Endoscopic sclerotherapy in extrahepatic portal hypertension in pregnancy

Pauzner, David; Wolman, Igal; Niv, David; Ber, Amos; David, Menachem P.

doi:10.1016/0002-9378(91)90646-9

Cited by 15 publications

(4 citation statements)

References 2 publications

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“…Sequential and simultaneous ligation and sclerotherapy is more effective than ligation alone, in reducing the recurrence rate after variceal obliteration 7,9 . The safety of sclerotherapy in pregnancy has also been established 10 …”

Section: Discussionmentioning

confidence: 99%

“…7,9 The safety of sclerotherapy in pregnancy has also been established. 10 There is no role of elective termination of pregnancy or caesarean section, these being reserved only for obstetric indications. Second stage of labor does not exacerbate upper gastrointestinal bleed and in patients who are at risk, it may be safely cut short by the operative vaginal delivery.…”

Section: • Fertility • Increased Incidence Of Upper Gastrointestinal mentioning

confidence: 99%

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Non‐cirrhotic portal hypertension and pregnancy outcome

Gurunath

Dadhwal

Deka

et al. 2008

J of Obstet and Gynaecol

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Section: Discussionmentioning

confidence: 99%

Section: • Fertility • Increased Incidence Of Upper Gastrointestinal mentioning

confidence: 99%

Non‐cirrhotic portal hypertension and pregnancy outcome

Gurunath

Dadhwal

Deka

et al. 2008

J of Obstet and Gynaecol

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“…The upper gastrointestinal endoscopy is safe in pregnancy with a small risk of fetal hypoxia from sedation and patient positioning. The mainstay of treatment remains endoscopic variceal ligation (EVL), [17][18][19] the first case during pregnancy was reported by Starkel et al 20 Endoscopic sclerotherapy has also been reported by a few, [21][22][23][24] however EVL remains the preferred choice as it avoids any potential risk of sclerosant injection. Medical therapy with vasopressors for acute variceal bleeding have a role.…”

Section: Esophageal Varicesmentioning

confidence: 99%

Pregnancy with Portal Hypertension

Aggarwal

Negi

Aggarwal

et al. 2014

Journal of Clinical and Experimental Hepatology

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Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of noncirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. ( J CLIN EXP HEPATOL 2014;4:163-171) P regnancy associated with liver diseases is an infrequent situation, but when seen together, presents a complicated clinical situation. Portal hypertension develops as a result of number of etiologies. In the west, cirrhosis is the commonest cause of portal hypertension. In the setting of cirrhotic portal hypertension, pregnancy is very rare due to hepatocellular damage leading to amenorrhea and infertility, the incidence of cirrhosis in pregnancy has been reported as 1 in 5950 pregnancies. 1 Cirrhosis may get exacerbated during pregnancy and has significant adverse effects on the mother and the baby. [2][3][4] In the developing countries, other causes like extrahepatic portal vein obstruction contribute significantly to noncirrhotic portal hypertension (NCPH). Mostly liver function is much better preserved in women with NCPH and pregnancy is spontaneous in these women. Portal hypertension associated with pregnancy is a high risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. The physiological changes, in adaptation to the pregnancy and fetal needs, worsen the portal hypertension resulting in potentially life-threatening variceal bleed and other complications. Pregnancy is a potential hazard for occurrence of recurrent variceal bleed due to its hyperdynamic state causing increase in flow to the collaterals. 5-7 Therefore management in pregnancy requires knowledge of both the effects of changes during pregnancy on portal hemodynamics and the effects of portal hypertension and its cause on both mother and fetus, hepatotoxic...

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“…30], In the 10% of non-responders who are Child class B or C. the mortality rate is substantial (90%), and these patients should be temporarily con trolled with tamponade immediately followed by emergency surgery [30,31]. Recent experi ence has now documented the safety and effi cacy of endoscopic injection sclerotherapy in children [32] and pregnant women [33,34], The recently developed technique of endo scopic ligation of esophageal varices has also met with some success [35]. The appropriate indications for ligation rather than sclerosis of varices await definition as experience with this technique accumulates.…”

Section: Non-operative Managementmentioning

confidence: 99%

Surgical Therapy of Acute Esophageal Variceal Hemorrhage

Lewis¹,

Basson²,

Modlin³

1992

Dig Dis

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Options for the management of patients with acute variceal hemorrhage must be compared for their ability to stop bleeding and prevent rebleeding, for their safety, and for their impact on hepatic reserve. Pharmacologic treatment may stop bleeding in up to 50% of patients, but cannot prevent rebleeding. Balloon tamponade controls bleeding in 90% of patients but is only transiently effective and may cause complications. Immediate sclerotherapy may stop acute bleeding and may provide chronic control with repeated treatments. However, patients who fail to respond to such measures must be submitted for surgical intervention. Emergency portosystemic shunt or esophageal transection represent the current procedures of choice for these patients. Surgery may also prove more cost effective than repeated sclerotherapy as primary therapy in a selstect group of patients with a high risk of rebleeding. Ultimately, however, primary pharmacologic therapy or hepatic transplantation to correct the pathophysiology underlying the esophageal variceal hemorrhage must be developed and refined if the natural history of this disease is to be substantially altered.

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Endoscopic sclerotherapy in extrahepatic portal hypertension in pregnancy

Cited by 15 publications

References 2 publications

Non‐cirrhotic portal hypertension and pregnancy outcome

Non‐cirrhotic portal hypertension and pregnancy outcome

Pregnancy with Portal Hypertension

Surgical Therapy of Acute Esophageal Variceal Hemorrhage

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