Outcome in cirrhotic patients with acute alcoholic hepatitis after emergency portacaval shunt for bleeding esophageal varices

Bell, Richard H.; Miyai, Katsumi; Orloff, Marshall J.

doi:10.1016/0002-9610(84)90038-2

Cited by 25 publications

(4 citation statements)

References 14 publications

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“…It is noteworthy that EPCS resulted in significantly higher survival rates of patients in each of Child's risk classes than did EMT, and the differences between the two groups were particularly striking in patients in class B and class C. In patients with alcoholic cirrhosis, two major factors that determine prolonged survival and quality of life are alcoholism and PSE (18,25). These factors are often interrelated.…”

Section: Discussionmentioning

confidence: 99%

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Prospective Randomized Trial of Emergency Portacaval Shunt and Emergency Medical Therapy in Unselected Cirrhotic Patients With Bleeding Varices

et al. 1994

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A prospective randomized trial was conducted in unselected, consecutive patients with bleeding esophageal varices resulting from cirrhosis comparing (1) emergency portacaval shunt performed within 8 hr of initial contact (21 patients) with (2) emergency medical therapy (intravenous vasopressin and esophageal balloon tamponade) followed in 9 to 30 days by elective portacaval shunt in survivors (22 patients). All patients underwent the same diagnostic workup within 3 to 6 hr of initial contact, and received identical supportive therapy initially. All patients were followed up for at least 10 yr. The protocol contained no escape or cross-over provisions. There were no statistically significant differences between the two treatment groups in the incidence of any of the clinical variables, results of laboratory tests or degree of portal hypertension. Child's risk classes in the shunt group were A-2 patients, B-8 patients and C-11 patients, whereas in the medical group they were A-10 patients, B-5 patients, and C-7 patients, a significant difference (p < 0.01) that might have favored emergency medical treatment. Bleeding was controlled initially and permanently by emergency shunt in every patient, but by medical therapy in only 45% (p < 0.001). Mean requirement for blood transfusion was 7.1 +/- 2.6 units in the shunt group and 21.4 +/- 2.6 units in the medical group (p < 0.001). Eighty-one percent of the patients in the shunt group were discharged alive compared with 45% in the medical group (p = 0.027). Five- and 10-yr observed survival rates were 67% and 57%, respectively, after emergency shunt compared with 18% and 18%, respectively, after the combination of emergency medical therapy and elective shunt (p < 0.01). These survival rates produced by emergency shunt performed within 8 hr of initial contact confirm the effectiveness of this procedure observed in our previous unrandomized studies.

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Section: Discussionmentioning

confidence: 99%

“…In patients with alcoholic cirrhosis, two major factors that determine prolonged survival and quality of life are alcoholism and PSE (18,25). These factors are often interrelated.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Trial of Emergency Portacaval Shunt and Emergency Medical Therapy in Unselected Cirrhotic Patients With Bleeding Varices

et al. 1994

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“…One single-center, retrospective study has reported an association between non-selective beta blocker use in severe AH and acute kidney injury, but further data are needed before drawing broad conclusions regarding safety in this setting and as with all patients safe use requires attention to patient hemodynamics [ 55 ]. While evidence on variceal hemorrhage specifically in AH remains sparse, one study evaluated outcomes of patients with AH undergoing emergency portacaval shunt surgery for bleeding esophageal varices and found no evidence that cirrhosis plus AH had a worse prognosis following surgery than cirrhosis alone [ 56 ]. Another study evaluated TIPS placement for hepatorenal syndrome in a small number of patients with severe AH and found that TIPS improved creatinine, blood urea nitrogen, and urine output and may be an area of further study for renal portal hypertensive complications in these patients [ 57 ].…”

Section: Management Of Portal Hypertension In Alcoholic Hepatitismentioning

confidence: 99%

Portal Hypertension in Alcohol-Associated Hepatitis

McConnell

Iwakiri

2023

Curr Hepatology Rep

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Purpose of Review This review article will examine portal hypertension in alcoholic hepatitis (AH) from both a basic mechanistic and a clinical perspective. Recent Findings Alcoholic hepatitis is a major public health problem in the USA, accounting for over 300,000 hospital admissions in a recent year of data (Jinjuvadia et al. J Clin Gastroenterol. 60 ;49:506–511). Portal hypertension is a key consequence of AH and a driver of liver-related morbidity and mortality. Alcohol may directly mediate portal hypertension via multiple possible mechanisms, including increased portal inflow, increased intrahepatic vasoconstriction, inflammation, and changes in the liver vasculature such as perisinusoidal fibrosis and phlebosclerosis. Summary Portal hypertension is a key consequence of AH and a critical area for future research.

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“…The early survival rate ws 53.4%. In 1983, Orloff and his associates [50] published the results of 20 years' experience with emergency portacaval shunts in over 250 consecutive unselected patients with acute variceal hemorrhage. During the last 5 years of the study, the operative mortality rate was reduced to 17% and the 5-year actuarial survival rate in 84 patients operated on since 1977 has been 72%.…”

Section: Emergency Portacaval Shuntmentioning

confidence: 99%

Portacaval shunts

Callow

1984

World j. surg.

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Although portacaval shunt has been amply demonstrated as providing effective therapy for the control of bleeding varices, it produces total diversion of portal flow with a high incidence of hepatic failure which, if not fatal, is frequently associated with encephalopathy. Various modifications of the portacaval shunt, physiologically a central shunt, are associated with the same immediate and delayed negative side effects as the standard end‐to‐side portacaval shunt. Numerous therapeutic modifications intended to lessen the incidence and severity of post‐shunt encephalopathy, such as limitation of protein intake, antibiotics, normalization of plasma amino acids, and modification of the gastrointestinal flora, are largely unsuccessful. Trials of adjuvant procedures such as arterialization of the portal vein and colon exclusion, as well as attempts to reduce the mortality rate of the first variceal hemorrhage by either prophylactic shunt or emergency portacaval shunt, have produced disappointing results in most instances. End‐to‐side portacaval shunt is not the therapeutic final solution. It may be indicated in the patient with intractable or severe ascites, in the presence of massive uncontrolled hemorrhage (an emergency situation), and to a very limited extent, in the presence of a few otherwise uncontrollable metabolic diseases such as hyperlipidemia. Ideally, one would prefer to restrict this operation to those patients who are destined to bleed from varices again.

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Outcome in cirrhotic patients with acute alcoholic hepatitis after emergency portacaval shunt for bleeding esophageal varices

Cited by 25 publications

References 14 publications

Prospective Randomized Trial of Emergency Portacaval Shunt and Emergency Medical Therapy in Unselected Cirrhotic Patients With Bleeding Varices

Prospective Randomized Trial of Emergency Portacaval Shunt and Emergency Medical Therapy in Unselected Cirrhotic Patients With Bleeding Varices

Portal Hypertension in Alcohol-Associated Hepatitis

Portacaval shunts

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