ACR Appropriateness Criteria® Radiologic Management of Gastric Varices

Kim, Charles Y.; Pinchot, Jason W.; Ahmed, O.; Braun, Aaron R; Cash, Brooks D.; Feig, Barry W.; Kalva, Sanjeeva P.; Koepsel, Erica M. Knavel; Scheidt, Matthew J.; Schramm, Kristofer; Sella, David M.; Weiss, Clifford R.; Hohenwalter, Eric J.

doi:10.1016/j.jacr.2020.01.017

Cited by 14 publications

(13 citation statements)

References 102 publications

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“…One such technique is splenic vein recanalization, which is utilized when the extrahepatic portal hypertension is a result of splenic vein occlusion. 16 Luo et al retrospectively analyzed 11 patients with pancreatitis-related splenic vein occlusion who underwent transjugular endovascular recanalization of the splenic vein with the deployment of bare stents or covered stents with an overall reduction in splenic vein pressure gradient (SPG) from 21.5 to 2.9 mm Hg ( p < 0.01). 18 In their median follow-up of 17.5 months, there was no recurrence of bleeding events.…”

Section: Interventional Radiology (Ir) Based Interventionsmentioning

confidence: 99%

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Advances in Management of Pancreatitis Related Portal Hypertension

Patel

Mingbunjerdsuk

Gabr

et al. 2022

Digestive Disease Interventions

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Extrahepatic portal hypertension (EPH) is hypertension that occurs in the extrahepatic portal vasculature in the absence of liver cirrhosis. Portal hypertension (PHTN) is defined as a pressure gradient between the portal vein and hepatic vein/inferior vena cava (IVC) exceeding more than 5 mm Hg. PHTN is more commonly known as a manifestation of cirrhosis and the related elevation in hepatic to venous pressure gradient (HVPG); however, there are other extrahepatic etiologies to PHTN that are important for review. Per our literary review, EPH as a complication of pancreatitis has been known as a manifestation since at least the 1970s. Among the severities of pancreatitis, it occurs most commonly with acute necrotizing pancreatitis and chronic pancreatitis. In this review, we plan to provide an understanding of mechanisms by which EPH occurs, discuss the treatments (e.g., anticoagulation, splenic artery embolization, and splenectomy) for the complications that result from prolonged EPH, and discuss the current endoscopic interventions available to counteract these complications.

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Section: Interventional Radiology (Ir) Based Interventionsmentioning

confidence: 99%

“…15 In certain cases of repeat bleeding episodes or inability to achieve hemostasis during initial EGD, balloon tamponade can be attempted with Linton-Nachlas tube or Sengstaken-Blakemore/Minnesota tubes before proceeding with emergent radiologic interventions. 16…”

Section: Endoscopic Therapymentioning

confidence: 99%

Advances in Management of Pancreatitis Related Portal Hypertension

Patel

Mingbunjerdsuk

Gabr

et al. 2022

Digestive Disease Interventions

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“…Embolisation of varices has become a treatment option for gastroesophageal varices in patients who are not eligible for TIPS. 63 Balloon-occluded retrograde transvenous obliteration has been performed in patients with bleeding from high-flow gastric varices. 64 The procedure has been associated with a lower rate of rebleeding and HE compared to TIPS for the management of gastric varices.…”

Section: Transjugular Intrahepatic Portosystemic Shuntmentioning

confidence: 99%

“…While it can reduce the splenic flow and portosystemic gradient, current studies did not report a survival benefit with combined TIPS and splenic embolisation. 63 , 71 , 72 …”

Section: Transjugular Intrahepatic Portosystemic Shuntmentioning

confidence: 99%

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

et al. 2022

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“…It is important to note that most randomized controlled trials discussing treatment of acute variceal bleeding tend to combine all variceal subtypes (esophageal, junctional gastroesophageal, and gastric), making interpretation of published results problematic at best. The radiologic management of gastroesophageal varices type 2 (GOV2) (cardiofundal) and isolated gastric varices (IGV1/2) is comprehensively discussed in the ACR Appropriateness CriteriaÒ topic on "Radiologic Management of Gastric Varices" [3]. To this end, the scope of this document will instead focus on the management of esophageal varices and those gastroesophageal varices extending across the cardia into the lesser curve of the stomach, ie, gastroesophageal varices type 1 (GOV1).…”

Section: Summary Of Literature Review Introduction/backgroundmentioning

confidence: 99%

ACR Appropriateness Criteria® Radiologic Management of Portal Hypertension

Imaging

Pinchot

Kalva

et al. 2021

Journal of the American College of Radiology

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Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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ACR Appropriateness Criteria® Radiologic Management of Gastric Varices

Cited by 14 publications

References 102 publications

Advances in Management of Pancreatitis Related Portal Hypertension

Advances in Management of Pancreatitis Related Portal Hypertension

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

ACR Appropriateness Criteria® Radiologic Management of Portal Hypertension

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