Evaluation of endoscopic variceal band ligation sessions in obliteration of esophageal varices

Alvi, Haris; Zuberi, Bader Faiyaz; Rasheed, Tazeen; Ibrahim, Muhammad Asad

doi:10.12669/pjms.36.1.1144

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…The study stressed the need for screening oesophagogastroduodenoscopy (OGD) to look for oesophageal varices (OV) prior to starting sorafenib and suggested the importance of achieving good OV obliteration before treatment initiation [7]. However, endoscopy is an invasive procedure that comes with risks and may not be preferred especially in patients who may already be frail from an advanced malignancy [8,9]. With the ongoing COVID-19 pandemic, many elective procedures may have been canceled or delayed, which may lead to further postponement in treatment initiation.…”

Section: Introductionmentioning

confidence: 99%

Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma

Lui

Wong

et al. 2023

Cancers

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The Baveno VII criteria are used in patients with liver cirrhosis to predict high-risk varices in patients with liver cirrhosis. Yet its use in patients with advanced hepatocellular carcinoma (HCC) has not been validated. HCC alone is accompanied with a higher variceal bleeding risk due to its association with liver cirrhosis and portal vein thrombosis. The use of systemic therapy in advanced HCC has been thought to further augment this risk. Upper endoscopy is commonly used to evaluate for the presence of varices before initiation of treatment with systemic therapy. Yet it is associated with procedural risks, waiting time and limited availability in some localities which may delay the commencement of systemic therapy. Our study successfully validated the Baveno VI criteria with a 3.5% varices needing treatment (VNT) missed rate, also with acceptable <5% VNT missed rates when considering alternative liver stiffness (LSM) and platelet cut-offs. The Baveno VII clinically significant portal hypertension rule-out criteria (LSM < 15 kPa and platelet >150 × 109/L) also revealed a low frequency (2%) of hepatic events, whilst the rule-in criteria (LSM > 25 kPa) was predictive of a higher proportion of hepatic events (14%). Therefore, our study has successfully validated the Baveno VII criteria as a non-invasive stratification of the risk of variceal bleeding and hepatic decompensation in the HCC population.

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Section: Introductionmentioning

confidence: 99%

Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma

Lui

Wong

et al. 2023

Cancers

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“…EBL is a simple, safe, and effective method that is commonly used for the treatment of EV. [17,18] Endoscopic ligation of GV was first reported in the early 1990s [19][20][21] ; however, this method has not been widely accepted because of limitations in the devices used for ligation and because the indications for GV ligation are greatly limited. [20][21][22][23][24][25] Moreover, in previous studies, it was found that detachable snares and nylon loops could only be used to ligate protuberant nodular or tuberous GV, whereas band ligators could only be used to ligate small-to moderate-sized GV due to their small volume.…”

Section: Introductionmentioning

confidence: 99%

Comparing large-volume band ligators and cyanoacrylate injection for gastric variceal eradication: A prospective study

Shi

Liu

2022

Medicine

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Background: The role of endoscopy in the ligation of gastric varices (GV) remains controversial. This study aimed to evaluate the efficacy of endoscopic band ligation (EBL) using large-volume ligators for the management of non-bleeding GV in patients with cirrhosis.Methods: One hundred fifty-eight patients with non-bleeding GV due to cirrhosis were divided randomly into 2 groups: the EBL group and the endoscopic variceal obturation (EVO) group. The EBL group underwent EBL with large-volume ligators and the EVO group underwent tissue glue injection for the treatment of GV. Follow-up endoscopy was performed 3 to 4 weeks after endoscopic treatment. Patients were followed up for ≥6 months after treatment. Eradication, complication, and recurrence rates were evaluated and compared between groups.Results: The type and size of GV were similar in both groups. No significant difference was found in the mean number of treatment sessions or eradication and recurrence rates after 6 months. Ulcer bleeding occurred in 2 EBL patients (2.50%) after ligation, whereas 8 EVO patients (10.25%) experienced bleeding due to glue extrusion. The bleeding rate after endoscopic treatment significantly differed between the groups. In the EVO group, 1 patient developed renal embolism after injection and 2 patients developed sepsis. The prevalence of postoperative fever was significantly higher in the EVO group than in the EBL group.Conclusion subsections: Large-volume band ligators have similar efficacy to tissue glue for eradicating GV, however, the former is safer. Nevertheless, multicenter studies are needed to further confirm these results.

