Update on gastric varices

Triantafyllou, Maria; Stanley, Adrian

doi:10.4253/wjge.v6.i5.168

Cited by 34 publications

(25 citation statements)

References 48 publications

(100 reference statements)

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“…The estimated incidence of bleeding from gastric varices is 25 % (with cumulative rates of bleeding from fundal varices at 1, 3, and 5 years of 16, 36, and 44 %, respectively) [43]. Furthermore, while gastric varices bleed less frequently than esophageal varices, gastric variceal hemorrhage tends to be more severe with a reported mortality of 45 %, thus providing a rationale for performing BRTO for at-risk varices (risk factors include variceal size, Child's grade of cirrhosis, presence of HCC, presence of red spots, and gastric variceal location) [44]. While the pooled technical and clinical success rates of 96.4 and 97.3 % were excellent, some adverse events were noted.…”

Section: Discussionmentioning

confidence: 97%

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis

et al. 2014

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Section: Discussionmentioning

confidence: 97%

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis

et al. 2014

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“…IGV located in the fundus are classified as IGV1, and those located in other regions of the stomach are defined as IGV2 [11]. Gastric varices were also classified as small (<5 mm), moderate (5-10 mm), and large (>10 mm) [12]. …”

Section: Methodsmentioning

confidence: 99%

The relationship between the size of varices and platelet count/spleen size ratio in cirrhotic patients

Öztürk¹

2016

North Clin Istanbul

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OBJECTIVE:This study investigated the relationship between size of gastroesophageal varices and platelet count/spleen diameter ratio in cirrhotic patients.METHODS:The present study included 186 cirrhotic patients in whom gastroesophageal varices were seen during upper gastrointestinal system endoscopy. Clinical features, laboratory parameters, upper gastrointestinal system endoscopy, and abdominal ultrasonographic findings of patients were evaluated retrospectively. Platelet count/spleen diameter ratio (P/S) was calculated by dividing number of platelets in complete blood count (CBC) to largest diameter of spleen. Varices were classified as small, medium, or large, and patients were separated into two groups for comparison: those with small varices and those with medium or large varices. Of the total, 66.7 % of the patients were men (n=124) and 33.3% were women (n=62). Esophageal varices were found in 82.7% and gastric varices were found in 17.3%.RESULTS:Patients with large esophageal varices were found to have significantly lower P/S compared to patients with small esophageal varices (p=0.04). In receiver operating characteristic (ROC) curve analysis, P/S and large varices correlated with 82% sensitivity and 79% positive predictive value. However, no statistically significant correlation between size of varices and P/S was found in patients with gastric varices (p=0.78).CONCLUSION:In patients with esophageal varices, P/S was found to be correlated with large varices with 82% sensitivity. However, this ratio did not predict large varices in patients with gastric varices. Prospective and randomized clinical researches are needed to clarify our findings.

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“…Screening for the presence of esophageal or gastric varices in risky patients is mandatory for initiating primary prophylaxis in such patients, with the choice dependent on clinical, radiological and endoscopic findings [41]. Also, performing endoscopic sclerotherapy without prior knowledge of whether the patient possesses gastric shunt, may easily lead to sudden mortality due to ectopic embolisation [42].…”

Section: Discussion:-mentioning

confidence: 99%

Large Silent Gastric Fundal Varices in Cirrhotic Patients: Role of Abdominal Multidetector Triphasic Computed Tomography.

MD¹,

MD²

2016

IJAR

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Background:-Gastric varices have been recognized as a major cause of gastrointestinal bleeding, reaching 33% in patients with portal hypertension mostly secondary to liver cirrhosis. Compared with esophageal variceal bleeding, haemorrhage caused by fundal varices, although less frequent, is more severe and haemostatic control is more difficult. The diagnosis and treatment of gastrointestinal bleeding are based mainly on endoscopic examinations however; radiological studies such as computed tomography (CT) studies have proved useful in clinical practice. Spiral imaging has dramatically improved CT in the evaluation of focal hepatic lesion. The aim of this study is to investigate the role of abdominal Multidetector triphasic CT scan done for early detection of hepatocellular carcinoma (HCC) as a predictor and diagnostic tool for silent large gastric fundal varices in patients with liver cirrhosis. Methods:-A total of 145 patients were enrolled in this study. All patients were referred for early detection of HCC with suspected focal hepatic lesion or elevated α fetoprotein above 50 and below 400 IU/dl. All patients underwent full clinical and laboratory investigations. Abdominal US was performed for all patients. Abdominal Multidetector triphasic CT scan was done by a single experienced radiologist for evaluation for the presence of hypervascular focal hepatic lesions, splenomegaly, epigastric and hilar collaterals, portal vein thrombosis and the presence of esophageal or gastric fundal varices. All patients underwent standard upper GIT endoscopy and according to the endoscopic findings the studied patients were further classified to three groups: group I (GI) 79 patients (54.48%) with no or small esophageal and/or gastric varices, group II (GII) 42 patients (28.97%) with large esophageal varices, and group III (GIII) 24 patients (16.55%) with large gastric fundal varices Results:-There was a statistically significant increase in portal vein diameter, splenic size (long axis span), splenic vein diameter, presence of gastro-renal collaterals, portal vein thrombosis and HCC in patients with large gastric fundal varices in relation to other groups. platelet/splenic ratio as calculated by dividing platelet count over long axis of the spleen was determined for each patient which had significant lower values in relation to presence of large gastric varicesStep-wise regression analysis was done for all the above mentioned variables revealing that only three predictors namely the presence of large fundal varices by abdominal CT, presence of splenic hilar or splenorenal collaterals and platelet/splenic ratio were found to have highly significant independent ISSN 2320-5407

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Update on gastric varices

Cited by 34 publications

References 48 publications

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis

The relationship between the size of varices and platelet count/spleen size ratio in cirrhotic patients

Large Silent Gastric Fundal Varices in Cirrhotic Patients: Role of Abdominal Multidetector Triphasic Computed Tomography.

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