Portal Pressure Decrease After Esophagogastric Devascularization and Splenectomy in Schistosomiasis: Long-Term Varices Behavior, Rebleeding Rate, and Role of Endoscopic Treatment

Neto, Walter De Biase da Silva; Tredicci, Thiago Miranda; Coelho, Fabrício Ferreira; Makdissi, Fábio F.; Herman, Paulo

doi:10.1590/s0004-2803.201800000-30

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…The effect of splenectomy on portal hypertension is largely unknown. Silva Neto et al described a decrease in intraoperative portal pressure and an improvement of symptoms related to portal hypertension after splenectomy. Makdissi et al stated that esophageal varices significantly decreased in both the caliber and number after esophagogastric devascularization.…”

Section: Discussionmentioning

confidence: 99%

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Individualized concept for the treatment of autosomal recessive polycystic kidney disease with end‐stage renal disease

Miura

Sato

Yabuuchi

et al. 2020

Pediatric Transplantation

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Management of children with autosomal recessive polycystic kidney disease (ARPKD) who develop end‐stage renal disease (ESRD) remains challenging because of concomitant liver disease. Patients with recurrent cholangitis are candidates for liver‐kidney transplantation, while the treatment for patients with splenomegaly and pancytopenia due to portal hypertension is controversial. Herein, we report 7 children who were treated using an individualized treatment strategy stratified by liver disease. Two patients with recurrent cholangitis underwent sequential liver‐kidney transplantation, while 4 patients with splenomegaly and pancytopenia but without recurrent cholangitis underwent splenectomy followed by isolated kidney transplantation. The remaining patient, who did not have cholangitis and pancytopenia, underwent isolated kidney transplantation. Blood cell counts were normalized after splenectomy was performed at the median age of 8.7 (range, 7.4‐11.7) years. Kidney transplantation was performed at the median age of 8.8 (range, 1.9‐14.7) years in all patients. Overwhelming post‐splenectomy infections and cholangitis did not occur during the median follow‐up period of 6.3 (range, 1.0‐13.2) years. The estimated glomerular filtration rate at the last follow‐up was 53 (range, 35‐107) mL/min/1.73 m2. No graft loss occurred. Our individualized treatment strategy stratified by recurrent cholangitis and pancytopenia can be a feasible strategy for children with ARPKD who develop ESRD and warrants further evaluation.

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Section: Discussionmentioning

confidence: 99%

“…These findings suggest that there was no aggravation of portal hypertension after splenectomy. However, previous reports described that long‐term recurrence of esophageal varices is the rule, emphasizing the need for lifelong endoscopic treatment for all patients …”

Section: Discussionmentioning

confidence: 99%

Individualized concept for the treatment of autosomal recessive polycystic kidney disease with end‐stage renal disease

Miura

Sato

Yabuuchi

et al. 2020

Pediatric Transplantation

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“…Granted the heterogeneity of the reviewed studies for what concerns follow-up length and ancillary interventions (e.g., local management of varices), overall, DSRS appears being followed by fewer episodes of UGB compared to EGDS, but being burdened by a more frequent development of hepatic encephalopathy, with comparable mortality rates between the 2 interventions. When looking at the whole picture of results of the included studies presented in Fig 5, it seems that a better outcome in terms of rebleeding was reported when EGDS was followed by variceal sclerotherapy or band ligation [68][69][70], but no study included in this review formally compared EGDS alone versus EGDS followed by local variceal management. Such comparison was carried out by Ferraz and colleagues [71] who applied a variation of the EDGS procedure, including splenectomy, ligature of the left gastric vein, and devascularization of the great gastric curvature, without, however, finding significant differences in rebleeding rate between patients undergoing such technique followed or not by local variceal management sessions.…”

Section: "Classic" Surgical Interventionsmentioning

confidence: 99%

“…SS, statistically significant, NS, not statistically significant, NR, statistical analysis not reported. #n = intervention indicated in the corresponding "Intervention #n" to which the outcome direction refers[45,65,[67][68][69][70][71][72][73][80][81][82][83][84][85][86][87][88][89][90][91][92][93].…”

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confidence: 99%

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

et al. 2021

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Background Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS. Methodology/principal findings We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking. Conclusions Most interventions have been developed on the basis of individual groups’ experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.

