Gastroesophageal endoscopic features in cirrhosis

Calès, Paul; Zabotto, Bernard; Meskens, C; Caucanas, J. P.; Vinel, Jean–Pierre; Desmorat, Hervé; Fermanian, Jacques; Pascal, Jean‐Pierre

doi:10.1016/0016-5085(90)91305-p

Cited by 173 publications

(26 citation statements)

References 22 publications

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“…[10][11][12]14 Additionally, individual manifestations of portal hypertension have been associated with survival in many studies. 7,[15][16][17][18][19][20] Therefore, the first aim of our study was to evaluate the impact of HVPG on survival in patients with cirrhosis, taking into account the MELD score. We hypothesized that HVPG as an estimation of portal pressure would improve the predictive ability of the MELD score.…”

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confidence: 99%

Influence of Hepatic Venous Pressure Gradient on the Prediction of Survival of Patients With Cirrhosis in the MELD Era *

et al. 2005

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Measurements of portal pressure, usually obtained via the hepatic venous pressure gradient (HVPG) may be a prognostic marker in cirrhosis. The aim of this study was to evaluate the impact of HVPG on survival in patients with cirrhosis in addition to the Model for EndStage Liver Disease (MELD) score. We also examined whether inclusion of HVPG in a model with MELD variables improves its prognostic ability. Retrospective analyses of all patients who had HVPG measurements between January 1998 and December 2002 were considered. Proportional hazards Cox models were developed. Prognostic calibrative and discriminative ability of the model was evaluated. In this period, 693 patients had a hepatic hemodynamic study, and 393 patients were included. Survival was significantly worse in those patients with greater HVPG value (univariate HR, 1.05; 95% CI, 1.02-1.08; P ‫؍‬ .001). HVPG remained as an independent variable in a model adjusted by MELD, ascites, encephalopathy, and age (multivariate HR, 1.03; 95% CI, 1.00-1.06; P ‫؍‬ .05) so that each 1-mmHg increase in HVPG had a 3% increase in death risk. In addition, HVPG as well as MELD score variables and age, significantly contributes to the calibrative predictive capacity of the prognostic model; however, discriminative ability improved only slightly (overall C statistic T he Model for End-Stage Liver Disease (MELD) score, initially developed for survival prediction of patients undergoing the transjugular intrahepatic portal systemic shunt (TIPS) procedure, 1 has been subsequently validated in an increasingly heterogeneous population of patients with cirrhosis as a very good tool to rank patients according to their short-term risk of death. [2][3][4][5] In the initial validation of the MELD score, individual complications of portal hypertension (ascites, spontaneous bacterial peritonitis, variceal bleeding, and encephalopathy) were added to the model, producing only minimal improvement in its discriminative ability. 2 However, each individual portal hypertensionrelated complication is only one aspect of the underlying pathophysiological mechanism, the portal hypertensive syndrome. Re-evaluation of the role of portal hypertension indexes in such predictive scores has been suggested, as portal hypertension has been described as the third parameter most frequently found to be a significant predictor of survival in cirrhosis. 6 Interestingly, after dividing patients in categories according to MELD score, 1-year mortality within each category was higher among patients with portal hypertension-related complications.

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confidence: 99%

Influence of Hepatic Venous Pressure Gradient on the Prediction of Survival of Patients With Cirrhosis in the MELD Era *

et al. 2005

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“…their propensity to bleed. 2,6,7,10,14 These studies show that the All nine of the control patients were correctly identified as larger the varix, the higher the incidence of bleeding. Alhaving no varices on both HRES and EGD by both observers.…”

Section: The Interobserver Correlation For Hres Was R å 88 Andmentioning

confidence: 81%

“…6,7,8 However, several studies have shown used to image and measure esophageal varices in control significant interobserver variability in the interpretation of subjects and patients with portal hypertension and comesophageal variceal endoscopic appearance. [9][10][11][12] Variceal size pared with endoscopic findings. Nine control patients can only be approximated and not precisely measured by and 68 patients with known cirrhosis or noncirrhotic endoscopic appearance.…”

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confidence: 99%

Comparison of high-resolution endoluminal sonography to video endoscopy in the detection and evaluation of esophageal varices

