TAE was the presence of shock and extravasation on contrast-enhanced CT. A switch to TAE treatment was likely when the shock index was more than 0.740. TAE should be considered in cases with a high shock index and showing extravasation on contrast-enhanced CT.
ObjectiveAscites in patients with decompensated cirrhosis can lead to abdominal distention and decrease quality of life. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective agent in the treatment of ascites, whereas some patients are refractory to tolvaptan. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for these patients is not known. In this study, we performed TIPS for tolvaptan-refractory cirrhotic patients and analysed its efficacy and safety in these patients.DesignThis retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS.ResultsThis study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m2in a month after TIPS procedure.ConclusionTIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.
The prevalence of hepatic cysts in the general population and their natural history are largely unknown. This study aimed to assess the prevalence and natural history of hepatic cysts by investigating health checkup participants. Ultrasonographic data of health checkup participants (n = 38,842) were retrospectively evaluated to calculate its prevalence. In addition, we assessed the changes in the size and characteristics of hepatic cysts over 10 years (n = 7,709). We found the prevalence of hepatic cysts was 21.9%. Older age, female sex, and presence of kidney cysts or pancreatic cysts were associated with the occurrence of hepatic cysts. Younger age, female sex, and the existence of multiple hepatic cysts were associated with cyst enlargement. Among 126 individuals who had hepatic cysts with a diameter of 30 mm or larger at the first visit, two (1.6%) required treatment. Remain 124 cases showed four patterns: 44 cases with enlargement, 47 stable, 11 regression after enlargement, and 22 regression. Hyperechoic fluid inside the cysts was observed in 54.5% (18 of 33), which was significantly higher than 6.6% (6 of 91) of the non-regression (OR = 17.0). The appearance of intracystic hyperechoic fluid by ultrasound may predict subsequent regression of the hepatic cyst.
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