Surgical shunts compared with endoscopic sclerotherapy for the treatment of variceal bleeding in adults with portal hypertension: a systematic review and meta-analysis

Tian, Lu; He, Yunjun; Li, Donglin; Zhang, Hongkun

doi:10.1136/postgradmedj-2016-134750

Cited by 4 publications

(6 citation statements)

References 36 publications

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“…To reduce venous blood reflux, splenectomy remains the preferred treatment for patients with gastric bleeding due to LSPH, and splenic artery embolization can be used as a supplementary measure in patients in whom splenectomy is deemed unsuitable [13,16,17,19,[57][58][59]. Moreover, while endoscopic therapy is highly advantageous for the treatment of acute massive gastric bleeding, rebleeding is unavoidable [60][61][62][63]. We are also currently investigating whether LSPH due to mechanical compression can be corrected via stent implantation.…”

Section: Discussionmentioning

confidence: 99%

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Yu¹,

Li²,

Gong

et al. 2020

BMC Gastroenterol

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Background: Left-sided portal hypertension (LSPH) is an extremely rare clinical syndrome, and it is the only form of curable portal hypertension. It is primarily caused by pancreatic disease, and is associated with complications that cause spleen vein compression. Specific symptoms are often lacking, rendering it difficult to diagnose. Splenectomy is the main treatment for cases complicated by variceal bleeding, and the effects of treatment primarily depend on the condition of the primary disease. Case presentation: The patient was a 29-year-old woman who was admitted to the hospital for repeated hematemesis and black stool. She had been misdiagnosed with pancreatic cancer 7 years prior. Combined imaging and endoscopic examination indicated varicose gastric fundus veins, a pancreatic mass, and enlarged peripancreatic lymph nodes. Laboratory investigations revealed reduced erythrocyte, platelet, and leukocyte counts, the interferon gamma release assay was positive, and liver function was normal. Abdominal exploration, splenectomy, varicose vein dissection, and lesion resection were performed via laparotomy. Postoperative biopsy analysis confirmed the diagnosis of lymph node tuberculosis. Based on the above-described factors, LSPH caused by peripancreatic lymph node tuberculosis was a diagnosed. Conclusions: Herein we describe the first reported case of LSPH caused by peripancreatic lymph node tuberculosis. When left portal hypertension occurs simultaneously, peripancreatic lymph node tuberculosis is often misdiagnosed as pancreatic cancer. Further studies are necessary to develop a more favorable diagnostic method for pancreas masses and more advantageous therapy for LSPH, especially in cases caused by mechanical compression.

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Section: Discussionmentioning

confidence: 99%

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Yu¹,

Li²,

Gong

et al. 2020

BMC Gastroenterol

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“…Від 40 до 50% смертей від цирозу печінки зумовлені кровотечами із ВРВ [1,3]. Частота виявлення варикозно розширених вен стравоходу у хворих на цироз печінки (ЦП) коливається від 25 % до 80 %, що становить в середньому 60% [2,4]. Збільшення розмірів вариксів відбувається у 10-20% хворих протягом року з моменту першого виявлення.…”

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“…Факторами ризику першої кровотечі є розмір ВРВ, червоні плями на їх поверхні ("cherryredspots") та ступінь декомпенсації печінкових Науковий вісник Ужгородського університету, серія «Медицина», випуск 1 (59), 2019 р. функцій. Хоча оцінені ретроспективно фактори ризику у хворих із кровотечами із ВРВ спостерігались тільки у 1/3 випадків, що не дає їх чітко класифікувати [4].…”

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“…Також щодо ендоскопічної склеротерапії відзначається, що ендоскопічне лігування не має переваг перед нею в плані зупинки кровотечі, на відсоток зупинених кровотеч не впливають спосіб введення та вибір склерозуючої речовини [6,7]. Зонд Blakemore у 6-20% відсотків хворих призводить до виникнення фатальних ускладнень, пов'язаних із неправильним його застосуванням (пролежні і медіастініт) [4,5]. Застосування ендоскопічної склеротерапії не має ніяких переваг перед застосуванням октреотиду в плані ефективності і економічності [4,6].…”

