Use of portal pressure studies in the management of variceal haemorrhage

Addley, Jennifer; Tham, T. C. K.; Cash, W.J.

doi:10.4253/wjge.v4.i7.281

Cited by 28 publications

(26 citation statements)

References 76 publications

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“…Moreover, approximately 50% of cirrhotic patients may not develop EV in the 10-year period after the initial cirrhosis diagnosis[5], and prophylactic medication with beta-blockers or invasive preventive treatments such as endoscopic sclerosis or band ligation[1] should have been initiated after diagnosis. Actually, according to the point prevalence of medium and significant varices the highest risk of hemorrhage is only 15% to 25%, and the majority of patients with cirrhosis who undergo screening EGD either do not have varices or have small EV that do not require prophylactic therapy[6].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Pu¹,

Shi²,

Wang³

et al. 2017

WJG

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AIMTo investigate the diagnostic accuracy of FibroScan (FS) in detecting esophageal varices (EV) in cirrhotic patients.METHODSThrough a systemic literature search of multiple databases, we reviewed 15 studies using endoscopy as a reference standard, with the data necessary to calculate pooled sensitivity (SEN) and specificity (SPE), positive and negative LR, diagnostic odds ratio (DOR) and area under receiver operating characteristics (AUROC). The quality of the studies was rated by the Quality Assessment of Diagnostic Accuracy studies-2 tool. Clinical utility of FS for EV was evaluated by a Fagan plot. Heterogeneity was explored using meta-regression and subgroup analysis. All statistical analyses were conducted via Stata12.0, MetaDisc1.4 and RevMan5.RESULTSIn 15 studies (n = 2697), FS detected the presence of EV with the summary sensitivities of 84% (95%CI: 81.0%-86.0%), specificities of 62% (95%CI: 58.0%- 66.0%), a positive LR of 2.3 (95%CI: 1.81-2.94), a negative LR of 0.26 (95%CI: 0.19-0.35), a DOR of 9.33 (95%CI: 5.84-14.92) and an AUROC of 0.8262. FS diagnosed the presence of large EV with the pooled SEN of 0.78 (95%CI: 75.0%-81.0%), SPE of 0.76 (95%CI: 73.0%-78.0%), a positive and negative LR of 3.03 (95%CI: 2.38-3.86) and 0.30 (95%CI: 0.23-0.39) respectively, a summary diagnostic OR of 10.69 (95%CI: 6.81-16.78), and an AUROC of 0.8321. A meta-regression and subgroup analysis indicated different etiology could serve as a potential source of heterogeneity in the diagnosis of the presence of EV group. A Deek’s funnel plot suggested a low probability for publication bias.CONCLUSIONUsing FS to measure liver stiffness cannot provide high accuracy for the size of EV due to the various cutoff and different etiologies. These limitations preclude widespread use in clinical practice at this time; therefore, the results should be interpreted cautiously given its SEN and SPE.

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Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Pu¹,

Shi²,

Wang³

et al. 2017

WJG

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“…In children HPVG values vary in liver disease. In adults values of 10 mm Hg are reportedly required for development of varices and exceeding 12 mm Hg leads to bleeding [31]. Measuring HVPG is an invasive procedure and so other measures are used to assess PHT indirectly.…”

Section: Discussionmentioning

confidence: 99%

Surviving Sengstaken

Jayakumar¹,

Odulaja²,

Patel³

et al. 2015

Journal of Pediatric Surgery

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“…(12) The 12 mmHg cut-off value is useful to guide management, providing prognostic and therapeutic benefits including titrating the dosage of beta-blockers. (13,14) HVPG measurement is a useful diagnostic tool in the evaluation of portal hypertension and is useful in differentiating between cirrhotic and non-cirrhotic aetiologies. Although the clinical presentation of NCPH is similar to cirrhosis with splenomegaly, thrombocytopenia, large varices and nodularity of the liver on imaging, a normal HVPG reading suggests a diagnosis of NCPH, in contrast to the elevated HVPG found in liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics

Tey

Gogna

Irani

et al. 2016

smedj

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INTRODUCTIONHepatic venous pressure gradient (HVPG) measurement is recommended for prognostic and therapeutic indications in centres with adequate resources and expertise. Our study aimed to evaluate the quality of HVPG measurements at our centre before and after introduction of a standardised protocol, and the clinical relevance of the HVPG to variceal bleeding in cirrhotics.METHODS HVPG measurements performed at Singapore General Hospital from 2005-2013 were retrospectively reviewed.Criteria for quality HVPG readings were triplicate readings, absence of negative pressure values and variability of ≤ 2 mmHg. The rate of variceal bleeding was compared in cirrhotics who achieved a HVPG response to pharmacotherapy (reduction of the HVPG to < 12 mmHg or by ≥ 20% of baseline) and those who did not.RESULTS 126 HVPG measurements were performed in 105 patients (mean age 54.7 ± 11.4 years; 55.2% men). 80% had liver cirrhosis and 20% had non-cirrhotic portal hypertension (NCPH). The mean overall HVPG was 13.5 ± 7.2 mmHg, with a significant difference between the cirrhosis and NCPH groups (p < 0.001). The proportion of quality readings significantly improved after the protocol was introduced. HVPG response was achieved in 28 (33.3%, n = 84) cirrhotics. Nine had variceal bleeding over a median follow-up of 29 months. The rate of variceal bleeding was significantly lower in HVPG responders compared to nonresponders (p = 0.025). CONCLUSIONThe quality of HVPG measurements in our centre improved after the introduction of a standardised protocol. A HVPG response can prognosticate the risk of variceal bleeding in cirrhotics.

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Use of portal pressure studies in the management of variceal haemorrhage

Cited by 28 publications

References 76 publications

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis

Surviving Sengstaken

Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics

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