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“…Модифицированная операция Sugiura включает, помимо трансабдоминальной спленэктомии, гастроэзофагеальную деваскуляризацию и дополнительно -транссекцию с реанастомозированием дистального отдела пищевода на расстоянии 4-6 см выше кардии, что способствует более полной деваскуляризации перфорантных и подслизистых вен пищевода [13,14,15,16,17,18]. В публикациях, посвященных нешунтирующим операциям, уделяется внимание обсуждению их влияния на портальное давление.…”

Section: Introductionunclassified

Surgical Tactics for Failure of Stapler Esofago-Esofagoanastomosis During Esophagastric Devascularization

Могилевец¹

2020

Hepatol Gastroenterol

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Гродненский государственный медицинский университет, Гродно, Беларусь Введение. Являясь на сегодняшний день резервными методами, шунтирующие и разобщающие (нешунтирующие) хирургические операции помогают добиться стабильной профилактики рецидивов кровотечений из варикозно расширенных вен пищевода. Хирургические операции азигопортального разобщения более просты в исполнении в сравнении с шунтирующими операциями, ассоциируются с меньшим риском развития энцефалопатии в послеоперационном периоде. Цель исследования-анализ результатов выполнения лапароскопической эзофагогастральной деваскуляризации со степлерной транссекцией пищевода с последующей конверсией в тораколапаротомную резекцию дистальной трети пищевода и проксимальную резекцию желудка. Материал и методы. Лапароскопическая эзофагогастральная деваскуляризация со степлерной транссекцией пищевода с последующей конверсией в тораколапаротомную резекцию дистальной трети пищевода и проксимальную резекцию желудка по поводу обширного дефекта в области аппаратного прошивания в зоне эзофаго-эзофагоанастомоза выполнена в УЗ «Гродненская университетская клиника» в феврале 2019 г. пациенту с циррозом печени, портальной гипертензией и рецидивирующими кровотечениями из варикозно расширенных вен пищевода. Результаты. Пациент выписан на амбулаторное лечение, рецидивов кровотечений из варикозно расширенных вен пищевода за период наблюдения, составляющий 12 месяцев, не было. Лапароскопическая эзофагогастральная деваскуляризация со степлерной транссекцией пищевода, являясь эффективной операцией для лечения и профилактики кровотечений из варикозно расширенных вен пищевода, в ряде случаев сопряжена с осложнениями, связанными с некорректным срабатыванием аппарата циркулярного механического шва. Выводы. Своевременная интраоперационная диагностика данных ситуаций с помощью тщательной ревизии зоны эзофаго-эзофагоанастомоза, проведение тестов на его герметичность, знание оперирующим хирургом техники корригирующих осложнения оперативных вмешательств и готовность к их выполнению позволяют предотвратить фатальные последствия для пациентов. Ключевые слова: цирроз печени, портальная гипертензия, варикозно расширенные вены пищевода, эзофагогастральная деваскуляризация, азигопортальное разобщение, транссекция пищевода, проксимальная резекция желудка, пластика пищевода желудком.

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Portal Pressure Decrease After Esophagogastric Devascularization and Splenectomy in Schistosomiasis: Long-Term Varices Behavior, Rebleeding Rate, and Role of Endoscopic Treatment

Cited by 11 publications

References 11 publications

Individualized concept for the treatment of autosomal recessive polycystic kidney disease with end‐stage renal disease

Individualized concept for the treatment of autosomal recessive polycystic kidney disease with end‐stage renal disease

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

Surgical Tactics for Failure of Stapler Esofago-Esofagoanastomosis During Esophagastric Devascularization

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