UK guidelines on the management of variceal haemorrhage in cirrhotic patients

Jalan, Rajiv; Hayes, Peter

doi:10.1136/gut.46.suppl_3.iii1

Cited by 177 publications

(179 citation statements)

References 164 publications

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“…Variceal size is identified to be one of the most important factors responsible for first variceal hemorrhage [17] . 10% to 20% of small varices progress in size during one year [18] which is close to 20% to 30% risk of bleeding in first 2-year after first detection [19] .…”

Section: Discussionmentioning

confidence: 99%

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Tarzamni¹,

Somi²,

Farhang³

et al. 2008

WJG

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AIM:To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS:A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible noninvasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni-and multivariate approaches. RESULTS:Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (± SD) was 47.5 (± 15.9). Portal vein diameter (13.88 ± 2.42 vs 12.00 ± 1.69, P < 0.0005) and liver vascular index (8.31 ± 2.72 vs 17.8 ± 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 ± 1.48 vs 13.24 ± 2.55, P < 0.05 and 6.45 ± 2.78 vs 10.96 ± 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 ± 3.66 vs 20.25 ± 5.05, P < 0.0005), congestion index (CI) (0.11 ± 0.03 vs 0.06 ± 0.03, P < 0.0005), portal hypertensive index (2.62 ± 0.79 vs 1.33 ± 0.53, P < 0.0005), and hepatic (0.73 ± 0.07 vs 0.66 ± 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 ± 0.06 vs 0.62 ± 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION:Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.

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Section: Discussionmentioning

confidence: 99%

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Tarzamni¹,

Somi²,

Farhang³

et al. 2008

WJG

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“…All available patients in both groups were followed up for 42 days for clinical assessment, variceal re-bleeding, and hepatic de-compensation. Failure to control active bleeding was considered according to the UK guidelines [6] as transfusion requirement of 4 units or more and inability to achieve an increase in systolic blood pressure by 20 mm Hg or to 70 mm Hg or more, and/or inability to achieve a pulse rate reduction to less than 100 beat/min or a reduction of 20 beat/min from baseline pulse rate (within the first six hours). Or the occurrence of haematemesis from the six hour point, reduction in blood pressure of more than 20 mm Hg from the six hour point and/or increase in pulse rate of more than 20 beat/min from the six hour point on two consecutive readings an hour apart, transfusion of 2 units of blood or more (over and above the previous transfusions) required to increase the haematocrit to above 27%, or haemoglobin to above 9 g/l.…”

Section: Introductionmentioning

confidence: 99%

Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study

Esmat¹,

Hamza²,

Abbas³

et al. 2013

OJGas

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Endoscopic band ligation is regarded as the main therapeutic option for acute esophageal variceal bleeding, while sclerotherapy may be used in the acute setting if ligation is technically difficult. The incidence of difficult-to-perform band ligation in acute esophageal variceal bleeding, as well as the outcome of patients subjected to injection sclerotherapy as an alternative treatment, has not been clearly investigated. Our aim is to study the outcome of patients subjected to injection sclerotherapy in the acute setting of esophageal variceal bleeding when endoscopic band ligation is technically difficult to perform. We included 151 patients with acute esophageal variceal bleeding originnating from medium or large sized varices. All patients were planned for EBL as the 1st treatment option (EBL group 61.6%), meanwhile, EIS using 5% ethanolamine oleate was reserved as the 2nd treatment option when EBL was technically difficult (EIS group 38.4%). The mean time to restore hemodynamic stability was significantly prolonged in the EIS group (11.5 ± 6.5 hrs versus 9.5 ± 5.0 hrs, p 0.05). Initial control of bleeding was significantly higher in the EBL group versus the EIS group (96.7% vs 84.5%, p 0.021). Re-bleeding was more among the EIS group (42.9% vs 24.2%, p 0.04). There were no significant differences as regarding mortality and duration of hospital stay. So, a considerable proportion of cases presenting with acute variceal bleeding will have difficulty in performing EBL. In these patients, sclerotherapy is not a waning procedure with an accepted success rate, without much additional complications and without deranging mortality.

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“…A profi laxia ao primeiro sangramento por meio de procedimentos endoscópicos é tema controverso, não sendo aceita por todos os pesquisadores, pois algumas vezes os efeitos adversos são maiores do que os seus benefícios (4,8,17) .…”

Section: Discussionunclassified

Tratamento endoscópico das varizes esofágicas utilizando alças pré-atadas confeccionadas com fio de poliamida

Koyama

Hashiba

Bromberg

et al. 2006

Arq. Gastroenterol.

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UK guidelines on the management of variceal haemorrhage in cirrhotic patients

Cited by 177 publications

References 164 publications

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study

Tratamento endoscópico das varizes esofágicas utilizando alças pré-atadas confeccionadas com fio de poliamida

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