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Update on the management of gastrointestinal varices 预览
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作者 Umesha Boregowda Chandraprakash Umapathy +7 位作者 Nasir Halim Madhav Desai Arpitha Nanjappa Subramanyeswara Arekapudi Thimmaiah Theethira Helen Wong Marina Roytman Shreyas Saligram 《世界胃肠药理与治疗学杂志:英文版(电子版)》 2019年第1期1-21,共21页
Cirrhosis of liver is a major problem in the western world.Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals.Gastro... Cirrhosis of liver is a major problem in the western world.Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals.Gastrointestinal varices are dilated submucosal veins,which often develop at sites near the formation of gastroesophageal collateral circulation.The incidence of varices is on the rise due to alcohol and obesity.The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices,which is associated with substantial morbidity and mortality.In addition,this can cause a significant burden on the health care facility.Gastrointestinal varices can happen in esophagus,stomach or ectopic varices.There has been considerable progress made in the understanding of the natural history,pathophysiology and etiology of portal hypertension.Despite the development of endoscopic and medical treatments,early mortality due to variceal bleeding remains high due to significant illness of the patient.Recurrent variceal bleed is common and in some cases,there is refractory variceal bleed.This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions,strategies to handle refractory variceal bleed and newer endoscopic treatment modalities.Early treatment and improved endoscopic techniques can help in improving morbidity and mortality. 展开更多
关键词 Portal hypertension ESOPHAGEAL VARICES Gastric VARICES ECTOPIC VARICES ENDOSCOPY
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Update on management of gastric varices 预览
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作者 Louisa J Vine Mohsan Subhani Juan G Acevedo 《世界肝病学杂志:英文版(电子版)》 2019年第3期250-260,共11页
Gastric varices (GV) have different physiology and clinical characteristics compared to oesophageal varices (OV). There is little information about the management of GV. Most part of the recommendations is extrapolate... Gastric varices (GV) have different physiology and clinical characteristics compared to oesophageal varices (OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies' recommendations are based are scrutinised in this review and areas of research are identified. 展开更多
关键词 GASTRIC VARICES OESOPHAGEAL VARICES PORTAL hypertension CIRRHOSIS
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Rare cause of dysphagia after esophageal variceal banding: A case report 预览
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作者 Lindsay A Sobotka Mitchell L Ramsey +1 位作者 Michael Wellner Sean G Kelly 《世界胃肠内镜杂志:英文版(电子版)》 2019年第4期292-297,共6页
BACKGROUND Esophageal varices are a result of progressive liver disease and portal hypertension. Treatment can be performed with band ligation versus nonselective beta blockers depending on the size of varices, abilit... BACKGROUND Esophageal varices are a result of progressive liver disease and portal hypertension. Treatment can be performed with band ligation versus nonselective beta blockers depending on the size of varices, ability to tolerate medications and history of variceal bleeding. Band ligation is an effective intervention with rare but serious complications including bleeding, ulcers and rarely obstruction. Few cases of esophageal obstruction and necrosis caused by banding have been reported, each with varied management from conservative treatment to band removal. CASE SUMMARY An 89 years old woman with a past medical history of nonalcoholic steatohepatitis cirrhosis presented to the hospital with an inability to swallow one day after screening esophagogastroduodenoscopy where band ligation of esophageal varices was performed for primary prophylaxis. The patient was not able to tolerate her oral secretions. Initial blood work revealed a Model of End Organ Liver Disease score of 7. She was treated with sublingual