Clinical trial: a randomized controlled study on prevention of variceal rebleeding comparing nadolol + ligation vs. hepatic venous pressure gradient‐guided pharmacological therapy

Villanueva, Càndid; Aracil, Carles; Colomo, Alan; López-Balaguer, J.M.; Piqueras, Marta; González, Begoña; Torras, Xavier; Guarner, Carlos; Balanzó, Joaquím

doi:10.1111/j.1365-2036.2008.03880.x

Cited by 52 publications

(56 citation statements)

References 35 publications

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“…Such as the addition of ISMN to b-blockers which enhances the fall in portal pressure achieved using only b-blockers and this combined therapy has shown efficacy in preventing variceal rebleeding. Responders to b-blockers have no further decrease in HVPG with the addition of vasodilators and the beneficial effects are restricted to nonresponders [55,56] . Villaneuva et al [55] carried out a study on cirrhotic patients following a variceal bleed to assess the value of HVPG-guided therapy using nadolol + prazosin in nonresponders to nadolol + ISMN compared with a control group treated with nadolol + ligation.…”

Section: Hvpg Monitoring In Secondary Prophylaxismentioning

confidence: 99%

Use of portal pressure studies in the management of variceal haemorrhage

Addley

Tham²,

Cash³

2012

WJGE

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Section: Hvpg Monitoring In Secondary Prophylaxismentioning

confidence: 99%

Use of portal pressure studies in the management of variceal haemorrhage

Addley

Tham²,

Cash³

2012

WJGE

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“…In patients with intolerance or contraindications to NSBB, EBL is recommended. In subjects without an hemodynamic response to NSBB, there is no consensus on the efficacy of EBL (26,157) .…”

Section: Recommendationsmentioning

confidence: 99%

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

Bittencourt

Farias

Strauss

et al. 2010

Arq. Gastroenterol.

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-In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all participants met together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manuscript is the summary of the systematic review that was presented during the meeting, organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

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“…HVPG plays a central role not only in diagnosis, but also for treatment monitoring of portal hypertension (8)(9)(10)(11)(12). Unfortunately, measurement of HVPG is invasive, typically performed by placement of a balloon catheter in the right hepatic vein, via the internal jugular vein, where the difference between the wedged venous pressure and systemic venous pressure is used to estimate HVPG (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

In vivo validation of 4D flow MRI for assessing the hemodynamics of portal hypertension

Roldán‐Alzate

Frydrychowicz

Niespodzany

et al. 2013

Magnetic Resonance Imaging

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Purpose-to implement and validate in vivo radial 4D flow MRI for quantification of blood flow in the hepatic arterial, portal venous and splanchnic vasculature of healthy volunteers and patients with portal hypertension.Methods & Materials-17 patients with portal hypertension and 7 subjects with no liver disease were included in this HIPAA-compliant and IRB-approved study. Exams were conducted at 3T using a 32-channel body coil with large volumetric coverage and 1.4mm isotropic true spatial resolution. Using post-processing software, cut-planes orthogonal to vessels were used to quantify flow (L/min) in the hepatic and splanchnic vasculature.Results-Flow quantification was successful in all cases. Portal vein and supra-celiac aorta flow demonstrated high variability among patients. Measurements were validated indirectly using internal consistency at three different locations within the portal vein (error=4.2±3.9%) and conservation of mass at the portal confluence (error=5.9±2.5%) and portal bifurcation (error=5.8±3.1%).Discussion-This work demonstrates the feasibility of radial 4D flow MRI to quantify flow in the hepatic and splanchnic vasculature. Flow results agreed well with data reported in the literature, and conservation of mass provided indirect validation of flow quantification. Flow in patients with portal hypertensions demonstrated high variability with patterns and magnitude consistent with the hyperdynamic state that commonly occurs in portal hypertension.

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Clinical trial: a randomized controlled study on prevention of variceal rebleeding comparing nadolol + ligation vs. hepatic venous pressure gradient‐guided pharmacological therapy

Abstract: SUMMARY BackgroundHepatic venous pressure gradient (HVPG) monitoring of therapy to prevent variceal rebleeding provides strong prognostic information. Treatment of nonresponders to b-blockers AE nitrates has not been clarified.

Cited by 52 publications

References 35 publications

Use of portal pressure studies in the management of variceal haemorrhage

Use of portal pressure studies in the management of variceal haemorrhage

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

In vivo validation of 4D flow MRI for assessing the hemodynamics of portal hypertension

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