Esplenectomia e ligadura da veia gástrica esquerda na esquistossomose mansônica: efeitos sobre pressão das varizes do esôfago e indicadores endoscópicos de risco de sangramento por varizes esofagogástricas

Evangelista-Neto, João; Pereira, Fernanda Maria Fernández; França, Suênia Tavares; Amaral, Fernando José do; Brandt, Carlos Teixeira; Fonseca-Neto, Olival Cirilo Lucena da; Lacerda, Cláudio Moura

doi:10.1590/s0102-67202012000100010

Cited by 10 publications

(6 citation statements)

References 25 publications

(27 reference statements)

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“…As shown by Cleva and colleagues 6 and Evangelista-Neto et al 8 there is varices venous pressure drop and a decrease in varices diameter after splenectomy and ligation of the left gastric vein 18 , favoring the intervention of the endoscopist. Due to the decrease in varicose veins diameter as a consequence of the decrease in its pressure, the risk of rebleeding is reduced.…”

Section: Discussionmentioning

confidence: 95%

“…Although leading to good postoperative results 8 , the rebleeding rate after EGDS is substantial, ranging from 6-29% 9 10 13 17 . However, Sakai et al, have shown a significant decrease in the postoperative bleeding rate when endoscopic therapy was annexed as an extension of postoperative follow-up 17 , showing the need of a follow-up endoscopy in patients submitted to EGDS.…”

Section: Introductionmentioning

confidence: 99%

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Late Results of Esophagogastric Devascularization and Splenectomy Associated With Endoscopic Treatment in Patients With Schistosomiasis

Silva-Neto

Junior

Tredicci

2015

ABCD, arq. bras. cir. dig.

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Background:Schistosomiasis is endemic problem in Brazil affecting about three to four million people, and digestive hemorrhage caused by esophageal varices rupture is the main complication of the disease. Surgical treatment has become a therapeutic option, especially for secondary prophylaxis after at least one episode of bleeding. The surgical technique used by the vast majority of surgeons for the prevention of rebleeding is esophagogastric devascularization and splenectomy. Although with good postoperative results, rebleeding rate is significant, showing the need to follow-up endoscopy in all patients. Aim:To evaluate long-term results of patients submitted to esophagogastric devascularization and splenectomy and postoperative endoscopic treatment regarding esophageal varices caliber and rebleeding rates. Methods:A retrospective study of 12 patients underwent esophagogastric devascularization and splenectomy followed for more than five years. Results: All patients showed varices size reduction, and no patient had postoperative bleeding recurrence. Conclusion:Esophagogastric devascularization and splenectomy decreased significantly the esophageal variceal size when associated with endoscopic follow-up, being effective for bleeding recurrence prophylaxis.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Late Results of Esophagogastric Devascularization and Splenectomy Associated With Endoscopic Treatment in Patients With Schistosomiasis

Silva-Neto

Junior

Tredicci

2015

ABCD, arq. bras. cir. dig.

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“…Preference for the application of EGDS over DSRS was expressed by several authors [67,110,111], but the opposite also by others [80,112]. Interestingly, a few publications described less invasive variations of EGDS, preserving or not the spleen [71,72,91], with seemingly good results. Such approaches may deserve further evaluation, as they may be more suitable in some less experienced or less equipped settings.…”

Section: Discussionmentioning

confidence: 99%

“…SS, statistically significant, NS, not statistically significant, NR, statistical analysis not reported. #n = intervention indicated in the corresponding "Intervention #n" to which the outcome direction refers[45,65,[67][68][69][70][71][72][73][80][81][82][83][84][85][86][87][88][89][90][91][92][93].…”

mentioning

confidence: 99%

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

et al. 2021

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Background Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS. Methodology/principal findings We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking. Conclusions Most interventions have been developed on the basis of individual groups’ experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.

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“…Consequently, the liver becomes extremely arterialized with greatly increased sinusoidal pressure, leading to loss of liver function in the long term. 16 , 17 …”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

2015

JCTH

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Background and Aims: Schistosomiasis is a major chronic disease of humans in endemic regions, and infected individuals may develop a spectrum of pathology, including hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world, and there is limited and controversial evidence suggesting that Schistosoma mansoni infection may be a possible risk factor for HCC. The aim of this study was to report a case series of patients with HCC and S. mansoni infection and to conduct a literature review on the topic. Methods: From January 2002 to January 2015, an institutional database was screened retrospectively to identify patients with HCC and S. mansoni infection at a single center in the Department of Gastroenterology of University of São Paulo School of Medicine and Hospital das Clínicas, Brazil. Results: Seven cases were included. The mean age of patients was 62.1±10.3 years; six (85.7%) were male and one (14.3%) was female. All cases had positive epidemiology, coming from endemic areas of S. mansoni infection in Brazil, and four (57.1%) had previous complications (upper gastrointestinal bleeding) related to portal hypertension or surgery intervention (splenectomy) performed more than 10 years before the HCC diagnosis. Nontumoral portal vein thrombosis was identified in five (71.4%) patients. All patients had negative serology for HCV, and four (57.1%) had positivity of HBVcore antibodies without evidence of viral replication. According to BCLC staging, one (14.3%) patient was BCLC A and received TACE instead of RFA because HCC size was >30 mm; three (42.8%) BCLC B patients received sorafenib instead of local regional treatment due to the presence of nontumoral TPV. During follow-up, all patients developed tumoral progression and died. Conclusions: It remains unclear if S. mansoni infection alone has carcinogenic potential. The available literature indicates that S. Mansoni, in the presence of HBV and HCV infections, likely acts as a cofactor for the hepatic lesion and potentiates injury.

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Esplenectomia e ligadura da veia gástrica esquerda na esquistossomose mansônica: efeitos sobre pressão das varizes do esôfago e indicadores endoscópicos de risco de sangramento por varizes esofagogástricas

Abstract: In patients with hepatosplenic schistosomiasis with a previous history of variceal hemorrhage, splenectomy and gastric vein ligation was effective in reducing the main hemorrhagic risk factors until the sixth month of follow-up, indicating a good way to control the bleeding episodes.

Cited by 10 publications

References 25 publications

Late Results of Esophagogastric Devascularization and Splenectomy Associated With Endoscopic Treatment in Patients With Schistosomiasis

Late Results of Esophagogastric Devascularization and Splenectomy Associated With Endoscopic Treatment in Patients With Schistosomiasis

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

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