Gastric Varices Bleed at Lower Portosystemic Pressure Gradients than Esophageal Varices

Morrison, Joseph D.; Mendoza-Elias, Nasya; Lipnik, Andrew J.; Lokken, R. Peter; Bui, James T.; Ray, Charles E.; Gaba, Ron C.

doi:10.1016/j.jvir.2017.10.014

Cited by 35 publications

(25 citation statements)

References 31 publications

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“…In a recent retrospective analysis, 95 patients with acute VH demonstrated EVH at significantly higher pressures than GVH (23 vs. 17-20 mm Hg). 32 These findings mirror a previous study where bleeding occurred at a higher PSG in EV than GV (21.4 vs. 15.8 mm Hg). 33 Moreover, 10% of GV bled at a PSG < 12 mm Hg (compared with 2% for EV), 32 echoing a cohort where 16% of patients with bleeding GV had a baseline HPVG < 12 mm Hg.…”

Section: Pathophysiology and Epidemiology Of Esophageal And Gastric Vsupporting

confidence: 89%

“…This is supported by studies demonstrating GV bleeding at lower PSG compared with EV, including evidence that GV can bleed at PSG < 12 mm Hg. 32 Furthermore, GV were found to have similar patency rates after TIPS placement, whether or not they were previously embolized. 101 This suggests that definitive treatment of GV may require obliteration rather than simple embolization.…”

Section: Combination Tips þ Obliterationmentioning

confidence: 90%

“…Although TIPS can establish control of acute GVH, it may not be as efficacious in this setting as GV persist and bleed at lower PSGs than EV. 3,17,32,33 Though historically studies have often discussed the two as a single entity and direct comparisons between rebleeding rates in EV and GV have demonstrated no difference in rates of rebleeding, 33,86,99 emerging data demonstrate that EV and GV respond differently to current treatment strategies. In a recent retrospective study of 78 patients with GVH who underwent TIPS creation with or without adjunctive embolization, GV remained patent (65%) with high rates of rebleeding (27%) and mortality at 90 days reported to be 15%.…”

Section: Effectiveness In Ev Versus Gvmentioning

confidence: 99%

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Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches

Lipnik

Pandhi

Khabbaz

et al. 2018

Semin intervent Radiol

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Variceal hemorrhage is a feared complication of portal hypertension, with high rates of morbidity and mortality. Optimal management requires a thoughtful, multidisciplinary approach. In cases of refractory or recurrent esophageal hemorrhage, endovascular approaches such as transjugular intrahepatic portosystemic shunt (TIPS) have a well-defined role. For hemorrhage related to gastric varices, the optimal treatment remains to be established; however, there is increasing adoption of balloon-occluded retrograde transvenous obliteration (BRTO). This article will review the concept, history, patient selection, basic technique, and outcomes for TIPS, BRTO, and combined TIPS + BRTO procedures for variceal hemorrhage.

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Section: Pathophysiology and Epidemiology Of Esophageal And Gastric Vsupporting

confidence: 89%

Section: Combination Tips þ Obliterationmentioning

confidence: 90%

Section: Effectiveness In Ev Versus Gvmentioning

confidence: 99%

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Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches

Lipnik

Pandhi

Khabbaz

et al. 2018

Semin intervent Radiol

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“…The other main issue in clinical practice with respect to GVs is that they do not correlate well with the measurement of hepatic vein pressure gradient (HVPG), which is usually considered as the gold‐standard method for confirming and monitoring clinically significant portal hypertension during treatment. In the presence of variceal bleeding, it has been shown that IGVs have significantly lower portal pressure than OVs . More interestingly, contrasting findings have been found in this study as GV (especially GOVs) bleeding in the 1‐year period was more frequent than OV bleeding (46.4% vs 19.6%).…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of isolated gastric varices in liver cirrhotic patients: A single‐referral‐centre retrospective cohort study

et al. 2019

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Introduction Gastric varices (GVs) occur in 10–30% of liver cirrhotic patients, with a mortality rate of up to 45%. Rupture of isolated GVs (IGVs) is less prevalent but often results in more severe hemorrhage and a higher risk of mortality than rupture of esophageal varices (EVs). However, there is no clear consensus yet about the optimal management for incidentally discovered IGVs. Objective To determine the clinical significance of IGVs in liver cirrhotic patients. Methods This was a retrospective cohort endoscopy database study within a 2‐year period (2016–2017). All study subjects were liver cirrhotic patients with OVs or GVs. The exclusion criteria were noncirrhotic portal hypertension, presence of malignancy, absence of varices, and incomplete data. Statistical analysis was performed using IBM SPSS 23. Results A total of 153 patients were included in this study. IGVs were found in 13 (8.49%) patients, whereas OVs were found in 112 (73.20%) patients and gastro‐OVs were found in 28 (18.30%) patients. Child‐Pugh class C (CP C) score was the strongest independent risk factor for variceal bleeding in bivariate analysis (hazard ratio [HR]: 10.21, 95% confidence interval [CI]: 4.15–25.12, P = 0.001) and multivariate analysis (HR: 12.49, 95% CI: 4.95–31.54, P 0.001); however, the presence of IGVs was not an independent risk factor. CP C score was also the only significant risk factor associated with 1‐year mortality in liver cirrhotic patients on multivariate analysis (HR: 26.77, 95% CI: 6.01–119.34, P 0.001). Conclusion The presence of IGVs has no clinical significance in the occurrence of 1‐year rebleeding and in patient survival.

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“…17,18 Data show that GV hemorrhage occurs at lower portosystemic gradients (PSGs)-approximating 16 to 20 mm Hg-when compared with EV hemorrhage (21-23 mm Hg), with 10% of GV hemorrhage and 2% of EV hemorrhage occurring at PSGs below 12 mm Hg. 23,24…”

mentioning

confidence: 99%

Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

Pandhi

Kuei

Lipnik

et al. 2020

Semin intervent Radiol

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Emergent transjugular intrahepatic portosystemic shunt (TIPS) creation is most commonly employed in the setting of acute variceal hemorrhage. Given a propensity for decompensation, these patients often require a multidisciplinary, multimodal approach involving prompt diagnosis, pharmacologic therapy, and endoscopic intervention. While successful in the majority of cases, failure to medically control initial bleeding can prompt interventional radiology consultation for emergent portal decompression via TIPS creation. This article discusses TIPS creation in emergent, acute variceal hemorrhage, reviewing the natural history of gastroesophageal varices, presentation and diagnosis of acute variceal hemorrhage, pharmacologic therapy, endoscopic approaches, patient selection and risk stratification for TIPS, technical considerations for TIPS creation, adjunctive embolotherapy, and the role of salvage TIPS versus early TIPS in acute variceal hemorrhage.

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Gastric Varices Bleed at Lower Portosystemic Pressure Gradients than Esophageal Varices

Cited by 35 publications

References 31 publications

Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches

Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches

Clinical significance of isolated gastric varices in liver cirrhotic patients: A single‐referral‐centre retrospective cohort study

Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

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