Effect of laparoscopic splenectomy on portal hypertensive gastropathy in cirrhotic patients with portal hypertension

Anegawa, Go; Kawanaka, Hirofumi; Uehara, Hideo; Akahoshi, Tomohiko; Konishi, Kozo; Yoshida, Daisuke; Kinjo, Nao; Hashimoto, Noriyuki; Tomikawa, Morimasa; Hashizume, Makoto; Maehara, Yoshihiko

doi:10.1111/j.1440-1746.2009.05906.x

Cited by 43 publications

(32 citation statements)

References 33 publications

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“…Partial splenic embolization also successfully controlled PHG bleeding in one case report [256] . Laparoscopic splenectomy, for various indications, was reported to decrease PHG severity [55] . Anegawa et al [55] prospectively analyzed the effect of laparoscopic splenectomy on preexistent PHG in 70 patients with liver cirrhosis from various etiologies.…”

Section: Sucralfate and Acid-suppressing Medicationsmentioning

confidence: 99%

“…Laparoscopic splenectomy, for various indications, was reported to decrease PHG severity [55] . Anegawa et al [55] prospectively analyzed the effect of laparoscopic splenectomy on preexistent PHG in 70 patients with liver cirrhosis from various etiologies. All patients underwent EGD before and 1 mo after splenectomy.…”

Section: Sucralfate and Acid-suppressing Medicationsmentioning

confidence: 99%

“…Child-Pugh stage C cirrhosis was associated with faster progression of PHG [34] . Liver disease severity: Numerous studies reported PHG is correlated with liver disease severity, as measured by Child-Pugh stage [8,9,29,35,37,55,57,67] . The reported strength of this correlation is variable.…”

Section: Liver Disease Durationmentioning

confidence: 99%

“…Table 5 [8, 9,11,14,34,41,55,62,67,71,83,85] lists wellestablished risk factors for PHG; Table 6 [11,41, 44,55,[75][76][77]83,85,[98][99][100][101][102][103][104][105][106][107] lists therapies that affect the severity of PHG or the risk of bleeding from PHG, and Table 7 [8, 14,28,30,35,42,84,[108][109][110] lists the factors that do not affect the risk of PGH.…”

Section: Additional Risk Factorsmentioning

confidence: 99%

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Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

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Section: Sucralfate and Acid-suppressing Medicationsmentioning

confidence: 99%

Section: Sucralfate and Acid-suppressing Medicationsmentioning

confidence: 99%

Section: Liver Disease Durationmentioning

confidence: 99%

Section: Additional Risk Factorsmentioning

confidence: 99%

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Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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“…2 Splenectomy not only effectively reverses thrombocytopenia, but also improves liver function, immune reaction and portal hypertensive gastropathy. [4][5][6][7] Therefore, splenectomy is still widely performed for patients with hypersplenism secondary to liver cirrhosis in China and Japan. 8,9 Haemorrhage from oesophagogastric varices is the major cause of death in cirrhotic patients with portal hypertension.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Chen

Yang

et al. 2012

ANZ Journal of Surgery

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Background: Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients. Objectives: A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients. Methods: A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers. Results: Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization. Conclusions: The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.

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Portal Hypertensive Gastropathy

Habib¹

2020

Variceal Bleeding in Liver Cirrhosis

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Effect of laparoscopic splenectomy on portal hypertensive gastropathy in cirrhotic patients with portal hypertension

Abstract: PHG may be associated with splenomegaly, and laparoscopic splenectomy may have a beneficial effect on PHG, at least for a short time.

Cited by 43 publications

References 33 publications

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Portal Hypertensive Gastropathy

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