BACKGROUND Endoscopic variceal band ligation(EVBL)represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis,but in some cases a single session of EVBL is unable to era...BACKGROUND Endoscopic variceal band ligation(EVBL)represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis,but in some cases a single session of EVBL is unable to eradicate esophageal varices completely,and a control endoscopy after 2-4 weeks is required to assess eradication and/or the need for another band ligation.Liver stiffness measurement(LSM)is being increasingly used as a screening non-invasive tool to predict varices according to Baveno VII criteria.However,to date,there are no instruments able to non-invasively predict the outcome of EVBL.AIM To identify non-invasive predictors of varices eradication(VE)after EVBL through multiparametric ultrasound(US).Secondary aim was to develop a prediction model of successful variceal eradication based on non-invasive parameters.METHODS We prospectively enrolled consecutive cirrhotic patients intolerant or with contraindications to beta-blockers undergoing EVBL for bleeding prophylaxis.Patients underwent multiparametric US with LSM,spleen stiffness measurement(SSM)and dynamic contrastenhanced US(DCE-US)on liver parenchyma and portal vein,at baseline(T0)and one month(T1)after EVBL.Each US parameter and their variations from baseline were correlated with VE evaluated by control endoscopy performed at T1.RESULTS We enrolled 41 patients(median age 64 years,75.6%males).At T128 patients(68.3%)reached VE,whereas 13(31.7%)required a second EVBL.Patients who achieved VE showed a significant decrease in SSM(P=0.018),and a significant increase in peak enhancement,area under the curve and wash-in rate of both liver parenchyma and portal vein after treatment(P<0.001).Statistically significant differences between the two groups of patients were incorporated in a multivariate analysis and used to develop three prediction models.CONCLUSION A multimodal US approach based on DCE-US parameters,LSM and SSM might become a reliable predictor of VE and a useful non-invasive alternative to endoscopy.展开更多
BACKGROUND Budd-Chiari syndrome(BCS)is caused by obstruction of the hepatic veins or suprahepatic inferior vena cava,leading to portal hypertension and the development of gastroesophageal varices(GEVs),which are assoc...BACKGROUND Budd-Chiari syndrome(BCS)is caused by obstruction of the hepatic veins or suprahepatic inferior vena cava,leading to portal hypertension and the development of gastroesophageal varices(GEVs),which are associated with an increased risk of bleeding.Existing risk models for variceal bleeding in cirrhotic patients have limited applicability to BCS due to differences in pathophysiology.Radiomics,as a noninvasive technique,holds promise as a tool for more accurate prediction of bleeding risk in BCS-related GEVs.AIM To develop and validate a personalized risk model for predicting variceal bleeding in BCS patients with GEVs.METHODS We retrospectively analyzed clinical data from 444 BCS patients with GEVs in two centers.Radiomic features were extracted from portal venous phase computed tomography(CT)scans.A training cohort of 334 patients was used to develop the model,with 110 patients serving as an external validation cohort.LASSO Cox regression was used to select radiomic features for constructing a radiomics score(Radscore).Univariate and multivariate Cox regression identified independent clinical predictors.A combined radiomics+clinical(R+C)model was developed using stepwise regression.Model performance was assessed using the area under the receiver operating characteristic curve(AUC),calibration plots,and decision curve analysis(DCA),with external validation to evaluate generalizability.RESULTS The Radscore comprised four hepatic and six splenic CT features,which predicted the risk of variceal bleeding.Multivariate analysis identified invasive treatment to relieve hepatic venous outflow obstruction,anticoagulant therapy,and hemoglobin levels as independent clinical predictors.The R+C model achieved C-indices of 0.906(training)and 0.859(validation),outperforming the radiomics and clinical models alone(AUC:training 0.936 vs 0.845 vs 0.823;validation 0.876 vs 0.712 vs 0.713).DCA showed higher clinical net benefit across the thresholds.The model stratified patients into low-,medium-and high-risk groups with significant differences in bleeding rates(P<0.001).An online tool is available at https://bcsvh.shinyapps.io/BCS_Variceal_Bleeding_Risk_Tool/.CONCLUSION We developed and validated a novel radiomics-based model that noninvasively and conveniently predicted risk of variceal bleeding in BCS patients with GEVs,aiding early identification and management of high-risk patients.展开更多