nitroglycerin for esophageal spasm, a known complication after esophageal banding. When she failed to improve, esophagogastroduodenoscopy was performed and revealed the mucosa surrounding the banded varix was necrosed and blocking the lumen of the esophagus. The band was purposefully dislodged, revealing distal ulceration and stricturing. Within 72 h after band removal, she was tolerating an oral diet. Endoscopy performed 2 wk later revealed an intrinsic stenosis, measuring 8 mm in diameter by 1 cm in length, which was dilated. CONCLUSION Esophageal obstruction is a complication of variceal banding that should be considered in patients with inability to tolerate oral diet after banding. 展开更多
关键词 Case report ESOPHAGEAL VARICES Band LIGATION ESOPHAGEAL necrosis ESOPHAGEAL OBSTRUCTION
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肝硬化门静脉高压食管胃静脉曲张出血的预防治疗研究 预览
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作者 吕美光 潘新智 《中国医药科学》 2019年第11期226-229,共4页
目的探讨肝硬化门静脉高压食管胃静脉曲张出血的预防治疗效果。方法选取本院2015年9月~2017年9月诊治的肝硬化门静脉高压食管胃静脉曲张患者90例,采用随机数字表法分为两组,对照组患者45例采用普萘洛尔治疗,观察组患者45例采用卡维地洛... 目的探讨肝硬化门静脉高压食管胃静脉曲张出血的预防治疗效果。方法选取本院2015年9月~2017年9月诊治的肝硬化门静脉高压食管胃静脉曲张患者90例,采用随机数字表法分为两组,对照组患者45例采用普萘洛尔治疗,观察组患者45例采用卡维地洛治疗,比较两组患者的出血风险。结果治疗前两组患者肝肾功能(总胆红素、肌酐、白蛋白、肝静脉压力梯度)比较,差异无统计学意义(P> 0.05)。治疗前后分析,两组患者肝肾功能(总胆红素、肌酐、白蛋白)比较,差异无统计学意义(P> 0.05);两组患者肝肾功能(肝静脉压力梯度)显著降低,差异有统计学意义(P <0.05)。治疗后分析,两组患者肝肾功能(总胆红素、肌酐、白蛋白)比较,差异无统计学意义(P> 0.05);观察组患者肝肾功能(肝静脉压力梯度)低于对照组(P <0.05)。观察组患者用药3、6、9、12个月出血风险低于对照组(P <0.05)。两组患者用药不良反应(腹痛、气短、嗜睡)比较,差异无统计学意义(P> 0.05)。结论卡维地洛可降低肝硬化门静脉高压食管胃静脉曲张患者的出血风险。 展开更多
关键词 肝硬化 门静脉高压 静脉曲张 出血风险
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Temporal trends of cirrhosis associated conditions 预览
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作者 Tomoki Sempokuya Guangxiang Zhang Kazuma Nakagawa 《世界肝病学杂志:英文版(电子版)》 2019年第1期74-85,共12页
AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Projec... AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant. RESULTS From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357%(P < 0.0001) in comparison to HC not related to viral hepatitis by 33 %(P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3%(P = 0.95). CONCLUSION The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased. 展开更多
关键词 CIRRHOSIS Hepatic ENCEPHALOPATHY Spontaneous bacterial PERITONITIS Esophageal VARICES Transjugular INTRAHEPATIC portosystemic SHUNT
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Parallel transjugular intrahepatic portosystemic shunt with Viatorr? stents for primary TIPS insufficiency: Case series and review of literature 预览
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作者 Driss Raissi Qian Yu +1 位作者 Michael Nisiewicz Steven Krohmer 《世界肝病学杂志:英文版(电子版)》 2019年第2期217-225,共9页
BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical s... BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr■) is largely lacking despite Viatorr■ being the current gold standard for modern TIPS placement. CASE SUMMARY All three patients had portal hypertension and already had a primary Viatorr■ TIPS placed previously. All patients have undergone failed endoscopy to manage acute variceal bleeding before referral for a parallel stent (PS). PS were placed in patients presenting with recurrent variceal bleeding despite existence of a widely patent primary TIPS. Primary stent patency was verified with either Doppler ultrasound or intra-procedural TIPS stent venography. Doppler ultrasound follow-up imaging demonstrated complete patency of both primary and parallel TIPS. All three patients did well on clinical follow-up of up to six months and no major complications were recorded. A review of existing literature on the role of PS in the management of portal hypertension complications is discussed. There are three case reports of use of primary and PS Viatorr? stents placement, only one of which is in a patient with gastrointestinal variceal bleeding despite a patent primary Viatorr? TIPS. CONCLUSION Viatorr?PS placement in the management of variceal hemorrhage is feasible with promising short term patency and clinical follow-up data. 展开更多
关键词 Transjugular INTRAHEPATIC portosystemic SHUNT PARALLEL stent Portal hypertension VARICES Viatorr? Tandem Double BARREL Case report
