Endoscopic band ligation is safe despite low platelet count and high INR

Pfisterer, Nikolaus; Schwarz, Michael; Jachs, Mathias; Putre, Florian; Ritt, Lukas; Mandorfer, Mattias; Madl, Christian; Trauner, Michael; Reiberger, Thomas

doi:10.1007/s12072-023-10515-y

Cited by 6 publications

(2 citation statements)

References 45 publications

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“…ПГ є складною для діагностики та лікування патологією. Залежно від можливостей інструментальноапаратного забезпечення застосовуються різні методи консервативного гемостазу, починаючи від встановлення зонда Sengstaken-Blackmore, накладання кілець, склеротерапії, балонної обтурації вариксів із заповненням їх піною до транс'югулярного портосистемного шунтування [8][9][10].…”

Section: обговоренняunclassified

Treatment of portal hypertension complicated by variceal bleeding

Tutchenko,

Rudyk,

Klyuzko

et al. 2024

ЕМ

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Background. Mortality in variceal bleeding (VB) on the background of portal hypertension (PH) is highest among patients with gastrointestinal bleeding. The treatment of PH complicated by VB is a complex problem that is far from being solved, especially in case of Child-Pugh class B and C decompensation. The aim of the study was to determine the causes of PH complicated by VB, features of conservative and interventional therapy, indications and nature of surgical procedures, treatment efficacy, as well as causes of complications and mortality. Materials and methods. We analyzed treatment outcomes of 923 inpatients with PH complicated by VB who were treated in the clinic of the Department of Surgery of the Faculty of Dentistry of Bogomolets National Medical University on the basis of the Kyiv City Clinical Emergency Hospital from 2012 to 2023. It was possible to talk about the cause of PH based on anamnestic data in 61 % of cases. In 711 (77 %) patients, the source of bleeding was detected endoscopically within 30–60 minutes from the moment of admission to the clinic. Conservative therapy included the administration of hemostatic and agents lowering pressure in the portal system, as well as vasoconstrictors that reduce portal blood flow. For the failure of conservative therapy, unstable hemostasis, and repeated previous bleedings, 59 (6.4 %) patients were operated. The methodology of the research analysis consisted in the fact that the arithmetic mean and standard error (M ± m) were determined as the characteristics of the groups for features with a distribution corresponding to the Gaussian law. This reference method of descriptive statistics was applied to evaluate surgical treatment in comparison with conservative therapy and interventional measures. Results. Endoscopic hemostasis by the ligature method was achieved in 97 (10.5 %) patients. Repeated endoscopy due to VB recurrence was done in 276 (29.9 %) participants. In cases of unsatisfactory endoscopic hemostasis, as well as recurrent VB, a Sengstaken-Blakemore probe was installed. In case of right-sided PH, the formation of varices in the esophagus is caused by the discharge of blood mainly through the coronary vein, which required its transection during еsophagogastric devascularization. In compliance with this rule, the patients underwent esophagogastric devascularization, circular transection of the esophagus, which provided portoazygous disconnection. The total mortality rate was 43.1 %, among operated people — 8.5 %, and among non-operated ones — 42.1 %. Conclusions. PH complicated by VB is evidence of decompensated processes in the liver parenchyma or obstruction in the portal system. Conservative therapy and interventional measures make it possible to stop bleeding and prepare the patient for elective surgery, if necessary. An operation that stops blood flow through dilated veins of the esophagus or stomach is an effective method of treating bleeding in portal hypertension.

