Impact of an acute hemodynamic response-guided protocol for primary prophylaxis of variceal bleeding

Fortea, José Ignacio; Puente, Ángela; Ruíz, P.; Ezcurra, Iranzu; Vaquero, Javier; Cuadrado, Antonio; Arias-Loste, María Teresa; Cabezas, Joaquín; Llerena, Susana; Iruzubieta, Paula; Rodríguez-Lope, Carlos; Huelín, Patrícia; Casafont, F.; Fábrega, Emilio; Crespo, Javier

doi:10.12998/wjcc.v6.i13.611

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…Review in a retrospective study, carvedilol was used in HVPG acute non-responders to intravenous propranolol. 50,51 In these patients, carvedilol facilitated further HVPG reduction and improved clinical outcomes long term, even in this high-risk group.…”

Section: Key Pointsmentioning

confidence: 94%

Management of the major complications of cirrhosis: Beyond guidelines

García-Pagán

Francoz

Montagnese

et al. 2021

Journal of Hepatology

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Along with a growing understanding of the pathophysiology of cirrhosis and its complications, new therapies and management strategies have emerged in recent years. Many of these advances have helped inform the current EASL clinical practice guidelines 1 on the management of some of the key complications of cirrhosis, such as ascites, variceal bleeding and infection. However, there are still some aspects of management where the evidence base is less clear, and/or where opinions amongst practitioners remain divided. Some of these more controversial areas are explored in this section, wherein we present evidence culminating in a suggested management approach based on expert opinion and extending beyond the current guidelines.

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Section: Key Pointsmentioning

confidence: 94%

Management of the major complications of cirrhosis: Beyond guidelines

García-Pagán

Francoz

Montagnese

et al. 2021

Journal of Hepatology

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“…HVPG was performed by experienced personnel as previously described 17 . Briefly, after an overnight fast a catheter introducer was placed under local anaesthesia in the right internal jugular vein using the Seldinger technique.…”

Section: Methodsmentioning

confidence: 99%

“…HVPG was performed by experienced personnel as previously described. 17 Briefly, after an overnight fast a catheter introducer was placed under local anaesthesia in the right internal jugular vein using the Seldinger technique. Under fluoroscopy, a 7-F balloon-tipped catheter was guided into the right hepatic vein to obtain triplicate measurements of wedged hepatic venous pressure and free hepatic venous pressure.…”

Section: Hepatic Venous Pressure Gradient Measurementmentioning

confidence: 99%

High accuracy of spleen stiffness measurement in diagnosing clinically significant portal hypertension in metabolic‐associated fatty liver disease

Odriozola

Puente

Cuadrado‐Lavín

et al. 2023

Liver International

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Background and Aims Spleen stiffness measurement (SSM) by vibration‐controlled transient elastography (VCTE) has been tested in a limited number of studies versus hepatic venous pressure gradient (HVPG), especially with the 100 Hz spleen‐specific module. The current study aims to evaluate the diagnostic performance of this novel module for detecting clinically significant portal hypertension (CSPH) in a cohort of compensated patients with metabolic‐associated fatty liver disease (MAFLD) as the main aetiology and to improve the performance of the Baveno VII criteria for CSPH diagnosis by including SSM. Methods This is a retrospective single‐centre study including patients with available measurements of HVPG, Liver stiffness measurement (LSM) and SSM by VCTE with the 100 Hz module. Area under the receiver operating characteristic (AUROC) curve analysis was conducted to identify dual cut‐offs (rule‐out and rule‐in) associated with the absence/presence of CSPH. The diagnostic algorithms were adequate if negative predictive value (NPV) and positive predictive values (PPV) were >90%. Results A total of 85 patients were included, 60 MAFLD and 25 non‐MAFLD. SSM showed a good correlation with HVPG (MAFLD: r = .74; p < .0001; non‐MAFLD: r = .62; p < .0011). In MAFLD patients, SSM had a high accuracy in discarding/diagnosing CSPH (cut‐off values of <40.9 and >49.9 kPa, AUC 0.95). The addition of these cut‐offs in a sequential or combined approach to the Baveno VII criteria significantly reduced the grey zone (60% vs. 15%–20%), while maintaining adequate NPV and PPV. Conclusions Our findings support the utility of SSM for diagnosing CSPH in MAFLD patients and demonstrate that the addition of SSM to the Baveno VII criteria increases accuracy.

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“…Patients with cirrhosis who are nonresponsive to propranolol should receive carvedilol to prevent the first bleeding from esophageal varices if contraindications are absent 96 . The optimal dose of carvedilol is 12.5 mg daily 97 .…”

Section: Primary Prevention Of Variceal Hemorrhagementioning

confidence: 99%

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

Garbuzenko

Arefyev

2020

J Evidence Based Medicine

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All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.

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Impact of an acute hemodynamic response-guided protocol for primary prophylaxis of variceal bleeding

Cited by 4 publications

References 22 publications

Management of the major complications of cirrhosis: Beyond guidelines

Management of the major complications of cirrhosis: Beyond guidelines

High accuracy of spleen stiffness measurement in diagnosing clinically significant portal hypertension in metabolic‐associated fatty liver disease

Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature

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