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Management of betablocked patients after sustained virological response in hepatitis C cirrhosis 预览
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作者 Marta Abadía María Luisa Montes +6 位作者 Dolores Ponce Consuelo Froilán Miriam Romero Joaquín Poza Teresa Hernández Rubén Fernández-Martos Antonio Olveira 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第21期2665-2674,共10页
BACKGROUND Current guidelines do not address the post–sustained virological response management of patients with baseline hepatitis C virus (HCV) cirrhosis and oesophageal varices taking betablockers as primary or se... BACKGROUND Current guidelines do not address the post–sustained virological response management of patients with baseline hepatitis C virus (HCV) cirrhosis and oesophageal varices taking betablockers as primary or secondary prophylaxis of variceal bleeding. We hypothesized that in some of these patients portal hypertension drops below the bleeding threshold after sustained virological response, making definitive discontinuation of the betablockers a safe option. AIM To assess the evolution of portal hypertension, associated factors, non-invasive assessment, and risk of stopping betablockers in this population. METHODS Inclusion criteria were age > 18 years, HCV cirrhosis (diagnosed by liver biopsy or transient elastography > 14 kPa), sustained virological response after directacting antivirals, and baseline oesophageal varices under stable, long-term treatment with betablockers as primary or secondary bleeding prophylaxis. Main exclusion criteria were prehepatic portal hypertension, isolated gastric varices, and concomitant liver disease. Blood tests, transient elastography, and upper gastrointestinal endoscopy were performed. Hepatic venous pressure gradient (HVPG) was measured five days after stopping betablockers. Betablockers could be stopped permanently if gradient was < 12 mmHg, at the discretion of the attending physician. RESULTS Sample comprised 33 patients under treatment with propranolol or carvedilol: median age 64 years, men 54.5%, median Model for End-Stage Liver Disease (MELD) score 9, Child-Pugh score A 77%, median platelets 77.000 × 103/μL, median albumin 3.9 g/dL, median baseline transient elastography 24.8 kPa, 88% of patients received primary prophylaxis. Median time from end of antivirals to gradient was 67 wk. Venous pressure gradient was < 12 mmHg in 13 patients (39.4%). In univariate analysis the only associated factor was a MELD score decrease from baseline. On endoscopy, variceal size regressed in 19/27 patients (70%), although gradient was ≥ 12 mmHg in 12/19 patients. The elastogr 展开更多
关键词 HEPATITIS C virus OESOPHAGEAL VARICES PORTAL hypertension Betablocker Variceal BLEEDING
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布加综合征合并上消化道出血患者的同期介入治疗
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作者 吴正阳 周朋利 +1 位作者 任建庄 韩新巍 《中华肝胆外科杂志》 CAS CSCD 北大核心 2019年第5期333-336,共4页
目的探讨布加综合征(BCS)合并上消化道出血患者同期介入治疗的可行性及临床疗效。方法回顾性分析郑州大学第一附属医院2015年10月至2018年4月收治的32例布加综合征合并上消化道出血患者的临床资料,同期行曲张静脉栓塞及下腔静脉(IVC)和... 目的探讨布加综合征(BCS)合并上消化道出血患者同期介入治疗的可行性及临床疗效。方法回顾性分析郑州大学第一附属医院2015年10月至2018年4月收治的32例布加综合征合并上消化道出血患者的临床资料,同期行曲张静脉栓塞及下腔静脉(IVC)和/或肝静脉(HV)成形术,观察围手术期并发症,并测量手术前后的门静脉压力,术后随访IVC及HV有无再狭窄及消化道出血。结果 32患者均手术成功,其中16例行IVC球囊扩张,17例行HV球囊扩张,均未置入支架;门静脉造影发现17例患者有1支曲张静脉,15例有2支曲张静脉,均成功栓塞。患者经过同期介入治疗,门静脉压力由术前的(35.7±2.9)cmH2O下降至术后的(31.2±2.5)cmH2O(P<0.05,1 cmH2O=0.098 kPa)。治疗前后差异有统计学意义(P<0.05)。其中肝静脉型BCS患者开通HV后,门静脉压力由术前的(35.8±3.0)cmH2O下降至(30.7±2.3)cmH2O;混合型BCS患者开通IVC后,门静脉压力由(35.6±3.0)cmH2O下降至(31.8±2.6)cmH2O,肝静脉型患者门静脉压力下降更明显,差异均有统计学意义(均P<0.05)。患者随访期3~32个月,平均(11.7±7.8)个月。其中7例IVC及5例HV再狭窄,再次行球囊扩张术,随访期内无再发上消化道出血。结论同期介入治疗BCS合并上消化出血安全可行,中远期效果满意。 展开更多
关键词 高血压 门静脉 静脉曲张 布加综合征 上消化道出血 经皮球囊成形术 栓塞
Elastography-based screening for esophageal varices in patients with advanced chronic liver disease 预览
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作者 Rafael Paternostro Thomas Reiberger Theresa Bucsics 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第3期308-329,共22页
