Management of Ascites in Patients with Cirrhosis: An Update

Zaccherini, Giacomo; Tufoni, Manuel; Iannone, Giulia; Caraceni, Paolo

doi:10.3390/jcm10225226

Cited by 15 publications

(19 citation statements)

References 75 publications

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“…Moreover, Et promote the synthesis of endothelin and nitric oxide in HSCs and ECs, which results in increased portal blood pressure [ 40 ]. Because the hemodynamic effects of portal hypertension (PHT) can induce hepatic encephalopathy [ 41 ], HRS [ 42 ], and ascites [ 43 ], it is possible that ADAMTS13:AC and VWF:Ag are associated with these conditions through Et-induced development of hepatic encephalopathy, HRS, ascites, and subsequent PHT.…”

Section: Discussionmentioning

confidence: 99%

ADAMTS13, VWF, and Endotoxin Are Interrelated and Associated with the Severity of Liver Cirrhosis via Hypercoagulability

Takaya

Namisaki

Asada

et al. 2022

JCM

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ADAMTS13 specifically cleaves the multimeric von Willebrand factor (VWF), and an imbalance between ADAMTS13 activity (ADAMTS13:AC) and VWF antigen (VWF:Ag) levels is associated with the severity of liver cirrhosis (LC). However, the reason for this imbalance in patients with LC is unknown. This study investigated the relationship among ADAMTS13:AC, VWF:Ag, and endotoxin (Et) levels in patients with LC. ADAMTS13:AC and VWF:Ag levels were determined using ELISA, whereas Et levels were estimated using a chromogenic substrate assay. The levels of ADAMTS13 inhibitor (ADAMTS13:INH) were evaluated by measuring the extent that heat-inactivated patient’s plasma reduces the ADAMTS13:AC of the control. The status (degraded, normal, or unusually large [UL]) of the VWF multimer (VWFM) was determined through vertical agarose gel electrophoresis. ADAMTS13:AC, VWF:Ag, and Et levels decreased, increased, and increased, respectively, with the severity of LC. Patients with cirrhosis with high Et levels had lower and higher ADAMTS13:AC and VWF:Ag levels, respectively, than those with low Et levels. Patients with cirrhosis with detectable ADAMTS13:INH had higher Et levels than those with undetectable ADAMTS13:INH. Patients whose VWFM was either normal or UL had higher Et levels than those with degraded VWFM. In conclusion, ADAMTS13, VWF, and Et may be interrelated and associated with the severity of LC via hypercoagulability.

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Section: Discussionmentioning

confidence: 99%

ADAMTS13, VWF, and Endotoxin Are Interrelated and Associated with the Severity of Liver Cirrhosis via Hypercoagulability

Takaya

Namisaki

Asada

et al. 2022

JCM

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“…Миниинвазивный вариант шунтирующего пособия, а именно трансъюгулярное внутрипеченочное портосистемное шунтирование (Transjugular Intrahepatic Portosystemic Shunt, TIPS), является важным элементом программы лечения пациента с продвинутой стадией ЦП [3,4]. Применение TIPS у больных с жизнеугрожающими осложнениями ПГ позволяет в значительной степени увеличить продолжительность бестрансплантационного периода за счет существенного уменьшения риска рецидива варикозного пищеводножелудочного кровотечения (ВПЖК) и развития гепаторенального синдрома (ГРС), нередко осложняющего течение рефрактерного асцита (РА) [5][6][7]. Уже более 20 лет TIPS имеет устойчивую репутацию эффективного способа достижения портальной декомпрессии за счет существенного уменьшения портосистемного градиента давления (ПСГД), особенно у больных с суб-и декомпенсированной стадиями печеночной недостаточности (ПН), соответствующими классам В и С по Child-Pugh [8].…”

Section: вве де ниеunclassified

“…У 57 пациентов 2-й группы показанием к TIPS был РА. Вмешательство преследовало цель существенного уменьшения ПСГД, являющегося важным звеном патогенеза асцитического синдрома [7,8]. Шунтирующую операцию в этой группе, обозначенной "Асцит", применяли ввиду отсутствия улучшения на фоне терапии продолжительностью не менее 6 мес, включавшей диуретики, ограничение соли и неоднократные сеансы лечебного парацентеза с последующими внутривенными инфузиями альбумина.…”

Section: материал и методыunclassified

“…Для эмболизации путей притока к ПЖВ предпочтение отдавали эмболизирующим спиралям модели MReye ® (Cook, США), поскольку их длинные волокна обеспечивают хорошую тромбогенность. Число спиралей, применяемых во время операции, зависело от выявленных путей притока, их диаметра и характера ветвления, в среднем составило 4,7 ± 2,9 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: материал и методыunclassified

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Selection of a portosystemic shunt placement procedure (TIPS) in the treatment of complicated portal hypertension

et al. 2022

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Aim. To improve treatment results in patients with the life-threatening complications of cirrhotic portal hypertension by making an informed choice of the optimal TIPS (transjugular intrahepatic portosystemic shunt) variant.Materials and methods. A total of 234 patients suffering from the complications of cirrhotic portal hypertension underwent TIPS placement. The indications for shunt placement include esophageal and gastric varices exhibiting the signs of bleeding or carrying the risk of rebleeding (in 172 patients), refractory ascites (in 57 patients), and portal vein thrombosis in the setting of cirrhosis (in 5 patients). Patients from Group 1 underwent shunt placement together with the embolization of inflow pathways to esophageal and gastric varices. In Group 2, priority was given to perioperative therapy, while shunt placement was used together with embolization only in cases of severe varices. In Group 3, the shunt placement stage was combined with the portal blood flow restoration. Immediate and late results were studied in terms of complications, as well as mortality rate and survival rates.Results. The maximum observation duration amounted to 140 months (11.7 years). TIPS efficacy in all patients was confirmed by a statistically significant decrease in the portosystemic pressure gradient. In Group 1, the highest mortality rate associated with rebleeding was observed in patients who had undergone only shunt placement (30.6%), while the lowest rate was noted in patients whose inflow pathways to varices had first been embolized and who then had undergone intrahepatic shunt placement (7.1%). Patients in Group 2 exhibited a reduction in ascites and the severity of varices. The technical feasibility of TIPS in the setting of portal vein thrombosis was enhanced by experience accumulation and preoperative planning relying on careful interpretation of computed splenoportography data.Conclusion. It is reasonable to combine the shunt placement stage of TIPS for variceal bleeding with selective embolization of all radiologically detected inflow pathways to gastroesophageal varices. If the portal vein thrombosis is not accompanied by cavernous transformation, TIPS can achieve effective portal decompression provided the portal blood flow is restored.

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“…More challenging is the treatment of ascites when it reaches the stage of refractoriness. An updated and exhaustive analysis of this topic has been reported in this issue of JCM , including the more recent data regarding the placement of a transjugular intrahepatic portosystemic shunt (TIPS) and chronic albumin administration [ 9 ]. TIPS reduces portal hypertension, allows greater control of ascites, and in some cases improves the clinical course of the disease.…”

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confidence: 99%