BACKGROUND The high rebleeding rate and severe adverse events have raised concerns regarding the safety of endoscopic cyanoacrylate as a conventional treatment for gastric variceal hemorrhage.Clip-assisted endoscopic ...BACKGROUND The high rebleeding rate and severe adverse events have raised concerns regarding the safety of endoscopic cyanoacrylate as a conventional treatment for gastric variceal hemorrhage.Clip-assisted endoscopic cyanoacrylate injection(Clip-CYA)and endoscopic ultrasound-guided coil and cyanoacrylate injection(EUS-CG)are two currently used modalities.There are limited data comparing the two techniques.AIM To compare the efficacy,safety,and procedural characteristics of Clip-CYA vs EUS-CG for treatment of gastric varices(GVs)with spontaneous portosystemic shunts.METHODS Between April 2019 and August 2023,162 patients with GVs and concomitant gastrorenal or splenorenal shunts who underwent either Clip-CYA or EUS-CG at our center were included.After 1:2 propensity score matching,108 patients were included in the final analysis.The evaluated outcomes included the amount of cyanoacrylate,eradication of GVs,cyanoacrylate embolization,all-cause rebleeding,operating time and endoscopic therapy costs.RESULTS Of the 108 patients,72(male,83.3%;mean age,56.2±10.8 years)received Clip-CYA,and 36(male,72.2%;mean age,59.1±10.7 years)received EUS-CG.The amount of cyanoacrylate used,rates of obliteration of GVs and all-cause rebleeding were similar between the two groups(2.0±1.1 mL vs 2.0±0.6 mL,P=0.913;91.7%vs 94.4%,P=0.603;and 23.6%vs 19.4%,P=0.623,respectively).No cyanoacrylate embolization occurred in either group.Compared with EUS-CG,Clip-CYA was associated with significantly shorter operating times(24.0±9.9 minutes vs 47.1±21.0 minutes,P<0.001)and lower endoscopic therapy costs(7523.4±5719.4 Chinese yuan vs 11153.7±7679.1 Chinese yuan,P=0.007).These advantages persisted in the subgroup analysis of patients whose GVs had a maximum diameter>3 cm or>4 cm.CONCLUSION Compared with EUS-CG,Clip-CYA of GVs appears to be a safe procedure with shorter operating times and lower endoscopic therapy costs.展开更多
BACKGROUND Severe esophagogastric varices(EGVs)significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage.Endoscopy is the gold standard for EGV detection but it is ...BACKGROUND Severe esophagogastric varices(EGVs)significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage.Endoscopy is the gold standard for EGV detection but it is invasive,costly and carries risks.Noninvasive predictive models using ultrasound and serological markers are essential for identifying high-risk patients and optimizing endoscopy utilization.Machine learning(ML)offers a powerful approach to analyze complex clinical data and improve predictive accuracy.This study hypothesized that ML models,utilizing noninvasive ultrasound and serological markers,can accurately predict the risk of EGVs in hepatitis B patients,thereby improving clinical decisionmaking.AIM To construct and validate a noninvasive predictive model using ML for EGVs in hepatitis B patients.METHODS We retrospectively collected ultrasound and serological data from 310 eligible cases,randomly dividing them into training(80%)and validation(20%)groups.Eleven ML algorithms were used to build predictive models.The performance of the models was evaluated using the area under the curve and decision curve analysis.The best-performing model was further analyzed using SHapley Additive exPlanation to interpret feature importance.RESULTS Among the 310 patients,124 were identified as high-risk for EGVs.The extreme gradient boosting model demonstrated the best performance,achieving an area under the curve of 0.96 in the validation set.The model also exhibited high sensitivity(78%),specificity(94%),positive predictive value(84%),negative predictive value(88%),F1 score(83%),and overall accuracy(86%).The top four predictive variables were albumin,prothrombin time,portal vein flow velocity and spleen stiffness.A web-based version of the model was developed for clinical use,providing real-time predictions for high-risk patients.CONCLUSION We identified an efficient noninvasive predictive model using extreme gradient boosting for EGVs among hepatitis B patients.The model,presented as a web application,has potential for screening high-risk EGV patients and can aid clinicians in optimizing the use of endoscopy.展开更多
In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a s...In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a significant consequence of portal hypertension,is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding.Although it has been studied,direct endoscopic injection of cyanoacrylate glue has limitations,such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism.In order to achieve this,endoscopic ultrasound has been used to support GV characterization,real-time therapy imaging,and Doppler obliteration verification.展开更多
BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospec...BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy(EIS)and subsequent interventional radiology(IR).AIM To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.METHODS This was a single tertiary care center before-after study,including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center.A retrospective review of the medical records was conducted.The management of these four patients involved the utilization of EIS followed by IR.The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches:Phase 1,from the initial occurrence of BEV-SB to the initial EIS;phase 2,from the initial EIS to the initial IR treatment;and phase 3,from the initial IR to December 2023.Descriptive statistics were performed to clarify the blood transfusions in each phase.RESULTS Four out of 519 patients diagnosed with PH were identified as having BEV-SB.The management duration of each phase was 20 person-months,42 personmonths,and 77 person-months,respectively.The four patients received a total of eight and five person-times of EIS and IR treatment,respectively.All patients exhibited recurrent gastrointestinal bleeding following the first EIS,while no further instances of gastrointestinal bleeding were observed after IR treatment.The transfusions administered during each phase were 34,31,and 3.5 units of red blood cells,and 13 units,14 units,and 1 unit of plasma,respectively.CONCLUSION EIS may be effective in achieving hemostasis for BEV-SB,but rebleeding is common,and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.展开更多
Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for...Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for portal hyper-tension and esophagogastric variceal bleeding,respectively.With advancements in artificial intelligence in medicine,non-invasive diagnostic methods are in-creasingly replacing traditional invasive procedures,permitting more rational and personalized patient care.This review summarizes the formation and diagnosis of portal hypertension,as well as the primary prophylaxis,secondary prophylaxis,and management of acute esophagogastric variceal bleeding.This study also highlights the latest progress in artificial intelligence in the diagnosis and treat-ment of portal hypertension and esophagogastric varices.展开更多
Variceal bleed represents an important complication of cirrhosis,with its presence reflecting the severity of liver disease.Gastric varices,though less frequently seen than esophageal varices,present a distinct clinic...Variceal bleed represents an important complication of cirrhosis,with its presence reflecting the severity of liver disease.Gastric varices,though less frequently seen than esophageal varices,present a distinct clinical challenge due to its higher intensity of bleeding and associated mortality.Based upon the Sarin classification,GOV1 is the most common subtype of gastric varices seen in clinical practice.展开更多
The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varice...The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.展开更多
BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to...BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONCLUSION For mild to moderate GOV1,patients with EBL had a greater one-time varix eradication rate,a greater 6-wk operation-related ulcer healing rate,a lower delayed rebleeding rate and a lower cost than patients with TAI.展开更多
BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been establi...BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been established.CASE SUMMARY We reported three patients with jejunal varices at the site of choledochojejun-ostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023.We reviewed all patient records,clinical presentation,endoscopic findings and treatment,outcomes and follow-up.Three patients who underwent pancre-aticoduodenectomy with a Whipple anastomosis were examined using conven-tional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop.Varices with stigmata of recent hemorrhage or active he-morrhage were observed around the choledochojejunostomy site in all three patients.Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients.The bleeding ceased and patency was observed for 26 and 2 months in two patients.In one patient with multiorgan failure and internal environment disturbance,rebleeding occurred 1 month after endoscopic sclerotherapy,and despite a second endoscopic sclero-therapy,repeated episodes of bleeding and multiorgan failure resulted in eventual death.CONCLUSION We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoac-rylate injection can be an easy,effective,safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.展开更多
BACKGROUND Interventional endoscopic ultrasound is clinically used for the treatment of isolated gastric varices(IGVs)owing to its precise visualization.CASE SUMMARY A 39-year-old man was diagnosed with a large IGV du...BACKGROUND Interventional endoscopic ultrasound is clinically used for the treatment of isolated gastric varices(IGVs)owing to its precise visualization.CASE SUMMARY A 39-year-old man was diagnosed with a large IGV during a routine physical examination.Endoscopic ultrasonography showed gastric varices entwined with an artery,which greatly increased the difficulty of treatment.We successfully treated the patient with endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection.CONCLUSION Endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection was safe and effective for the treatment of an IGV entwined with an artery.展开更多