Elastography-based liver stiffness measurement(LSM)is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver dis... Elastography-based liver stiffness measurement(LSM)is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease(ACLD).The presence of varices and especially of varices needing treatment(VNT)indicates distinct prognostic stages in patients with compensated ACLD(cACLD).The Baveno VI guidelines suggested a simple algorithm based on LSM<20 kPa(by transient elastography,TE)and platelet count>150 G/L for ruling-out VNT in patients with cACLD.These(and other)TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies.Novel point shear-wave elastography(pSWE)and two-dimensional shear wave elastography(2D-SWE)methodologies for LSM have also been evaluated for their ability to screen for“any”varices and for VNT.Finally,the measurement of spleen stiffness(SSM)by elastography(mainly by pSWE and 2D-SWE)may represent another valuable screening tool for varices.Here,we summarize the current literature on elastography-based prediction of“any”varices and VNT.Finally,we have summarized the published LSM and SSM cut-offs in clinically useful scale cards. 展开更多
关键词 ELASTOGRAPHY LIVER STIFFNESS SPLEEN STIFFNESS Shear wave Magnetic resonance ELASTOGRAPHY VARICES Portal hypertension Cirrhosis ADVANCED chronic LIVER disease
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Role of band ligation for secondary prophylaxis of variceal bleeding 预览
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作者 Ioanna Aggeletopoulou Christos Konstantakis +1 位作者 Spilios Manolakopoulos Christos Triantos 《世界胃肠病学杂志:英文版》 SCIE CAS 2018年第26期2902-2914,共13页
AIM To summarize and critically examine the role of band ligation in secondary prophylaxis of variceal bleeding in patients with cirrhosis.METHODS A literature review was performed using the MEDLINE and PubMed databas... AIM To summarize and critically examine the role of band ligation in secondary prophylaxis of variceal bleeding in patients with cirrhosis.METHODS A literature review was performed using the MEDLINE and PubMed databases.The search terms consisted of the words“endoscopic band ligation”OR“variceal band ligation”OR“ligation”AND“secondary prophylaxis”OR“secondary prevention”AND“variceal bleeding”OR“variceal hemorrhage”AND“liver cirrhosis”.The data collected from relevant meta-analyses and from the most recent randomized studies that were not included in these meta-analyses were used to evaluate the role of endoscopic band ligation in an effort to demonstrate the most recent advances in the treatment of esophageal varices.RESULTS This study included 11 meta-analyses published from 2002 to 2017 and 10 randomized trials published from 2010 to 2017 that evaluated the efficacy of band ligation in the secondary prophylaxis of variceal bleeding.Overall,the results proved that band ligation was superior to endoscopic sclerotherapy.Moreover,the use ofβ-blockers in combination with band ligation increased the treatment effectiveness,supporting the current recommendations for secondary prophylaxis of variceal bleeding.The use of transjugular intrahepatic portosystemic shunt was superior to combination therapy regarding rebleeding prophylaxis,with no difference in the survival rates;however,the results concerning the hepatic encephalopathy incidence were conflicting.Recent advances in the management of secondary prophylaxis of variceal bleeding have targeted a decrease in portal pressure based on the pathophysiological mechanisms of portal hypertension.CONCLUSION This review suggests that future research should be conducted to enhance current interventions and/or to develop innovative treatment options with improved clinical endpoints. 展开更多
关键词 Band LIGATION Variceal BLEEDING REBLEEDING Liver cirrhosis Endoscopic therapy Variceal ERADICATION Secondary PROPHYLAXIS Esophageal VARICES
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Curative effect and prognosis of endoscopic tissue glue + lauromacrogol therapy for patients with cirrhosis and variceal bleeding
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作者 Hai-Tao Hao Xiao-Liang Ren 《海南医科大学学报(英文版)》 2018年第13期38-41,共4页
