Efficacy and Safety of Treatments for Patients With Portal Hypertension and Cirrhosis: A Systematic Review and Bayesian Network Meta-Analysis

Yao, Qigu; Chen, Wenyi; Yan, Cuilin; Yu, Jiong; Cao, Hong

doi:10.3389/fmed.2021.712918

Cited by 6 publications

(6 citation statements)

References 64 publications

(46 reference statements)

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“…The findings of this systematic review indicated that the entire literature confirmed the excellent efficacy, safety, and clinical outcomes of splenorenal shunt surgery in patients with portal hypertension. The aforementioned results are consistent with the meta-analysis conducted by Yao et al (2021), who revealed that transjugular intrahepatic portosystemic shunts and distal splenorenal shunts exhibited a greater capacity to decrease rebleeding rates when compared to other therapeutic approaches. Several other studies have indicated that the use of mixed treatments may (Gómez et al 2021).…”

Section: Discussionsupporting

confidence: 90%

“…These complications had a significant impact on the prognosis and clinical outcomes of splenorenal shunt surgery. A broad range of therapeutic options were widely used, spanning from pharmacological to nonpharmacological interventions (Gairing et al 2021, Yao et al 2021. The pharmacological intervention exhibits favourable effectiveness in the short-term management of portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…This surgical procedure is typically performed to treat hepatic portal hypertension and its common complications. The procedure consisted of two types, i.e., proximal splenorenal shunt (PSRS) and distal splenorenal shunt (DSRS) (Papandria et al 2019, Yao et al 2021. Portal hypertension patients with clinical symptoms, such as upper gastrointestinal bleeding due to rupture of esophagogastric varices, may consider the option of undergoing splenorenal shunt surgery.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy, Safety, and Clinical Outcomes of Splenorenal Shunt Surgery as a Therapeutic Intervention for Portal Hypertension Patients

Yan Efrata Sembiring,

Heroe Soebroto,

Ito Puruhito

et al. 2023

FMI

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Highlights: 1. This study systematically reviewed the efficacy, clinical outcomes, and safety of the splenorenal shunt procedure with a comprehensive and meticulous approach.2. The splenorenal shunt procedure is an innovative surgical intervention that offers a viable option for the management of portal hypertension. Abstract Portal hypertension is the second most common gastrointestinal bleeding in cirrhosis and non-cirrhosis patients. The splenorenal shunt surgery is a potential intervention that may be considered for portal hypertension patients with clinical symptoms such as upper gastrointestinal bleeding caused by the rupture of gastro-esophageal varices. In this study, the researchers aimed to analyze the efficacy, clinical outcomes, and safety of splenorenal shunt surgery in portal hypertension patients. The sources were obtained from electronic search databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords "Efficacy," "Safety," and "Clinical Outcomes." in relation to splenorenal shunt surgery in portal hypertension patients. The researchers set specific criteria for inclusion and exclusion to select the articles. This systematic review revealed the efficacy of the splenorenal shunt procedure with favorable outcomes. The success rate of splenorenal shunt surgery in reducing the clinical symptoms of portal hypertension varied between 66% and 100%. The prevailing complications observed in this study were shunt thrombosis, rebleeding, and thrombocytopenia. However, notable improvements could be achieved with general treatment. In terms of short- and long-term clinical outcomes, the splenorenal shunt procedure demonstrated favorable results. It can be concluded that splenorenal shunt surgery provides excellent clinical outcomes and should be considered a viable treatment option for patients with both cirrhotic and non-cirrhotic portal hypertension.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy, Safety, and Clinical Outcomes of Splenorenal Shunt Surgery as a Therapeutic Intervention for Portal Hypertension Patients

Yan Efrata Sembiring,

Heroe Soebroto,

Ito Puruhito

et al. 2023

FMI

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“…У большинства пациентов (58,82%) по результатам ЭФГС ВРВП исчезли и уменьшились до I степени. Тромбоз шунта возник у двух больных из двадцати через 7 и 10 лет, что согласуется с данными литературы [11].…”

Section: Discussionunclassified

The effectiveness of splenorenal shunt in the correction of portal hypertension and hypersplenism in the long-term period