BACKGROUND The stent embedded in the esophageal mucosa is one of the complications after stenting for esophageal stricture.We present a case of stent adjustment with the aid of a transparent cap after endoscopic injec...BACKGROUND The stent embedded in the esophageal mucosa is one of the complications after stenting for esophageal stricture.We present a case of stent adjustment with the aid of a transparent cap after endoscopic injection of an esophageal varices stent.CASE SUMMARY A 61-year-old male patient came to the hospital with discomfort of the chest after the stent implanted for the stenosis because of endoscopic injection of esophageal varices.The gastroscopy was performed,and the stent embedded into the esophageal mucosa.At first,we pulled the recycling line for shrinking the stent,however,the mucosa could not be removed from the stent.Then a forceps was performed to remove the mucosa in the stent,nevertheless,the bleeding form the mucosa was obvious.And then,we used a transparent cap to scrape the mucosa along the stent,and the mucosa were removed successfully without bleeding.CONCLUSION A transparent cap helps gastroscopy to remove the mucosa embedded in the stent after endoscopic injection of the esophageal varices stent.展开更多
BACKGROUND Liver cirrhosis is the end stage of progressive liver fibrosis as a consequence of chronic liver inflammation,wherein the standard hepatic architecture is replaced by regenerative hepatic nodules,which even...BACKGROUND Liver cirrhosis is the end stage of progressive liver fibrosis as a consequence of chronic liver inflammation,wherein the standard hepatic architecture is replaced by regenerative hepatic nodules,which eventually lead to liver failure.Cirrhosis without any symptoms is referred to as compensated cirrhosis.Complications such as ascites,variceal bleeding,and hepatic encephalopathy indicate the onset of decompensated cirrhosis.Gastroesophageal varices are the hallmark of clini-cally significant portal hypertension.AIM To determine the accuracy of the platelet count-to-spleen diameter(PC/SD)ratio to evaluate esophageal varices(EV)in patients with cirrhosis.METHODS This retrospective observational study was conducted at Tikur Anbessa Specia-lized Hospital and Adera Medical Center from January 1,2019,to December 30,2023.Data were collected via chart review and direct patient interviews using structured questionnaires.The data were exported to the SPSS software version 26 for analysis and clearance.A receiver operating characteristic curve was plotted for splenic diameter,platelet count,and PC/SD ratio to obtain sensitivity,speci-ficity,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio.RESULTS Of the 140 participants,67%were men.Hepatitis B(38%)was the most common cause of cirrhosis,followed by cryptogenic cirrhosis(28%)and hepatitis C(16%).Approximately 83.6%of the participants had endoscopic evidence of EV,whereas 51.1%had gastric varices.Decompensated cirrhosis and PC were associated with the presence of EV with adjusted odds ratios of 12.63(95%CI:3.16-67.58,P=0.001)and 0.14(95%CI:0.037-0.52,P=0.004),respectively.A PC/SD ratio<1119 had a sensitivity of 86.32%and specificity of 70%with area under the curve of 0.835(95%CI:0.736-0.934,P<0.001).CONCLUSION A PC/SD ratio<1119 predicts EV in patients with cirrhosis.It is a valuable,noninvasive tool for EV risk assess-ment in resource-limited settings.展开更多
The Baveno VII consensus,released in 2023,recommends that the endoscopic treatment of choice for managing bleeding gastric varices(GV)is endoscopic ultrasound(EUS)-guided treatment,specifically EUS-guided cyanoacrylat...The Baveno VII consensus,released in 2023,recommends that the endoscopic treatment of choice for managing bleeding gastric varices(GV)is endoscopic ultrasound(EUS)-guided treatment,specifically EUS-guided cyanoacrylate(CYA)glue injection.This approach has been endorsed due to its efficacy in controlling bleeding while reducing rebleeding rates,compared to other endoscopic techniques.Despite its efficacy,CYA injection for GV has been linked to rare but serious adverse events,such as glue embolization leading to pulmonary embolism,infection/bacteremia,splenic infarction,intra-procedural and post-procedural complications.The technique for endoscopic obliteration of GV was subsequently refined using EUS guidance,aiming to more accurately direct the injection into the varix,reduce the volume of injected glue,target the perforating vein when possible,and confirm obliteration of GV via Doppler examination.展开更多
