Bleeding in patients with Budd–Chiari syndrome

Rautou, Pierre‐Emmanuel; Douarin, Ludivine; Denninger, Marie‐Hélène; Escolano, Sylvie; Lebrec, Didier; Moreau, Richard; Vidaud, Michel; Itzykson, Raphaël; Moucari, Rami; Bezeaud, Annie; Valla, Dominique; Plessier, Aurélie

doi:10.1016/j.jhep.2010.06.019

Cited by 61 publications

(26 citation statements)

References 19 publications

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“…Bleeding occurred within 1 month in 10 (22%) patients and was associated with administration of anticoagulant or antiplatelet agents. This high incidence is reminiscent of the frequent bleeding episodes reported in patients with Budd‐Chiari syndrome undergoing invasive procedures while receiving anticoagulation therapy …”

Section: Discussionmentioning

confidence: 96%

Abdominal Surgery in Patients With Idiopathic Noncirrhotic Portal Hypertension: A Multicenter Retrospective Study

et al. 2019

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In patients with idiopathic noncirrhotic portal hypertension (INCPH), data on morbidity and mortality of abdominal surgery are scarce. We retrospectively analyzed the charts of patients with INCPH undergoing abdominal surgery within the Vascular Liver Disease Interest Group network. Forty‐four patients with biopsy‐proven INCPH were included. Twenty‐five (57%) patients had one or more extrahepatic conditions related to INCPH, and 16 (36%) had a history of ascites. Forty‐five procedures were performed, including 30 that were minor and 15 major. Nine (20%) patients had one or more Dindo‐Clavien grade ≥ 3 complication within 1 month after surgery. Sixteen (33%) patients had one or more portal hypertension–related complication within 3 months after surgery. Extrahepatic conditions related to INCPH (P = 0.03) and history of ascites (P = 0.02) were associated with portal hypertension–related complications within 3 months after surgery. Splenectomy was associated with development of portal vein thrombosis after surgery (P = 0.01). Four (9%) patients died within 6 months after surgery. Six‐month cumulative risk of death was higher in patients with serum creatinine ≥ 100 μmol/L at surgery (33% versus 0%, P < 0.001). An unfavorable outcome (i.e., either liver or surgical complication or death) occurred in 22 (50%) patients and was associated with the presence of extrahepatic conditions related to INCPH, history of ascites, and serum creatinine ≥ 100 μmol/L: 5% of the patients with none of these features had an unfavorable outcome versus 32% and 64% when one or two or more features were present, respectively. Portal decompression procedures prior to surgery (n = 10) were not associated with postoperative outcome. Conclusion: Patients with INCPH are at high risk of major surgical and portal hypertension–related complications when they harbor extrahepatic conditions related to INCPH, history of ascites, or increased serum creatinine.

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Section: Discussionmentioning

confidence: 96%

Abdominal Surgery in Patients With Idiopathic Noncirrhotic Portal Hypertension: A Multicenter Retrospective Study

et al. 2019

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“…Moreover, as a consequence of the hindered hepatic venous outflow, radiological criteria for HCC can be altered [8,9] . Finally, although the risk of procedure-related bleeding is probably increased [10] , generally diagnosis of HCC in BCS still needs histological confirmation [8,9] . Overall, the incidence of HCC is increasing, not only in the general population of patients with cirrhosis [11,12] , but particularly in some subgroups of patients, like those with human immunodeficiency virus (HIV) infection or thalassemia.…”

Section: Reviewmentioning

confidence: 99%

Management of hepatocellular carcinoma: Enlightening the gray zones

Mancuso¹

2013

WJH

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Management of hepatocellular carcinoma (HCC) has been continuously evolving during recent years. HCC is a worldwide clinical and social issue and typically a complicates cirrhosis. The incidence of HCC is increasing, not only in the general population of patients with cirrhosis, but particularly in some subgroups of patients, like those with human immunodeficiency virus infection or thalassemia. Since a 3% annual HCC incidence has been estimated in cirrhosis, a bi-annual screening is generally suggested. The diagnostic criteria of HCC has recently had a dramatic evolution during recent years. HCC diagnosis is now made only on radiological criteria in the majority of the cases. In the context of cirrhosis, the universally accepted criteria for HCC diagnosis is contrast enhancement in arterial phase and washout in venous/late phase at imaging, the so called "typical pattern". However, recently updated guidelines slightly differ in diagnostic criteria. Apart from liver transplantation, the only cure of both HCC and underlying liver cirrhosis, all the other treatments have to match with higher rate of HCC recurrence. The latter can be classified into curative (resection and percutaneous ablation) and palliative treatments. The aim of this paper was to review the current knowledge on management of HCC and to enlighten the areas of uncertainty.

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“… General laboratory findings Blood test: at least one blood cell component is decreased. Liver function test: the test results range from normal to severely abnormal levels according to disease severity. Endoscopy: upper gastrointestinal varices are often observed. In some cases, portal hypertensive gastroenteropathy is evident and so‐called ectopic varices in the duodenum, around bile ducts, and in the lower gastrointestinal tract Imaging modality findings Ultrasonography, CT, MRI, and laparoscopy. Contrast radiography of inferior vena cava and hepatic vein and their pressure measurement …”

Section: Guidelines For Diagnosis Of Aberrant Portal Hemodynamicsmentioning

confidence: 99%

Diagnosis and treatment guidelines for aberrant portal hemodynamics

Furuichi

Tanaka

Takikawa

et al. 2017

Hepatology Research

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Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.

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Bleeding in patients with Budd–Chiari syndrome

Cited by 61 publications

References 19 publications

Abdominal Surgery in Patients With Idiopathic Noncirrhotic Portal Hypertension: A Multicenter Retrospective Study

Abdominal Surgery in Patients With Idiopathic Noncirrhotic Portal Hypertension: A Multicenter Retrospective Study

Management of hepatocellular carcinoma: Enlightening the gray zones

Diagnosis and treatment guidelines for aberrant portal hemodynamics

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