Assessment of the risk of bleeding from esophageal varices by continuous monitoring of portal pressure

Ready, Joanna; Robertson, Alastair D.; Goff, John S.

doi:10.1016/0016-5085(91)90796-n

Cited by 45 publications

(36 citation statements)

References 17 publications

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“…These re-therapy or spontaneously. In the most recent report evaluatsults were supported by another later study, 19 in which portal ing rebleeding, Feu et al 49 followed up 69 cirrhotic patients pressure was measured during and immediately after the for a mean period ({SD) of 28 { 17 months and demonstrated variceal bleeding episode with the use of an indwelling he-that a pharmacological decrease in HVPG at the third month patic venous catheter. This study concluded that the HVPG to more than 20% of the initial values had independent progis significantly higher in patients who continue bleeding or nostic value for variceal rebleeding.…”

Section: Assessment Of Prognosis In Cirrhosismentioning

confidence: 86%

“…These results have transjugular liver biopsy and it is also possible to leave an been confirmed recently in another prospective study 32 by indwelling catheter safely for several hours. 19 Thus, the more Merkel et al with 129 patients. Although they did not notice invasive procedures for portal pressure measurement need any significant difference in the mean HVPG values between only be used in patients with presinusoidal portal hypertenthe patients who died during the follow-up period (median of sion, because hepatic venous pressure measurement may un-45 months) and those who survived, the cumulative probabilderestimate portal pressure levels in such cases.…”

Section: Hepatic Venous Pressure Measurementmentioning

confidence: 99%

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Hepatic venous pressure measurement: An old test as a new prognostic marker in cirrhosis?

Armonis¹

1997

Hepatology

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Section: Assessment Of Prognosis In Cirrhosismentioning

confidence: 86%

Section: Hepatic Venous Pressure Measurementmentioning

confidence: 99%

Hepatic venous pressure measurement: An old test as a new prognostic marker in cirrhosis?

Armonis¹

1997

Hepatology

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“…The procedure is safe and readily applicable because of the amount and short half life of radioactive substance used. Portal pressure increases shortly after an episode of variceal bleeding [11] and is stable over 72 h after bleeding [12] . Therefore, per rectal portal scintigraphy in patients of the bleeding group was performed 72 h after bleeding when the portal pressure returned to baseline level in order to determine the risk of that episode of bleeding.…”

Section: Measurement Of the Portal Shunt Indexmentioning

confidence: 99%

Per rectal portal scintigraphy as a useful tool for predicting esophageal variceal bleeding in cirrhotic patients

Chitapanarux¹

2007

WJG

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AIM:To investigate potential roles of per rectal portal scintigraphy in diagnosis of esophageal varices and predicting the risk of bleeding. METHODS:Fifteen normal subjects and fifty cirrhotic patients with endoscopically confirmed esophageal varices were included. Patients were categorized into bleeder and non-bleeder groups according to history of variceal bleeding. All had completed per rectal portal scintigraphy using 99m Technetium pertechnetate. The shunt index was calculated from the ratio of 99m Technetium pertechnetate in the heart and the liver. Data were analyzed using Student's t -test and receiver operating characteristics. RESULTS:

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confidence: 99%

“…In fact, although portal hypertension is the cause for the development of esophageal varices, the relationship between the level of portal pressure, as measured by the hepatic venous pressure gradient and the individual risk of variceal bleeding, has not been definitively established. [6][7][8][9][10] In recent years, several authors have shown a similar rhythmic circadian distribution of variceal hemorrhage in cirrhotic patients. [11][12][13][14][15] All of them found variceal hemorrhages occurring more frequently in the evening (hours 19:00 to 23:20) and in the early morning (hours 7:00 to 9:00).…”

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confidence: 99%

Diurnal changes of fibrinolysis in patients with liver cirrhosis and esophageal varices

et al. 2000

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Variceal bleeding, whose triggering mechanisms are largely unknown, occurs with a circadian rhythmicity, with 2 peaks, one greater, in the evening, and one smaller, in the early morning. We assessed some clotting and hemodynamic parameters, possibly involved in variceal hemorrhage, over a 24-hour period, at 4-hour intervals, in 16 patients with cirrhosis and esophageal varices and in 9 controls. At each time interval, tissue plasminogen activator (tPA) and tPA inhibitor-1 (PAI-1) antigens and activities and total euglobulin fibrinolytic activity were determined and portal-vein flow velocity, volume, and congestion index were measured by duplex-Doppler. Significant circadian rhythms were searched for by least-squares and cosinor methods. tPA activity showed a circadian rhythm in cirrhosis, with a peak of 2.85 times the trough value, calculated at 18:42, and remained over 2.5-fold until shortly after 22:00. Total fibrinolytic activity showed a similar pattern, which was statistically significant also in controls. tPA and PAI antigens also showed significant circadian rhythm both in controls and cirrhotics, with higher values in the morning. Among the portal hemodynamic parameters only the congestion index showed significant rhythmic changes and only in cirrhosis, with the highest values in the late evening, but with limited diurnal excursion (Ϯ 5.5%). In conclusion, we showed the existence of a circadian rhythm of fibrinolysis in cirrhosis, whose temporal distribution might suggest a role of fibrinolysis in variceal hemorrhage on the basis of the comparison to the known chronorisk of variceal bleeding. (HEPATOLOGY 2000;31:349-357.)Several biological processes are driven by rhythms possessing a circadian, infradian, or ultradian frequency. 1 Similarly, some clinical manifestations of chronic diseases also appear according to a distinct temporal rhythm. 2,3 Discovering the time points of maximal risk favors the identification of the events triggering the onset of clinical manifestations. This was the case for hemostatic, coagulative, and hemodynamic factors for myocardial infarction and cerebrovascular events. 2,4,5 Hemorrhage from gastroesophageal varices is one of the most harmful complications of portal hypertension, but the pathophysiology of the acute event is still unclear. In fact, although portal hypertension is the cause for the development of esophageal varices, the relationship between the level of portal pressure, as measured by the hepatic venous pressure gradient and the individual risk of variceal bleeding, has not been definitively established. [6][7][8][9][10]

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Assessment of the risk of bleeding from esophageal varices by continuous monitoring of portal pressure

Cited by 45 publications

References 17 publications

Hepatic venous pressure measurement: An old test as a new prognostic marker in cirrhosis?

Hepatic venous pressure measurement: An old test as a new prognostic marker in cirrhosis?

Per rectal portal scintigraphy as a useful tool for predicting esophageal variceal bleeding in cirrhotic patients

Diurnal changes of fibrinolysis in patients with liver cirrhosis and esophageal varices

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