Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III)

Reiberger, Thomas; Püspök, Andreas; Schoder, Maria; Baumann-Durchschein, Franziska; Bucsics, Theresa; Datz, Christian; Dolak, Werner; Ferlitsch, Arnulf; Finkenstedt, Armin; Graziadei, Ivo; Hametner, S; Karnel, F; Krones, Elisabeth; Maieron, A; Mandorfer, Mattias; Peck‐Radosavljevic, Markus; Rainer, Florian; Schwabl, Philipp; Stadlbauer, Vanessa; Stauber, Rudolf; Tilg, Herbert; Trauner, Michael; Zoller, Heinz; Schöfl, R; Fickert, Peter

doi:10.1007/s00508-017-1262-3

Cited by 122 publications

(207 citation statements)

References 188 publications

(400 reference statements)

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“…Portal hypertension, as assessed by hepatic venous pressure gradient (HVPG), drives the development of complications (ie, hepatic decompensation) in patients with advanced chronic liver disease (ACLD) …”

Section: Introductionmentioning

confidence: 99%

Controlled attenuation parameter does not predict hepatic decompensation in patients with advanced chronic liver disease

Scheiner

Steininger

Semmler

et al. 2018

Liver International

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Section: Introductionmentioning

confidence: 99%

Controlled attenuation parameter does not predict hepatic decompensation in patients with advanced chronic liver disease

Scheiner

Steininger

Semmler

et al. 2018

Liver International

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“…According to current guidelines, the standard treatment for VB is hemodynamic stabilization, vasoactive drugs (terlipressin, somatostatin or analogues) and antibiotic prophylaxis, followed by esophagogastroduodenoscopy and variceal band ligation within 12 hours (ideally within the first 6 hours after admission) . Control of VB can be achieved in 80%‐90% of cases .…”

Section: Introductionmentioning

confidence: 99%

Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study

Pfisterer

Riedl

Pachofszky

et al. 2018

Liver International

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Background Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited. Methods Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed. Results SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients. Conclusion SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement.

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“…According to the primary study aim, patients were divided into four groups according to the presence of thrombocytopenia (platelet count < 150 g/L, lower limit of normal) and MPV (MPV </≥ median value of the respective cohort; derivation cohort: ≥11 fL, validation cohort: ≥10.6 fL). Liver function at baseline was assessed by MELD and Child-Pugh score [31].…”

Section: Patients and Definitionsmentioning

confidence: 99%

Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma

et al. 2018

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Background: Platelets have been reported to influence tumor biology and may promote metastasis. Traditionally, thrombocytopenia, a hallmark of cirrhosis, was associated with hepatocellular carcinoma (HCC) development. However, the impact of platelet count on outcome in patients with established HCC is not well studied. Methods: Outcomes of patients with cirrhosis diagnosed with HCC between 1995 and 2013 (derivation cohort) and 2000-2016 (validation cohort) who were not eligible for surgical treatment and did not receive antiplatelet therapy were retrospectively studied. Thrombocytopenia was defined as platelet count < 150 g/L. High mean platelet volume (MPV) was defined as ≥median value of the respective cohort (derivation cohort: ≥11 fL; validation cohort: ≥10.6 fL). Results: Among 626 patients with unresectable HCC, thrombocytopenia was present in 378 (60.4%) and was associated with favorable baseline tumor characteristics: lower diameter of the largest nodule (5.6 ± 3.2 vs. 7.6 ± . These results were confirmed in an independent external validation cohort of 525 patients with cirrhosis and HCC. Again, patients with thrombocytopenia and high MPV had significantly longer .2] months; p < 0.001). Conclusions: Thrombocytopenia and higher MPV are associated with better outcome in patients with advanced HCC. These findings may prompt further clinical research on additive antiplatelet therapy in the prevention and management of HCC.

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Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III)

Cited by 122 publications

References 188 publications

Controlled attenuation parameter does not predict hepatic decompensation in patients with advanced chronic liver disease

Controlled attenuation parameter does not predict hepatic decompensation in patients with advanced chronic liver disease

Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study

Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma

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