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“…It is reported that varices are found in around 70% of Child-Turcotte-Pugh (CTP) class B or C patients, and in 40% of CTP class A patients. 4,5 Bearing in mind the above mentioned figures, it is evident that a significant proportion of patients with a newly diagnosed early cirrhosis undergo endoscopy needlessly. This concept became even more crucial in recent years, when cirrhosis is diagnosed earlier because of the availability of non-invasive methods for its diagnosis such as Liver Stiffness Measurement (LSM) by Fibroscan or Elastography.…”

Section: Introductionmentioning

confidence: 99%

Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease?

et al. 2021

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Objectives: This study aimed to validate Baveno-VI recommendations for variceal screening in cACLD in our region and proposed our own cutoff values. Methods: Prospective cross-sectional study was conducted on cACLD patients from August 2020 till April 2021. Patients segregated into Group-A, having Liver stiffness measurement (LSM) of ≥ 20 kPa and platelet of ≤ 150 × 109 cells/L; and Group-B having LSM of < 20 kPa and PLT of > 150 × 109 cells/L. Gastroscopic findings were segregated into three categories, VNT, Varices Not Needing Treatment (VNNT) and No Varix (NV). ROC plots were generated for LSM and Platelet for VNT for sensitivity, specificity, Negative and Positive Predictive Values were calculated. Results: A total of 134 patients of cACLD were included. Group-A had 72 (53.7%) patients and Group-B had 62 (46.3%) patients. Group-A had 6 (8.3%) NV; 18 (25.0%) VNNT and 48 (66.7%) VNT. Group-B had 26 (41.9%) NV, 24 (38.7%) VNNT and 12 (19.4%) VNT. The sensitivity of 66.7%, specificity of 80.6% and NPV of 67.56% was obtained. Thus 19.4% VNT were missed on following Baveno VI recommendations. ROC in our study suggested cutoff value of 11.5 kPa with sensitivity of 100% and 1-sepcifity pf 78% (AUROC = 0.865; p < .001) of LSM below which screening gastroscopy could be avoided. The positive and negative predicted values for 84.85% and 100% respectively. Cut off value of platelet count for VNNT came out to be ≥ 97.5 × 109 cells/L with AUROC 0.891 (p < .001), having sensitivity of 100 % and 1-specificity of 83.3%. Conclusions: Substantial number of VNT in cACLD patients are missed by following Baveno-VI recommendations and these needs to be revised on regional basis. List If Abbreviations: AASLD: American Association for Study of Liver Diseases (AASLD), AUROC: Area Under Receiver Operating Characteristic, cACLD: Compensated Advance Chronic Liver Disease (cACLD), CTP: Child-Turcotte-Pugh, DCLD: Decompensated Chronic Liver Disease (DCLD), EV: Esophageal Varices, KPa: Kilo Pascal, LSM: Liver stiffness measurement (LSM), NPV: Negative Predictive Value, NV: No Varix (NV)., PPV: Positive Predictive Value, ROC: Receiver Operating Characteristic, VNNT: Varices Not Needing Treatment (VNNT) and VNT: Varices Needing Treatment (VNT). How to cite this:Ali FS, Bader N, Zuberi BF, Rasheed T. Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease? Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Evaluation of endoscopic variceal band ligation sessions in obliteration of esophageal varices

Cited by 3 publications

References 11 publications

Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma

Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma

Comparing large-volume band ligators and cyanoacrylate injection for gastric variceal eradication: A prospective study

Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease?

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