BACKGROUND Esophageal stricture is one of the complications after esophageal varices sclero-therapy injection(ESI),and the incidence rate is between 2%-10%.AIM To explore the efficacy of self-expanding metal stent(SEM...BACKGROUND Esophageal stricture is one of the complications after esophageal varices sclero-therapy injection(ESI),and the incidence rate is between 2%-10%.AIM To explore the efficacy of self-expanding metal stent(SEMS)for the stricture after endoscopic injection with cyanoacrylate(CYA)and sclerotherapy for esophageal varices.METHODS We retrospectively analyzed the efficacy of SEMS to improve the stricture after endoscopic injection with CYA and sclerotherapy for esophageal varices in 4 patients from February 2023 to June 2023.RESULTS The strictures were improved in four patients after stenting.The stent was removed after two weeks because of chest pain with embedding into esophageal mucosa in one patient.The stent was removed after one month,however,the stent was reinserted because of the strictures happening again in two patients.The stent was removed after three months,however,the stent was reinserted because of the strictures happening again in one patient.The stent embedded into esophageal mucosa in three patients.There were 3 patients suffered reflux esophagitis,and the acid reflux was relieved by taking hydrotalcite.There was no other complication of esophageal perforation,bleeding from varices or infection.CONCLUSION SEMS may relieve the stricture which happened after endoscopic injection with CYA and sclerotherapy for esophageal varices.However,when we should remove the stent still needs to be explored.展开更多
Rectal varices are an uncommon manifestation of portal hypertension.Although hemorrhoids can be seen in cirrhotic patients,distinguishing between rectal varices and hemorrhoids can be challenging.Furthermore,the under...Rectal varices are an uncommon manifestation of portal hypertension.Although hemorrhoids can be seen in cirrhotic patients,distinguishing between rectal varices and hemorrhoids can be challenging.Furthermore,the underlying mechanism and treatment options vary.Hence,the correct identification is of utmost important.Through this letter,we highlight the features of both and listed the distinguishing points between the two etiologies.展开更多
BACKGROUND To avoid acute variceal bleeding in cirrhosis,current guidelines recommend screening for high-risk esophageal varices(EVs)by determining variceal size and identifying red wale markings.However,visual measur...BACKGROUND To avoid acute variceal bleeding in cirrhosis,current guidelines recommend screening for high-risk esophageal varices(EVs)by determining variceal size and identifying red wale markings.However,visual measurements of EV during routine endoscopy are often inaccurate.AIM To determine whether biopsy forceps(BF)could be used as a reference to improve the accuracy of binary classification of variceal size.METHODS An in vitro self-made EV model with sizes ranging from 2 to 12 mm in diameter was constructed.An online image-based survey comprising 11 endoscopic images of simulated EV without BF and 11 endoscopic images of EV with BF was assembled and sent to 84 endoscopists.The endoscopists were blinded to the actual EV size and evaluated the 22 images in random order.RESULTS The respondents included 48 academic and four private endoscopists.The accuracy of EV size estimation was low in both the visual(13.81%)and BF-based(20.28%)groups.The use of open forceps improved the ability of the endoscopists to correctly classify the varices by size(small≤5 mm,large>5 mm)from 71.85%to 82.17%(P<0.001).CONCLUSION BF may improve the accuracy of EV size assessment,and its use in clinical practice should be investigated.展开更多
With increasing burden of compensated cirrhosis,we desperately need noninvasive methods for assessment of clinically significant portal hypertension.The use of liver and spleen stiffness measurement helps in deferring...With increasing burden of compensated cirrhosis,we desperately need noninvasive methods for assessment of clinically significant portal hypertension.The use of liver and spleen stiffness measurement helps in deferring unnecessary endoscopies for low risk esophageal varices.This would reduce cost and patient discomfort.However,these special techniques may not be feasible at remote areas where still we need only biochemical parameters.More prospective studies validating the non-invasive risk prediction models are definitely needed.展开更多
Background: upper digestive endoscopy is the best method for detecting esophageal varices, but its invasiveness and cost make it inaccessible to certain social classes. Aim: to evaluate the performance of non-invasive...Background: upper digestive endoscopy is the best method for detecting esophageal varices, but its invasiveness and cost make it inaccessible to certain social classes. Aim: to evaluate the performance of non-invasive methods for the presumptive diagnosis of esophageal varices in cirrhotic patients in Togo. Patients and method: this was a cross-sectional descriptive and analytical retrospective data collection conducted over 2 years. It included medical records of cirrhotic patients hospitalized in the Hepato-gastroenterology who undergone transaminase assay, blood count, abdominal ultrasound and an upper GI endoscopy. Results: A total of 114 patients were included, 84 of them were men (sex ratio: 2.8). The mean age of patients was 48±14 years. The most frequent reason for admission was abdominal distension (86%). According to the Child-Pugh classification, cirrhosis was decompensated in 109 patients (95.6%). Esophageal varices were present in 71.1% of patients. At a cutoff value of 110 mm for spleen diameter, the sensitivity for prediction of esophageal esophageal varices was 70.4%, with an area under the ROC curve of 0.63. The areas under the ROC curve for prediction of esophageal varices were 0.27;0.29;0.29 respectively for platelet count, platelet/spleen diameter ratio and the [platelets²/spleen diameter] x AST level. A low [platelets²/spleen diameter] x AST level ratio correlated with the presence of esophageal varices at endoscopy. Conclusion: Spleen diameter is a performant non-invasive tool for the prediction of esophageal varices.展开更多
