Prediction of variceal hemorrhage by esophageal endoscopy

Beppu, Kiichiro; Inokuchi, Kiyoshi; Koyanagi, Nobuhiro; Nakayama, Shinichi; Sakata, Hisanobu; Kitano, Seigo; Kobayashi, Michio

doi:10.1016/s0016-5107(81)73224-3

“…17 The degree of variceal size was based on Beppu's classification. 18 Patients in both groups were advised to abstain from drinking alcohol. Antiviral treatments such as lamivudine or entecavir may be administered in patients related to hepatitis B virus decompensation.…”

Section: Methodsmentioning

confidence: 99%

Controlled Trial of Ligation Plus Nadolol Versus Nadolol Alone for the Prevention of First Variceal Bleeding

Lo

¹

,

Chen

²

,

Wang

³

et al. 2010

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Both nadolol and ligation have proved to be effective in the prophylaxis of first variceal bleeding. This study was conducted to evaluate the effects and safety of combining nadolol with ligation. Cirrhotic patients with high-risk esophageal varices but without a bleeding history were considered for enrolment. Eligible patients were randomized to receive band ligation plus nadolol (Combined group, 70 patients) or nadolol alone (Nadolol group, 70 patients). In the Combined group multiligators were applied. Patients received regular ligation treatment at an interval of 4 weeks until variceal obliteration. Nadolol was administered at a dose to reduce 25% of the pulse rate in both the Combined group and the Nadolol group. Both groups were comparable in baseline data. In the Combined group 50 patients (71%) achieved variceal obliteration. The mean dose of nadolol was 52 ± 16 mg in the Combined group and 56 ± 19 mg in the Nadolol group. During a median follow-up of 26 months, 18 patients (26%) in the Combined group and 13 patients (18%) in the Nadolol group experienced upper gastrointestinal bleeding ( P = NS). Esophageal variceal bleeding occurred in 10 patients (14%) in the Combined group and nine patients (13%) in the Nadolol group ( P = NS). Adverse events were noted in 48 patients (68%) in the Combined group and 28 patients (40%) in the Nadolol group ( P = 0.06). Sixteen patients in each group died. Conclusion: The addition of ligation to nadolol may increase adverse events and did not enhance effectiveness in the prophylaxis of first variceal bleeding. (Hepatology 2010)

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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: Methodsmentioning

confidence: 84%

“…EGD can provide valuable information about variceal appearance, such as the presence or absence of stigmata of recent bleeding. 2,6,7 Additionally, therapeutic intervention can be delivered during the same session.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of High–Resolution Endoluminal Sonography to Video Endoscopy in the Detection and Evaluation of Esophageal Varices

Miller

¹

,

Schiano

²

,

Adrain

³

et al. 1996

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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 the case of portal hypertension, previous studies showed that large varices [22], variceal cherry red spots [22], hepatic functional status [23], hyperfi brinolysis [15] and portal-vein congestion index [24] were predictive factors for variceal hemorrhage, but what acutely determines variceal bleeding remains unclear and is possibly the result of several concurrent factors. In the 1990s, a biphasic circadian rhythm of variceal hemorrhage was identifi ed, with two distinct peaks in the early morning and in the evening [8][9][10][11], reproducible with the evening peak greater than the other [8,11].…”

Section: Discussionmentioning

confidence: 99%