Objective:To study the curative effect and prognosis of endoscopic tissue glue + lauromacrogol therapy for patients with cirrhosis and variceal bleeding.Methods: Patients with cirrhosis and variceal bleeding who under... Objective:To study the curative effect and prognosis of endoscopic tissue glue + lauromacrogol therapy for patients with cirrhosis and variceal bleeding.Methods: Patients with cirrhosis and variceal bleeding who underwent endoscopic hemostasis in the First Hospital of Yulin between March 2015 and February 2018 were retrospectively studied and divided into the observation group who accepted endoscopic hemostasis by lauromacrogol - tissue glue - lauromacrogol solution and the control group who accepted endoscopic hemostasis by lipiodol - tissue glue - lipiodol solution according to the history data. After treatment, the hemostasis time was observed, and the differences in blood routine indicators, stress-related hormones, oxidation-related mediators and inflammation-related mediators were compared.Results: The mean hemostasis time of observation group was shorter than that of control group, hemoglobin and hematokrit after 24 h of treatment were higher than those of control group, and serum GAS, AT-II, NE, E, Cor, MDA, LPO, NO, iNOS, p38MAPK, NF-κB, TNF-α, IL-6 and IL-8 levels were lower than those of control group.Conclusion: Endoscopic tissue glue combined with lauromacrogol therapy is better than tissue glue combined with lipiodol therapy in hemostasis, and can also relieve the oxidative stress response and inflammatory response. 展开更多
关键词 CIRRHOSIS Gastric and ESOPHAGEAL VARICES Lauromacrogol OXIDATIVE stress RESPONSE INFLAMMATORY RESPONSE
Adherence to surveillance endoscopy following hospitalization for index esophageal variceal hemorrhage 预览
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作者 Brendan T Everett Steven D Lidofsky 《世界胃肠外科杂志:英文版(电子版)》 2018年第4期40-48,共9页
AIM To investigate patient adherence to surveillance endoscopy after index esophageal variceal hemorrhage and the extent to which adherence influences outcomes.METHODS We reviewed the records of patients with cirrhosi... AIM To investigate patient adherence to surveillance endoscopy after index esophageal variceal hemorrhage and the extent to which adherence influences outcomes.METHODS We reviewed the records of patients with cirrhosis admitted to the medical intensive care unit between 2000 and 2014 for first time esophageal variceal hemorrhage treated with endoscopic variceal ligation who were subsequently discharged and scheduled for surveillance endoscopy at our medical center.Demographic and clinical data were obtained through the medical records,including etiology of cirrhosis,completion of variceal obliteration,attendance at surveillance endoscopy,zip code of primary residence,distance from home to hospital,insurance status,rehospitalization for variceal hemorrhage,beta-blocker at discharge,pharmacologically treated psychiatric disorder,and transplant free survival.RESULTS Of 99 consecutive survivors of esophageal variceal bleeding,the minority(33)completed variceal obliteration and fewer(12)adhered to annual surveillance.Completion of variceal obliteration was associated with fewer rehospitalizations for variceal rebleeding(27%vs56%,P=0.0099)and when rehospitalizations occurred,they occurred later in those who had completed obliteration(median 259 d vs 207 d,P=0.0083).Incomplete adherence to endoscopic surveillance was associated with more rehospitalizations for variceal rebleeding compared to those fully adherent to annual endoscopic surveillance(51%vs 17%,P=0.0328).Those adherent to annual surveillance were more likely to be insured privately or through Medicare compared to those who did not attend post-hospital discharge endoscopy(100%vs 63%,P=0.0119).CONCLUSION Most patients do not complete variceal obliteration after index esophageal variceal hemorrhage and fewer adhere to endoscopic surveillance,particularly the uninsured and those insured with Medicaid. 展开更多
关键词 Liver CIRRHOSIS ENDOSCOPY ESOPHAGEAL VARICES Secondary prevention Patient ADHERENCE
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Is P2/MS score valuable for prediction in HBV-related variceal bleeding?