文摘BACKGROUND Endoscopic variceal band ligation(EVBL)represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis,but in some cases a single session of EVBL is unable to eradicate esophageal varices completely,and a control endoscopy after 2-4 weeks is required to assess eradication and/or the need for another band ligation.Liver stiffness measurement(LSM)is being increasingly used as a screening non-invasive tool to predict varices according to Baveno VII criteria.However,to date,there are no instruments able to non-invasively predict the outcome of EVBL.AIM To identify non-invasive predictors of varices eradication(VE)after EVBL through multiparametric ultrasound(US).Secondary aim was to develop a prediction model of successful variceal eradication based on non-invasive parameters.METHODS We prospectively enrolled consecutive cirrhotic patients intolerant or with contraindications to beta-blockers undergoing EVBL for bleeding prophylaxis.Patients underwent multiparametric US with LSM,spleen stiffness measurement(SSM)and dynamic contrastenhanced US(DCE-US)on liver parenchyma and portal vein,at baseline(T0)and one month(T1)after EVBL.Each US parameter and their variations from baseline were correlated with VE evaluated by control endoscopy performed at T1.RESULTS We enrolled 41 patients(median age 64 years,75.6%males).At T128 patients(68.3%)reached VE,whereas 13(31.7%)required a second EVBL.Patients who achieved VE showed a significant decrease in SSM(P=0.018),and a significant increase in peak enhancement,area under the curve and wash-in rate of both liver parenchyma and portal vein after treatment(P<0.001).Statistically significant differences between the two groups of patients were incorporated in a multivariate analysis and used to develop three prediction models.CONCLUSION A multimodal US approach based on DCE-US parameters,LSM and SSM might become a reliable predictor of VE and a useful non-invasive alternative to endoscopy.
基金Supported by Natural Science Foundation of Henan Province,China,No.232300420232Henan Provincial Key Research and Development Project,No.231111313500.
文摘BACKGROUND Budd-Chiari syndrome(BCS)is caused by obstruction of the hepatic veins or suprahepatic inferior vena cava,leading to portal hypertension and the development of gastroesophageal varices(GEVs),which are associated with an increased risk of bleeding.Existing risk models for variceal bleeding in cirrhotic patients have limited applicability to BCS due to differences in pathophysiology.Radiomics,as a noninvasive technique,holds promise as a tool for more accurate prediction of bleeding risk in BCS-related GEVs.AIM To develop and validate a personalized risk model for predicting variceal bleeding in BCS patients with GEVs.METHODS We retrospectively analyzed clinical data from 444 BCS patients with GEVs in two centers.Radiomic features were extracted from portal venous phase computed tomography(CT)scans.A training cohort of 334 patients was used to develop the model,with 110 patients serving as an external validation cohort.LASSO Cox regression was used to select radiomic features for constructing a radiomics score(Radscore).Univariate and multivariate Cox regression identified independent clinical predictors.A combined radiomics+clinical(R+C)model was developed using stepwise regression.Model performance was assessed using the area under the receiver operating characteristic curve(AUC),calibration plots,and decision curve analysis(DCA),with external validation to evaluate generalizability.RESULTS The Radscore comprised four hepatic and six splenic CT features,which predicted the risk of variceal bleeding.Multivariate analysis identified invasive treatment to relieve hepatic venous outflow obstruction,anticoagulant therapy,and hemoglobin levels as independent clinical predictors.The R+C model achieved C-indices of 0.906(training)and 0.859(validation),outperforming the radiomics and clinical models alone(AUC:training 0.936 vs 0.845 vs 0.823;validation 0.876 vs 0.712 vs 0.713).DCA showed higher clinical net benefit across the thresholds.The model stratified patients into low-,medium-and high-risk groups with significant differences in bleeding rates(P<0.001).An online tool is available at https://bcsvh.shinyapps.io/BCS_Variceal_Bleeding_Risk_Tool/.CONCLUSION We developed and validated a novel radiomics-based model that noninvasively and conveniently predicted risk of variceal bleeding in BCS patients with GEVs,aiding early identification and management of high-risk patients.
