Coexisting Gastric Varices Should Not Preclude Prophylactic Ligation of Large Esophageal Varices in Cirrhosis

Schepke, Michael; Biecker, Erwin; Appenrodt, Beate; Heller, J.; Sauerbruch, Tilman

doi:10.1159/000226968

Cited by 5 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, because the mechanism of varix obliteration differs between EIS and EBL, it is not clear whether EBL also affects portal pressure and GVs development. Some studies have suggested that EVs eradication by EBL is associated with increased portal pressure and risk of bleeding [25], while other studies have suggested that EBL does not affect portal pressure [26] and that it is not associated with GVs development [20]. In the present study, consistent with that latter finding, GVs did not aggravate after EVs eradication by EBL in all enrolled patients.…”

Section: Discussionsupporting

confidence: 90%

“…In this regard, several previous studies have shown conflicting results regarding the influence of EBL on cardiac varices; in one study, cardiac varices disappeared at similar frequencies between EIS (61.5%) and EBL (50%) [9], while another study suggested that cardiac varices do not disappear after EVs eradication by EBL in patients with GOVs [20]. In the present study, cardiac varices had disappeared in 64.7% of patients with GOV1s who had undergone EVs eradication by EBL.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation

Park

Seo

Lee

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

View full text Add to dashboard Cite

Background and Aims. Cardiac varices (CVs) in patients with type 1 gastroesophageal varices (GOV1s) usually disappear with treatment for esophageal varices (EVs) by endoscopic injection sclerotherapy (EIS). However, whether this applies to patients treated with endoscopic band ligation (EBL) for EVs remains unclear. We evaluated the effect of EVs eradication by EBL on CVs. Methods. We included cirrhotic patients whose EVs had been eradicated using EBL and excluded those who had been treated using EIS, those who had received endoscopic therapy for CVs, and those who were combined with hepatocellular carcinoma. Results. A total of 123 patients were enrolled. The age was 59.7 ± 11.7 years, and 96 patients (78.0%) were men. Thirty-eight patients (30.9%) had EVs only, while 85 (69.1%) had GOV1s. After EVs eradication, the CVs disappeared in 55 patients (64.7%). EVs recurred in 40 patients, with recurrence rates at 1, 2, and 3 years of 16.0%, 29.6%, and 35.6%, respectively, the recurrence being more frequent in patients who had undergone EBL for secondary prophylaxis and in those with persisting CVs after EVs eradication (P = 0.003). Conclusions. CVs frequently disappeared when EVs were eradicated using EBL in patients with GOV1s. Persistence of CVs after EVs eradication by EBL was associated with EVs recurrence.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation

Park

Seo

Lee

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

“…Some studies have shown that EVL results in an increase in the incidence and worsening of portal hypertensive gastropathy [44–47]. Others studies have shown that EVL influences also the development of gastric varices [48–50].…”

Section: Discussionmentioning

confidence: 99%

Esophageal variceal ligation in the secondary prevention of variceal bleeding: result of long term follow-up

Lahbabi¹,

Mellouki²,

Aqodad³

et al. 2013

Pan Afr Med J

View full text Add to dashboard Cite

IntroductionLong-term outcome of patients after band ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation in patients with portal hypertension in the Hassan II university hospital, Fes, Morocco.MethodsOver 118 months patients treated by endoscopic variceal ligation were received regular follow- up and detailed clinical assessment of at least 24 months.ResultsOne hundred twenty five patients were followed up for a mean of 31 months (range 12-107 months). Obliteration of the varices was achieved in 89.6 % (N = 112) of patients, with 3 +/-1.99 (range 1-8) endoscopy sessions over a period of 14 + /-6.8 weeks (range 3-28). The percentage of variceal recurrence during follow-up after ligation was 20.5 % (N = 23). Recurrence were observed in a mean of 22 months +/- 7.3 (range 3-48). Bleeding rate from recurrent varices was 30.4 % (7/23). Rebleeding from esophageal ulcers occurred in 5.6 % (7/125) of patients. Portal hypertensive gastropathy before and after eradication of varices was 17.6% (N = 22) and 44.6% (N = 50) respectively; p< 0.05. Fundal gastric varices was 30.4% (N = 38) and 35.7% (N = 40) before and after eradication of varices respectively; p> 0.05. The overall mortality was 4 % (N = 5).ConclusionBand ligation was an effective technical approach for variceal obliteration with low rates of variceal recurrence, rebleeding and development of gastric varices. Furthermore, it was associated with frequent development of portal hypertensive gastropathy.

show abstract

“…The risk of recurrent bleeding is dependent on the localization of the varix: isolated varices in the gastric fundus (53%) bear the highest risk of recurrent bleeding, followed by varices of the greater curvature (19%) and lesser curvature (6%) [ 189 ]. The prophylactic treatment of esophageal varices by VBL does not increase the risk of secondary gastric varices compared to propranolol [ 192 ].…”

Section: Gastric Varicesmentioning

confidence: 99%

Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

Biecker

2013

ISRN Hepatology

Self Cite

View full text Add to dashboard Cite

Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology.

show abstract

Coexisting Gastric Varices Should Not Preclude Prophylactic Ligation of Large Esophageal Varices in Cirrhosis

Cited by 5 publications

References 31 publications

Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation

Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation

Esophageal variceal ligation in the secondary prevention of variceal bleeding: result of long term follow-up

Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

Contact Info

Product

Resources

About