Does Large Spontaneous Portal Systemic Shunt in Cirrhosis Protect from the Risk of Gastroesophageal Bleeding?

Aseni, Paolo; Beati, C.; Brambilla, Giorgio; Bertini, M; Belli, L

doi:10.1097/00004836-198606000-00006

Cited by 17 publications

(33 citation statements)

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“…Spontaneous splenorenal shunts may on splenorenal shunt. unexplained why many patients with large portosystemic shunts have encephalopathy [16,24,26,27] or bleeding varices [9,10,22,23], whereas others (such as our patient) do not suffer from these complications [10,20]. For bleeding, the age of the patient is probably important, children with spontaneous splenorenal shunt being at very high risk of gastroesophageal bleeding [14].…”

Section: ) Gastroesophageal Varicesmentioning

confidence: 79%

“…The CPT score has proved to be a very useful objective index (calculated from clinical data) to estimate the splenoportography or celiac-mesenteric angiography), 20 (4.38%) showed evidence of large self-established porto-severity of liver disease and the prognosis in patients with cirrhosis (the mortality from hepatic failure, gastrointessystemic shunt, including 3 patients with splenorenal shunt, 2 with mesenteric-caval shunt, and 15 with a large tinal bleeding, or hepatocellular carcinoma increases with increasing CPT score) [12,13]. The variables considered patent umbilical vein [10]. Twelve of these 20 patients had one or more episodes of bleeding, and 7 of them are ascites, encephalopathy, serum albumin, serum bilirubin, and prothrombin time.…”

mentioning

confidence: 99%

“…Twelve of these 20 patients had one or more episodes of bleeding, and 7 of them are ascites, encephalopathy, serum albumin, serum bilirubin, and prothrombin time. According to the CPT score, were submitted to surgical treatment to prevent recurrent gastrointestinal bleeding [10]. No correlation was found our patient (who was in a good nutritional status, without ascites or encephalopathy) was assigned a CPT score of between the risk of gastroesophageal hemorrhage and the type of portosystemic shunt [10].…”

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confidence: 99%

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A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

Iannello¹,

Libertini

Martini

et al. 1999

Dig Dis

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The aim of this paper is to describe and discuss, on the basis of a thorough review of the literature, the case of a 70-year-old woman with probable cirrhosis secondary to chronic hepatitis B and C, uncomplicated portal hypertension (without ascites, encephalopathy or bleeding varices), splenomegaly and hypersplenism, and an unusual, spontaneous, large splenorenal shunt and recanalization of the umbilical vein. The tortuous and varicose splenorenal shunt was diagnosed by abdominal ultrasound and CT investigations. A duplex Doppler ultrasonography evaluation was performed to study shunt flow direction and velocity. No gastroesophageal varices were identified on endoscopic examination. The clinical relevance of spontaneous splenorenal shunt, often associated with fundic gastric varices, is discussed.

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Section: ) Gastroesophageal Varicesmentioning

confidence: 79%

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confidence: 99%

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confidence: 99%

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A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

Iannello¹,

Libertini

Martini

et al. 1999

Dig Dis

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“…Preprocedural cross-sectional imaging of the liver and portal system can detect important contraindications to TIPS placement, such as multiple or huge hepatic cysts or hepatocellular carcinomas or obstruction or thrombosis of the portal or hepatic veins. 1,[9][10][11][12][13][14] Many researchers have investigated the relationships between diameter of the portal vein and portal pressure, 16 ‰ow direction, 17 development of the shunting vessels, 18 diameter of the shunting vessels and gastroesophageal bleeding, 19 or onset of encephalopathy. 20 Ito and associates 21 recently reported decreased diameter and hepatopetal ‰ow of the left gastric vein and the presence of non-variceal portosystemic shunt as predictive factors for variceal relapse after endoscopic therapies.…”

Section: Discussionmentioning

confidence: 99%

“…This cut-oŠ value was set based on results of previous reports. [16][17][18][19][20] Statistical analysis We performed statistical analysis using statistical analysis software (StatView version 5.0, SAS, Cary, NC, USA); compared mean age, Child-Pugh score, PV pressure, PV-IVC pressure gradient, post-TIPS pressure gradient, or PV diameter between the 2 groups using unpaired t test; and compared sex, emergent case number, or therapeutic success, early mortality, onset or worsening of hepatic encephalopathy, technical di‹culty, or shunt dysfunction rates after TIPS using Fisher's exact probability test. Quantitative variables were expressed as mean±standard deviation (SD), and statistical signiˆcance was established as Pº0.05.…”

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confidence: 99%

MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

Yoshikawa

Mitchell

2011

magn reson med sci

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Purpose: We assessed whether magnetic resonance (MR) imaging evaluation of portosystemic collateral shunts can aid prediction of therapeutic eŠectiveness and complications after creation of a transjugular portosystemic shunt (TIPS), and technical di‹culty during the TIPS procedure.Materials and Methods: We retrospectively reviewed 32 patients (27 men, 5 women; mean age, 56.4 years) who underwent TIPS creation following gadolinium-enhanced MR examination. We measured the diameters of pre-existing portosystemic collateral shunting vessels, added the measurements together to generate a shunting collateral score for each patient, and divided patients into 2 groups by score of 4 or greater or less than 4. We then compared therapeutic eŠectiveness, technical di‹culty and complications of the TIPS procedure, and portal venous (PV) pressure, PV-inferior vena cava (IVC) pressure gradient, and PV diameter between the groups.Results: The patients with a pre-existing large portosystemic shunt showed insigniˆcant trends toward higher technical di‹culty of the shunt procedure and rate of shunt dysfunction. The 2 groups showed no signiˆcant diŠerence in early mortality rate, onset or worsening rate of hepatic encephalopathy after TIPS creation, PV pressure, PV-IVC pressure gradient, or PV diameter.Conclusion: Gadolinium-enhanced MR imaging may help in predicting technical di‹-culty and complications of TIPS.

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Radioisotopic splenoportography in patients with portal hypertension

Samejima

Ikeda

Yokoyama

et al. 1989

The Japanese Journal of Surgery

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Radio-isotopic splenoportography was performed by injecting 99mTcO4- into the spleens of 46 patients with portal hypertension and 14 patients with various disorders not having portal hypertension. No collateral circulation was demonstrated in the 14 patients without portal hypertension whereas some RI-images of portosystemic collaterals were found in 40 (87.0 per cent) of the 46 patients with portal hypertension. Collaterals were divided into an ascending group and a descending group, the appearance rate of ascending collaterals being 80.4 per cent and that of descending collaterals, 41.3 per cent. There were 3 image patterns in the ascending group, namely, an AZ-pattern in which the azygos vein was demonstrated; a SC-pattern in which the RI-bolus ascended along the esophagus to the neck and the subclavian vein; and an EG-pattern which showed stagnation of the RI-bolus in the esophagogastric region. There were 4 patterns in the descending group, namely; a pattern of gastro-renal caval shunt (GR-pattern); reverse flow patterns into the umbilical or paraumbilical veins (UV-pattern); into the superior mesenteric vein (SMV-pattern); and into the inferior mesenteric vein (IMV-pattern). The appearance of the EG-pattern was seen most frequently (74.4 per cent). The usefulness of this method for surveying the collateral circulation in portal hypertension, estimating the risk of esophageal variceal bleeding and evaluating its treatments, was suggested by the results of this study.

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Does Large Spontaneous Portal Systemic Shunt in Cirrhosis Protect from the Risk of Gastroesophageal Bleeding?

Cited by 17 publications

References 0 publications

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

Radioisotopic splenoportography in patients with portal hypertension

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