基金Supported by the National Natural Science Foundation of China,No.82200664the Clinical Research Program of The First Affiliated Hospital,Zhejiang University School of Medicine,No.BL2025023.
文摘BACKGROUND The high rebleeding rate and severe adverse events have raised concerns regarding the safety of endoscopic cyanoacrylate as a conventional treatment for gastric variceal hemorrhage.Clip-assisted endoscopic cyanoacrylate injection(Clip-CYA)and endoscopic ultrasound-guided coil and cyanoacrylate injection(EUS-CG)are two currently used modalities.There are limited data comparing the two techniques.AIM To compare the efficacy,safety,and procedural characteristics of Clip-CYA vs EUS-CG for treatment of gastric varices(GVs)with spontaneous portosystemic shunts.METHODS Between April 2019 and August 2023,162 patients with GVs and concomitant gastrorenal or splenorenal shunts who underwent either Clip-CYA or EUS-CG at our center were included.After 1:2 propensity score matching,108 patients were included in the final analysis.The evaluated outcomes included the amount of cyanoacrylate,eradication of GVs,cyanoacrylate embolization,all-cause rebleeding,operating time and endoscopic therapy costs.RESULTS Of the 108 patients,72(male,83.3%;mean age,56.2±10.8 years)received Clip-CYA,and 36(male,72.2%;mean age,59.1±10.7 years)received EUS-CG.The amount of cyanoacrylate used,rates of obliteration of GVs and all-cause rebleeding were similar between the two groups(2.0±1.1 mL vs 2.0±0.6 mL,P=0.913;91.7%vs 94.4%,P=0.603;and 23.6%vs 19.4%,P=0.623,respectively).No cyanoacrylate embolization occurred in either group.Compared with EUS-CG,Clip-CYA was associated with significantly shorter operating times(24.0±9.9 minutes vs 47.1±21.0 minutes,P<0.001)and lower endoscopic therapy costs(7523.4±5719.4 Chinese yuan vs 11153.7±7679.1 Chinese yuan,P=0.007).These advantages persisted in the subgroup analysis of patients whose GVs had a maximum diameter>3 cm or>4 cm.CONCLUSION Compared with EUS-CG,Clip-CYA of GVs appears to be a safe procedure with shorter operating times and lower endoscopic therapy costs.
基金Supported by the Agency Natural Science Foundation of Fujian Province,China,No.2022J011285 and No.2023J011480.
文摘BACKGROUND Severe esophagogastric varices(EGVs)significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage.Endoscopy is the gold standard for EGV detection but it is invasive,costly and carries risks.Noninvasive predictive models using ultrasound and serological markers are essential for identifying high-risk patients and optimizing endoscopy utilization.Machine learning(ML)offers a powerful approach to analyze complex clinical data and improve predictive accuracy.This study hypothesized that ML models,utilizing noninvasive ultrasound and serological markers,can accurately predict the risk of EGVs in hepatitis B patients,thereby improving clinical decisionmaking.AIM To construct and validate a noninvasive predictive model using ML for EGVs in hepatitis B patients.METHODS We retrospectively collected ultrasound and serological data from 310 eligible cases,randomly dividing them into training(80%)and validation(20%)groups.Eleven ML algorithms were used to build predictive models.The performance of the models was evaluated using the area under the curve and decision curve analysis.The best-performing model was further analyzed using SHapley Additive exPlanation to interpret feature importance.RESULTS Among the 310 patients,124 were identified as high-risk for EGVs.The extreme gradient boosting model demonstrated the best performance,achieving an area under the curve of 0.96 in the validation set.The model also exhibited high sensitivity(78%),specificity(94%),positive predictive value(84%),negative predictive value(88%),F1 score(83%),and overall accuracy(86%).The top four predictive variables were albumin,prothrombin time,portal vein flow velocity and spleen stiffness.A web-based version of the model was developed for clinical use,providing real-time predictions for high-risk patients.CONCLUSION We identified an efficient noninvasive predictive model using extreme gradient boosting for EGVs among hepatitis B patients.The model,presented as a web application,has potential for screening high-risk EGV patients and can aid clinicians in optimizing the use of endoscopy.