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作者 Firdevs Topal Umut Payza +3 位作者 Fatih Esad Topal Zeynep Karakaya Rezan Karaali Tahtaci Serkan Bilgin 《急性病杂志(英文版)》 2018年第4期158-162,共5页
Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-rel... Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-related cirrhosis who were admitted to our hospital between August 2014 and August 2017 were retrospectively evaluated. A diagnosis of cirrhosis was made with standard laboratory, radiological and physical examination findings. According to these evaluations, esophageal varices were classified as small, medium and large. For all obtained data, P2/MS was calculated. Two threshold values (P2/MS<11 and P2/MS>25) were considered in predicting the presence of high-risk EVs during recording. And the optimal cut-off value of the P2/MS index was determined for high-risk esophageal varices in patients with chronic viral hepatitis B.Results:A total of 375 patients who met the inclusion criteria were included in the study. When the P2/MS index was compared with other noninvasive tests, the mean and median P2/MS scores were respectively 54.17 and 33.25. The P2/MS value of the patients without esophageal varices was higher than that of the patients with esophageal varices. When these results were evaluated, the higher the score, the lower the risk of varices. We obtained a positive predictive value of 93.80% [95%CI(80.20-98.70)] when the cut-off value of P2/MS was taken as <11, and obtained a negative predictive value of 94.30% [95%CI(86.20-98.20%)] when the cut-off value of P2/MS was taken as >25.Conclusions:We could predict the patients with high-risk esophageal varices within this group at a extremely good rate. We also compared the results of this test with other non-invasive tests and achieved successful results. We have shown that P2/MS can be used in order to optimally select patients for endoscopic screening and prevent all of the expensive and unnecessary procedures safely. 展开更多
关键词 P2/MS SCORE Chronic HBV-related cirrhosis Esophageal VARICES Predictive value
密集套扎治疗肝硬化重度食管静脉曲张的效果观察 预览
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作者 薛耀峰 陈永忠 仝亚林 《河南医学研究》 CAS 2018年第16期2908-2911,共4页