Miller¹

1996

Hepatology

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gastric varices are all associated with a greater propensity for High-resolution endoluminal sonography (HRES) was variceal bleeding. 6,7,8 However, several studies have shown used to image and measure esophageal varices in control significant interobserver variability in the interpretation of subjects and patients with portal hypertension and comesophageal variceal endoscopic appearance. [9][10][11][12] Variceal size pared with endoscopic findings. Nine control patients can only be approximated and not precisely measured by and 68 patients with known cirrhosis or noncirrhotic endoscopic appearance. portal hypertension underwent videotaped HRES andEndoscopic ultrasonography has been shown to be superior videotaped esophagoscopy (EGD). Two blinded investito endoscopy in detecting gastric varices 13,14 ; however, its role gators reviewed the videotapes to determine the presin evaluating esophageal varices is still undefined. The aim ence and size of the largest esophageal varix in each of this study is to evaluate high-resolution endoluminal sonopatient. The largest varix by HRES was measured with graphy's (HRES) potential as a screening modality for dethe esophagus at rest at a point where the varix aptecting early esophageal varices and to compare measurepeared most circular. The largest varix seen on EGD was ment of esophageal variceal size by HRES with grading as graded on a 5-point scale. All nine of the control patients determined by endoscopy. were correctly identified by both EGD and HRES as grade I (no varices). Eight of the 10 patients with no varices seen on EGD had varices identified by HRES. PATIENTS AND METHODS The interobserver correlation for HRES was r Å .88 andPatients. Sixty-eight patients with biopsy-proven cirrhosis or for EGD was r Å .79. The correlation between EGD and known noncirrhotic portal hypertension underwent 76 upper endo-HRES was r Å .50. High resolution endoluminal sonogra-scopic and HRES examinations from November, 1993 to December, phy allows quantitative measurement of variceal size, is 1995. All patients were hemodynamically stable at the time of the a more sensitive and reproducible imaging modality study. Nine volunteers known to have normal upper gastrointestinal than esophagoscopy for the detection and sizing of tracts were used as controls. All patients gave informed consent beesophageal varices. There is poor correlation between fore undergoing endoscopy; the study was approved by the Temple University Hospital Investigational Review Board, Phila., PA. with portal hypertension is of great clinical relevance because on the end of a wire core that was connected to a motor drive on the of the significant morbidity, mortality, and hospitalization ultrasound machine. The 1.35-mm diameter transducer core was costs associated with variceal bleeding.1,2 When esophageal placed into a flexible 2-mm diameter catheter, and rotated to produce varices are detected before an initial bleed, the prophylactic a 360Њ transaxial real-time image. One mL of sterile water was introuse of beta-...

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“…In addition, congestive gastropathy and peptic ulcer disease are important causes of hemorrhage in cirrhotic patients [19, 20]. While these situations usually do not create diagnostic difficulties, bleeding from colonic varices associated with portal hypertension is a rarity and may be difficult to diagnose.…”

Section: Discussionmentioning

confidence: 99%

Massive Gastrointestinal Bleeding from Colonic Varices in a Patient with Portal Hypertension

Naef¹,

Holzinger²,

Glättli³

et al. 1998

Dig Surg

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Colonic variceal bleeding is a rarity and is most commonly due to portal hypertension. The present report describes a patient with portal hypertension due to portal vein thrombosis who, following esophageal transection and successful sclerotherapy, developed a massive lower gastrointestinal bleeding from colonic varices. The literature is reviewed, and the pathophysiology of this complication is discussed. Possible etiologies of this condition may be esophageal transection and devascularization, successful sclerotherapy, and extensive thrombosis of the portal vein resulting in obliteration of the coronary-azygous anastomotic system. In such a situation other potential sites of portosystemic anastomoses, such as the colon, may be opened up, resulting in the development of colonic varices. Indeed, the incidence of colonic varices in two series after sclerotherapy for esophageal varices was 60–100%. Of 33 candidates evaluated for liver transplantation, colonic varices were found in 1.

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Gastroesophageal endoscopic features in cirrhosis

Cited by 173 publications

References 22 publications

Influence of Hepatic Venous Pressure Gradient on the Prediction of Survival of Patients With Cirrhosis in the MELD Era *

Influence of Hepatic Venous Pressure Gradient on the Prediction of Survival of Patients With Cirrhosis in the MELD Era *

Comparison of high-resolution endoluminal sonography to video endoscopy in the detection and evaluation of esophageal varices

Massive Gastrointestinal Bleeding from Colonic Varices in a Patient with Portal Hypertension

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