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“…Зонд Blakemore у 6-20% відсотків хворих призводить до виникнення фатальних ускладнень, пов'язаних із неправильним його застосуванням (пролежні і медіастініт) [4,5]. Застосування ендоскопічної склеротерапії не має ніяких переваг перед застосуванням октреотиду в плані ефективності і економічності [4,6]. Застосування TIPS є настільки вартісним навіть для розвинених країн, що з метою покращання результатів ліку-вання і досягнення кращого економічного ефекту його використання в останній час різко обмежене: наявність асциту, тромбопенії, гепаторенального синдрому і потреба в інтубації є відносними протипоказаннями, якщо TIPS в цих умовах все ж застосовується, то летальність сягає 60% [1,2,4,5].…”

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Інтенсивна Терапія Та Малоінвазивні Втручання В Комплексному Лікуванні Крово-Теч Із Варикозно Розширених Вен Стравоходу У Пацієнтів Із Декомпенсованим Цирозом Печінки

Румянцев¹,

Balazh²

2019

Наук.Вісн.Уж.Унів.Сер.Мед

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The endoscopic ultrasound probe findings in prediction of esophageal variceal recurrence after endoscopic variceal eradication therapies in cirrhotic patients: a cohort prospective study

Zheng

Zhang

et al. 2019

BMC Gastroenterol

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Background The recurrence of esophageal varices remains high in patients with hepatic portal hypertension after the endoscopic esophageal variceal eradication therapies, including endoscopic variceal band ligation (EVL), injection sclerotherapy (EIS) or EVL plus EIS. The aim of this study was to evaluate the endoscopic ultrasound probe examinations (EUP) findings in the prediction of recurrence following esophageal variceal eradication in a prospective cohort. Methods A total of 206 cirrhotic portal hypertension patients with esophageal variceal eradication, who underwent endoscopic variceal therapy (EVL or EIS or EVL plus EIS) were initially enrolled. All patients were scheduled for a follow-up every 6 months for up to 3 years. EUP was performed to evaluate peri-esophageal collateral veins (peri-ECVs), perforating veins (PFV) and para-esophageal collateral veins (para-ECVs). In addition, computed tomography (CT) were conducted to detect portal vein diameter, portal vein embolus, and major portosystemic collateral shunts. The relationship between esophageal variceal recurrence and EUP findings were analyzed. Results We found that as high as 93.5% of patients developed esophageal variceal recurrence in the 3-year follow-up. The time of esophageal variceal recurrence after variceal eradication was 13.4 months (13.4 ± 9.2 months). Furthermore, the median time of recurrence in patients who were undertaken EVL,EIS and EVL plus EIS was 10, 13 and 12 months, respectively. We identified that the risk factors, including EVL (OR 0.23, 95% CI 0.08–0.71, p < 0.01), Child-Pugh score (OR 3.32,95% CI 1.31–35.35, p < 0.05), large peri-ECVs (OR 4.56, 95% CI 2.17–9.58, p < 0.0001), and existence of PFV (OR 2.14, 95% CI 1.44–3.16, p < 0.001), were significantly associated with the recurrence of esophageal varices. The peri-ECVs and PFV showed better ability to predict esophageal variceal recurrence. When cut-off value of peri-ECVs diameter was 3.5 mm, the specificity of prediction 1-year variceal recurrence was 86% and the sensitivity was 45%. Conclusions The EUP appears to be very effective, convenient and economical examinations to predict esophageal varices recurrence after variceal eradication by endoscopic therapies. The high Child-pugh score, large peri-ECVs, and PFV are independent risk factors related to esophageal varices recurrence.

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Surgical shunts compared with endoscopic sclerotherapy for the treatment of variceal bleeding in adults with portal hypertension: a systematic review and meta-analysis

Abstract: This analysis indicated that the two types of treatment have similar mortality rates but differed with respect to rebleeding rate, incidence of hepatoencephalopathy and length of hospital stay.

Cited by 4 publications

References 36 publications

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

The endoscopic ultrasound probe findings in prediction of esophageal variceal recurrence after endoscopic variceal eradication therapies in cirrhotic patients: a cohort prospective study

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