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Section: обговоренняunclassified

Treatment of portal hypertension complicated by variceal bleeding

Tutchenko,

Rudyk,

Klyuzko

et al. 2024

ЕМ

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“…B. Parazentese, Pleurapunktion, elektive endoskopische Varizenligatur) können trotz abnormaler Gerinnungsparameter (z. B. Thrombozytenzahl < 50 000/µl, INR > 1,5) ohne spezifische Korrekturmaßnahmen des Gerinnungsstatus meist sicher durchgeführt werden [30,31]. Bei einer hochgradigen Thrombozytopenie (< 20 000/µl) kann eine prophylaktische Thrombozyten-Transfusion vor einer Parazentese durchgeführt werden [32].…”

Section: Management Vor Geplanten Interventionenunclassified

Gerinnungsstörungen bei Leberzirrhose – Diagnostik und Management

Kasper,

Tacke,

Michels

2024

Dtsch Med Wochenschr

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Patienten mit Leberzirrhose weisen komplexe Veränderungen des hämostatischen Systems auf, die sowohl mit Blutungs- als auch mit thrombotischen Komplikationen einhergehen können und im Rahmen des klinischen Managements berücksichtigt werden sollten.Während eine prophylaktische Korrektur abnormaler Gerinnungsparameter vermieden werden sollte, ist vor invasiven Prozeduren ein individualisiertes Vorgehen zu empfehlen, wobei sich spezifische Präventionsmaßnahmen zur Stabilisierung der Gerinnung am periprozeduralen Blutungsrisiko orientieren sollten.Weiterhin gilt zu beachten, dass sich die hämostatischen Veränderungen in Abhängigkeit des Stadiums der Erkrankung unterscheiden. Während sich das hämostatische System bei kompensierter Zirrhose oftmals in einem Gleichgewicht befindet, kann das Auftreten einer akuten Dekompensation zu einer Destabilisierung dieses Zustands führen.Da konventionelle Gerinnungstests die komplexen Veränderungen des hämostatischen Systems bei Zirrhose nicht adäquat erfassen, können funktionelle Analysemethoden, wie viskoelastische Testverfahren oder Thrombingenerierungstests bei der Evaluation des Gerinnungsstatus hilfreich sein.Die vorliegende Übersichtsarbeit beschreibt die zugrunde liegenden pathophysiologischen Veränderungen des hämostatischen Systems bei Leberzirrhose, liefert einen Überblick über geeignete Diagnostikmethoden und thematisiert Therapiemaßnahmen im Falle von Blutungs- und thrombotischen Komplikationen.

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Endoscopic Band Ligation for Weight Loss: A Clinical Trial

Abeid,

Zaitoun

2024

OBES SURG

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Background and Study Aim We previously reported the utility of endoscopic band ligation (EBL) in weight loss in a female patient with obesity. This study aimed to evaluate the safety of weight loss using EBL in a larger cohort. Patients and Methods This prospective cohort study included 13 female patients aged ≥ 18 years with a body mass index of ≥ 30 kg/m2 who were unwilling to undergo bariatric surgery. Patients with obesity-related comorbidities such as diabetes, hypertension, dyslipidemia, and cardiovascular disease were included. Patients with a history of bariatric surgery and those with clinical manifestations of gastroparesis, portal hypertension, liver cirrhosis, and coagulopathies were excluded. Primary study outcomes were technical feasibility and safety, and secondary study outcomes were the percentage of total weight loss, excess weight loss, and the change in gastroparesis clinical symptom index at 1 month after surgery. Results No serious complications occurred during the endoscopy or immediately after that. All patients experienced epigastric pain, nausea, and vomiting for the first 3 days, with one patient developing mild hematemesis on the second day that stopped spontaneously and revealed no abnormalities on endoscopy. At 1 month after EBL, the mean percent excess weight loss and total weight loss were 22.3% ± 9.9% and 7.8% ± 2.5%, respectively. Conclusions EBL is an effective and safe intervention for obesity management. Further studies with larger cohorts are warranted to comprehensively evaluate of the long-term efficacy and safety of EBL for obesity management.

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Endoscopic band ligation is safe despite low platelet count and high INR

Cited by 6 publications

References 45 publications

Treatment of portal hypertension complicated by variceal bleeding

Treatment of portal hypertension complicated by variceal bleeding

Gerinnungsstörungen bei Leberzirrhose – Diagnostik und Management

Endoscopic Band Ligation for Weight Loss: A Clinical Trial

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