目的观察密集套扎治疗肝硬化重度食管静脉曲张的效果。方法 选取2014年7月至2017年6月于郑州大学第一附属医院接受内镜下套扎治疗的114例肝硬化重度食管静脉曲张患者为研究对象,根据套扎方式分为A组(密集套扎,69例)和B组(非密集套扎... 目的观察密集套扎治疗肝硬化重度食管静脉曲张的效果。方法 选取2014年7月至2017年6月于郑州大学第一附属医院接受内镜下套扎治疗的114例肝硬化重度食管静脉曲张患者为研究对象,根据套扎方式分为A组(密集套扎,69例)和B组(非密集套扎,45例),观察两组的治疗效果。结果 A组平均首次套扎个数[(13.32±2.21)个]多于B组[(5.98±1.16)个],差异有统计学意义(P〈0.05);治疗4周后复查,A组治愈率(18.8%)和总有效率(92.7%)高于B组(6.7%、71.1%),差异有统计学意义(P〈0.05)。A组平均治疗次数[(2.25±0.85)次]少于B组[(2.89±0.88)次],差异有统计学意义(P〈0.05)。A组术后早期再出血率(11.6%)和B组(15.6%)比较,差异无统计学意义(P〉0.05)。两组不良反应发生率比较,差异无统计学意义(P〉0.05)。随访6个月,A组静脉曲张复发率为36.2%,B组为40.0%,差异无统计学意义(P〉0.05)。结论 密集套扎治疗重度食管静脉曲张安全有效,与非密集套扎治疗相比,可降低静脉曲张程度,减少套扎次数。 展开更多
关键词 肝硬化 食管 静脉曲张 密集套扎
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异位静脉曲张出血二例并文献报道127例临床分析 被引量:1
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作者 胡振 曹素艳 张新超 《中华全科医师杂志》 2017年第4期307-309,共3页
分析2例异位静脉曲张(EV)病例及万方数据库和中国知网数据库文献报道的127例EV患者临床资料。129例中,男93例,女36例,年龄35~80岁。有肝硬化病史104例(80.6%)。首发表现主要包括黑便46例(35.7%),呕血24例(18.6%)。确诊检... 分析2例异位静脉曲张(EV)病例及万方数据库和中国知网数据库文献报道的127例EV患者临床资料。129例中,男93例,女36例,年龄35~80岁。有肝硬化病史104例(80.6%)。首发表现主要包括黑便46例(35.7%),呕血24例(18.6%)。确诊检查方法:内镜100例(77.5%),手术病理检查16例(12.4%),血管造影13例(10.1%)。EV多发部位为十二指肠52例(40.3%),直肠34例(26.4%)。死亡4例(3.1%),125例(96.9%)短期预后较好。提示EV以肝硬化合并门脉高压原因多见,在消化道出血病例中有一定发病率,在临床工作中应提高警惕。 展开更多
关键词 胃肠出血 肝硬化 静脉曲张 异位
Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding 预览
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作者 Keishi Komori Masaru Kubokawa +4 位作者 Eikichi Ihara Kazuya Akahoshi Kazuhiko Nakamura Kenta Motomura Akihide Masumoto 《世界胃肠病学杂志:英文版》 SCIE CAS 2017年第3期496-504,共9页
AIM To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.METHODS In total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000... AIM To determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.METHODS In total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients’ medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results(hemoglobin, albumin, and bilirubin concentrations), and imaging results(including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality(up to 90 d) and long-term mortality in all patients.RESULTS Multivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95%CI: 0.01-0.52) and longterm mortality (OR = 0.27, 95%CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in shortterm mortality(HCC: OR = 15.4, 95%CI: 2.08-114.75;PPI: OR = 12.76, 95%CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95%CI: 1.98-31.58;PPI: OR = 10.91, 95%CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI(P = 0.0074).CONCLUSION Administration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality. 展开更多