Kotelnikova

Мухамадеев

2023

jour

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The aim is to evaluate the long-term results of splenorenal anastomosis (SRA) in the treatment of portal hypertension a year or more after surgery. Materials and methods. The long-term results of the imposition of CPA after one to ten years have been studied. Life expectancy, the number of bleeding recurrences, and the severity of thrombocytopenia were assessed based on the results of fibrogastroscopy, duplex scanning (DS), and computed tomography with bolus enhancement. Results. One-year survival rate was 96.77%, three-year - 87.09%, five-year - 74.19%, ten-year - 22.58%. Within three years after bypass surgery, no recurrence of bleeding was observed, while in half of the patients (54.28%) the varicose veins of the esophagus disappeared, in the rest (45.72%) they decreased to grade I. Recurrence of bleeding occurred in six patients (17.14%) after 5-13 years, in one case massive, which was accompanied by shunt thrombosis (2.85%) according to the results of DS. For the rest, its function was preserved. The median platelet count one year and three after CP did not differ and was 110 x109 and 105 x109. It was found that the larger the diameter of the portal vein and the lower the volume velocity of blood flow in it, the smaller was the increase in platelets in the long-term period (r=0.90, p=0.037; r=0.87, p=0.01). Conclusions. After performing splenorenal bypass surgery for portal hypertension for the purpose of primary and secondary prevention of gastric bleeding, its recurrence occurred in 17.14% 5-13 years after surgery. After the correction of portal hypertension, there was a tendency to increase the number of platelets in the long-term postoperative period, which was dependent on the volume velocity of blood flow in the portal vein and the degree of its expansion before surgical treatment.

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“…The main purpose of treatment is to control symptoms and finally prevent progression to cirrhosis and/or PH. Reached this stage, the management of patients can be similar to that of other causes of cirrhosis and/or PH, including medical treatment such as β-blockers, sclerotherapy of esophageal variceal, or TIPS ( 40 ). Yao et al studied the efficacity of TIPS for non-cirrhotic PH over 25 patients, including three patients with sarcoidosis ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

Hepatic sarcoidosis with symptomatic portal hypertension: A report of 12 cases with review of the literature

et al. 2022

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IntroductionSarcoidosis is a systemic granulomatosis of unknown etiology, characterized by the presence of immune granulomas. Liver damage is a relatively common extra-pulmonary manifestation, occurring in 3.6–30% of cases. Some patients can develop symptomatic portal hypertension (PH). Few series have evaluated the prognosis of symptomatic PH as well as the efficacy and safety of specific treatment on this complication.MethodsThis is a multicenter retrospective study of cases of histologically proven hepatic sarcoidosis with symptomatic PH (ascites, digestive hemorrhage) and/or hepatic encephalopathy. Demographic characteristics, comorbidities, clinical manifestations of sarcoidosis, biological data, imaging study of the liver, treatment, and clinical outcomes were collected.ResultsTwelve patients were identified, with a mean follow-up of 140 months. The M/F ratio was 1 and Caucasian origin was the most represented (75%). Seven patients presented with hepatic comorbidities: metabolic syndrome, chronic alcoholism or chronic viral hepatitis. Apart from hepatic involvement, mediastino-pulmonary involvement was the most common followed by osteoarticular and skin. Liver damage was inaugural in two thirds of cases. Nine patients developed ascites, six presented esophageal varices complicated by gastrointestinal bleeding. Three patients presented with both ascites and variceal bleeding. One case of hepatic encephalopathy was observed. Five patients presented signs of hepatocellular insufficiency during follow-up, of whom three had hepatic comorbidities. Eight out of 12 patients required second-line treatment after failure of corticosteroids, three patients underwent ligation of esophageal varices but with recurrent digestive bleeding in all cases. Two patients benefited from a transjugular intrahepatic portosystemic shunt (TIPS), also with poor result. At the end of follow-up, five patients were alive and seven patients died. Two patients received a liver transplant, with good result and without recurrence of sarcoidosis on the transplant thereafter. Two patients had quiet sarcoidosis on low dose of corticosteroids and one patient was lost to follow-up.ConclusionSymptomatic PH related to hepatic sarcoidosis is a severe complication, with high morbidity and mortality, and frequent failure of specific treatments of PH. Early management of these patients, with detection of hepatic comorbidities seems important. In case of therapeutic failure, liver transplantation is an option to consider.

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Efficacy and Safety of Treatments for Patients With Portal Hypertension and Cirrhosis: A Systematic Review and Bayesian Network Meta-Analysis

Cited by 6 publications

References 64 publications

Efficacy, Safety, and Clinical Outcomes of Splenorenal Shunt Surgery as a Therapeutic Intervention for Portal Hypertension Patients

Efficacy, Safety, and Clinical Outcomes of Splenorenal Shunt Surgery as a Therapeutic Intervention for Portal Hypertension Patients

The effectiveness of splenorenal shunt in the correction of portal hypertension and hypersplenism in the long-term period

Hepatic sarcoidosis with symptomatic portal hypertension: A report of 12 cases with review of the literature

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