Management of gastric variceal bleeding: Role of endoscopy and endoscopic ultrasound

Girotra, Mohit; Raghavapuram, Saikiran; Abraham, Rachel; Pahwa, Mrinal; Pahwa, Archna Rautela; Rego, Rayburn

doi:10.4254/wjh.v6.i3.130

Cited by 22 publications

(17 citation statements)

References 42 publications

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“…The utility of Doppler EUS guidance during the GO procedure has also been questioned [6,11,26,27] because its usefulness may be counterbalanced by a longer and more complex procedure. Our results are in accordance with this unresolved issue as only a minority of practitioners (5.2%) systematically used this time-consuming technique.…”

Section: Discussionmentioning

confidence: 99%

“…located anywhere in the stomach), is considered to be more severe and difficult to treat than EV bleeding [5]. Few studies [6][7][8][9][10][11][12], mostly retrospective and uncontrolled, have focused on the management of non-GOV1 GV, and the optimal treatment remains controversial. The aim of this survey was to determine how French hepatogastroenterologists manage patients with non-GOV1 GV at the time of an acute episode of bleeding and manage the primary and secondary prophylaxis.…”

Section: Introductionmentioning

confidence: 99%

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Management of gastric varices

Weil

Cervoni

Farés

et al. 2016

European Journal of Gastroenterology & Hepatology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of gastric varices

Weil

Cervoni

Farés

et al. 2016

European Journal of Gastroenterology & Hepatology

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“…Patients were carefully selected for the procedures under strict weighing of the presumed benefits and possible disadvantages of the treatment. Since patients with previous EV bleedings have the highest mortality from any re-bleeding, these patients were preferred ( 16 ). Informed consent according to local standards was obtained in each patient.…”

Section: Mateirlas and Methodsmentioning

confidence: 99%

Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy

Unnewehr

Stich

2015

J Korean Med Sci

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In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea.

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“…Endoscopic therapies such as endoscopic variceal ligation (EVL) and endoscopic variceal obturation (EVO) are considered effective methods for treating GVB [7]. However, EVL and EVO are limited in value for GV bleeding.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis

Wang

Liu

Zhao

et al. 2020

Canadian Journal of Gastroenterology and Hepatology

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Background and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have concluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are effective treatments for patients with GV. We aimed to compare the efficiency and outcomes of these two procedures in GV patients through meta-analysis. Methods. The PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched using the keywords: GV, bleeding, TIPS, and BRTO to identify relevant randomized controlled trials and cohort studies. The overall survival (OS) rate, imminent haemostasis rate, rebleeding rate, technical success rate, procedure complication rate (hepatic encephalopathy and aggravated ascites), and Child-Pugh score were evaluated. Randomized clinical trials and cohort studies comparing TIPS and BRTO for GV due to portal hypertension were included in our meta-analysis. Two independent reviewers performed data extraction and assessed the study quality. A meta-analysis was performed to calculate risk ratios (RRs), mean differences (MDs), and 95% CIs using random effects models. Results. A total of nine studies fulfilled the inclusion criteria. There was a significant difference between TIPS and BRTO in the OS rate (RR, 0.81 (95% CI, 0.66 to 0.98); P=0.03) and rebleeding rate (RR, 2.61 (95% CI, 1.75 to 3.90); P<0.00001). TIPS had a higher incidence rate of hepatic encephalopathy (RR, 16.11 (95% CI, 7.13 to 36.37); P<0.00001). There was no significant difference between TIPS and BRTO in the immediate haemostasis rate (RR, 0.99 (95% CI, 0.89 to 1.10); P=0.84), technical success rate (RR, 1.06 (95% CI, 0.98 to 1.16); P=0.16), aggravated ascites rate (RR, 0.60 (95% CI, 0.33 to 1.09); P=0.10), or Child-Pugh change (MD, 0.22 (95% CI, −0.21 to 0.65); P=0.31). Conclusions. In this meta-analysis, BRTO brought more benefits to patients, with a higher OS rate and lower rebleeding rate. BRTO is a feasible method for GVB.

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Management of gastric variceal bleeding: Role of endoscopy and endoscopic ultrasound

Cited by 22 publications

References 42 publications

Management of gastric varices

Management of gastric varices

Fighting Hepatitis B in North Korea: Feasibility of a Bi-modal Prevention Strategy

Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis

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