关键词 ANTIBIOTICS GASTRIC VARICES GASTRIC FUNDUS PROTON pump inhibitors HEMORRHAGE
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彩色多普勒超声对子宫圆韧带静脉曲张的诊断价值 预览 被引量:1
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作者 汤晓飞 黄斌 +2 位作者 李燕青 魏琳 谢霖霄 《医学影像学杂志》 2017年第6期1144-1146,共3页
目的探讨多普勒超声对子宫圆韧带静脉曲张的诊断价值。方法回顾分析我院2011年5月~2016年11月经多普勒超声检查并随访证实的19例子宫圆韧带静脉曲张患者的超声影像资料,并归纳总结声像图特征。结果 4例超声检查诊断为腹股沟疝,声像图表... 目的探讨多普勒超声对子宫圆韧带静脉曲张的诊断价值。方法回顾分析我院2011年5月~2016年11月经多普勒超声检查并随访证实的19例子宫圆韧带静脉曲张患者的超声影像资料,并归纳总结声像图特征。结果 4例超声检查诊断为腹股沟疝,声像图表现为与腹腔相通的无-强回声包块,内见条索状强回声分隔,其中1例4周后复查,超声检查修正诊断为子宫圆韧带静脉曲张。其余15例均首次正确诊断,声像图表现为包块位于腹股沟区,呈蜂窝样无回声,形态不规则,边界清,瓦氏动作后包块变大,CDFI内见丰富的静脉血流信号。结论子宫圆韧带静脉曲张具有典型的声像图特征,彩色超声诊断准确性高,可作为临床首选的检查方法。 展开更多
关键词 子宫圆韧带 静脉曲张 超声诊断
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聚桂醇纤维蛋白原凝血酶序贯法治疗胃底静脉曲张出血 预览 被引量:2
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作者 冯凯祥 鲜于剑波 +4 位作者 杨培 彭庆慧 游晓娟 竹建强 张献文 《西南国防医药》 CAS 2017年第1期8-11,共4页
目的探讨聚桂醇纤维蛋白原凝血酶序贯法治疗胃底静脉曲张出血的临床价值。方法 152例胃底静脉曲张破裂出血患者随机分为两组,各76例。治疗组采取聚桂醇纤维蛋白原凝血酶序贯法治疗,对照组采取组织胶(α-氰基丙烯酸烷基酯)三明治法治疗... 目的探讨聚桂醇纤维蛋白原凝血酶序贯法治疗胃底静脉曲张出血的临床价值。方法 152例胃底静脉曲张破裂出血患者随机分为两组,各76例。治疗组采取聚桂醇纤维蛋白原凝血酶序贯法治疗,对照组采取组织胶(α-氰基丙烯酸烷基酯)三明治法治疗,比较两组止血成功率及仪器损害、再出血、静脉改善、并发症等发生情况。结果治疗组与对照组的止血成功率分别为98.68%与93.42%,差异无统计学意义(P〉0.05);再出血率分别为4.00%与25.35%,二者差异有统计学意义(P〈0.01);两组发热、腹痛不良反应发生率相近(P〉0.05),但对照组溃疡发生率高于治疗组(P〈0.05);对照组堵针、粘镜发生率高于治疗组(P〈0.01)。两组均未出现异位栓塞等严重并发症。结论聚桂醇纤维蛋白原凝血酶序贯法止血效果好,再出血率低,安全可靠。 展开更多
关键词 胃底 静脉曲张 出血 凝血酶 纤维蛋白原 聚桂醇
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超声内镜:门静脉高压评估诊治的新手段 被引量:1
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作者 陆伟 李爽 《中华肝脏病杂志》 CSCD 北大核心 2017年第6期411-414,共4页
超声内镜(EUS)通过全面扫查门静脉高压侧支循环建立情况,可预判食管胃静脉曲张发生、破裂出血、治疗后复发及再出血的风险,并能参与引导静脉曲张的治疗。EUS凭借上述独特优势,为肝硬化合并门静脉高压患者的个体化治疗提供了重要参... 超声内镜(EUS)通过全面扫查门静脉高压侧支循环建立情况,可预判食管胃静脉曲张发生、破裂出血、治疗后复发及再出血的风险,并能参与引导静脉曲张的治疗。EUS凭借上述独特优势,为肝硬化合并门静脉高压患者的个体化治疗提供了重要参考依据,提高了治疗的有效率和安全性,作为系统评估诊治门静脉高压的新手段,已成为近几年的研究热点。 展开更多
关键词 超声内镜 高血压 门静脉 静脉曲张
多层螺旋CT血管造影在诊断肺静脉瘤临床应用中的研究 被引量:1
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作者 张志强 张强 《中国煤炭工业医学杂志》 2016年第11期1545-1548,共4页
目的 探讨多层螺旋CT血管造影在肺静脉瘤诊断中的临床应用及其价值。方法 回顾性分析经多层螺旋CT血管造影检查的3例肺静脉瘤患者临床资料并进行相关文献复习。结果 多层螺旋CT血管造影检查图像可完全显示肺静脉瘤的空间解剖和病变特征... 目的 探讨多层螺旋CT血管造影在肺静脉瘤诊断中的临床应用及其价值。方法 回顾性分析经多层螺旋CT血管造影检查的3例肺静脉瘤患者临床资料并进行相关文献复习。结果 多层螺旋CT血管造影检查图像可完全显示肺静脉瘤的空间解剖和病变特征。结论 多层螺旋CT血管造影可准确诊断肺静脉瘤,具有较高的分辨率,在病变的诊断与治疗中发挥着重要作用。 展开更多
关键词 静脉瘤 多层螺旋CT 血管造影
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