文摘In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a significant consequence of portal hypertension,is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding.Although it has been studied,direct endoscopic injection of cyanoacrylate glue has limitations,such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism.In order to achieve this,endoscopic ultrasound has been used to support GV characterization,real-time therapy imaging,and Doppler obliteration verification.
基金Supported by the Air Force Medical Center Outstanding Youth Program,No.2022YXQNNO36.
文摘BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy(EIS)and subsequent interventional radiology(IR).AIM To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.METHODS This was a single tertiary care center before-after study,including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center.A retrospective review of the medical records was conducted.The management of these four patients involved the utilization of EIS followed by IR.The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches:Phase 1,from the initial occurrence of BEV-SB to the initial EIS;phase 2,from the initial EIS to the initial IR treatment;and phase 3,from the initial IR to December 2023.Descriptive statistics were performed to clarify the blood transfusions in each phase.RESULTS Four out of 519 patients diagnosed with PH were identified as having BEV-SB.The management duration of each phase was 20 person-months,42 personmonths,and 77 person-months,respectively.The four patients received a total of eight and five person-times of EIS and IR treatment,respectively.All patients exhibited recurrent gastrointestinal bleeding following the first EIS,while no further instances of gastrointestinal bleeding were observed after IR treatment.The transfusions administered during each phase were 34,31,and 3.5 units of red blood cells,and 13 units,14 units,and 1 unit of plasma,respectively.CONCLUSION EIS may be effective in achieving hemostasis for BEV-SB,but rebleeding is common,and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.
基金Supported by the National Natural Science Foundation of China,No.81970533the Natural Science Foundation of Shandong Province,No.ZR2022ZD21.
文摘Esophagogastric variceal bleeding is a common and severe complication of cirr-hotic portal hypertension.Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the diagnostic gold standards for portal hyper-tension and esophagogastric variceal bleeding,respectively.With advancements in artificial intelligence in medicine,non-invasive diagnostic methods are in-creasingly replacing traditional invasive procedures,permitting more rational and personalized patient care.This review summarizes the formation and diagnosis of portal hypertension,as well as the primary prophylaxis,secondary prophylaxis,and management of acute esophagogastric variceal bleeding.This study also highlights the latest progress in artificial intelligence in the diagnosis and treat-ment of portal hypertension and esophagogastric varices.
文摘Variceal bleed represents an important complication of cirrhosis,with its presence reflecting the severity of liver disease.Gastric varices,though less frequently seen than esophageal varices,present a distinct clinical challenge due to its higher intensity of bleeding and associated mortality.Based upon the Sarin classification,GOV1 is the most common subtype of gastric varices seen in clinical practice.
文摘The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.
基金Supported by the Guizhou Provincial Science and Technology Program,No.[2020]4Y004.
文摘BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONCLUSION For mild to moderate GOV1,patients with EBL had a greater one-time varix eradication rate,a greater 6-wk operation-related ulcer healing rate,a lower delayed rebleeding rate and a lower cost than patients with TAI.
文摘BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been established.CASE SUMMARY We reported three patients with jejunal varices at the site of choledochojejun-ostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023.We reviewed all patient records,clinical presentation,endoscopic findings and treatment,outcomes and follow-up.Three patients who underwent pancre-aticoduodenectomy with a Whipple anastomosis were examined using conven-tional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop.Varices with stigmata of recent hemorrhage or active he-morrhage were observed around the choledochojejunostomy site in all three patients.Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients.The bleeding ceased and patency was observed for 26 and 2 months in two patients.In one patient with multiorgan failure and internal environment disturbance,rebleeding occurred 1 month after endoscopic sclerotherapy,and despite a second endoscopic sclero-therapy,repeated episodes of bleeding and multiorgan failure resulted in eventual death.CONCLUSION We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoac-rylate injection can be an easy,effective,safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
基金Supported by Jinhua City Science and Technology Plan Project,China,No.2019-4-027.
文摘BACKGROUND Interventional endoscopic ultrasound is clinically used for the treatment of isolated gastric varices(IGVs)owing to its precise visualization.CASE SUMMARY A 39-year-old man was diagnosed with a large IGV during a routine physical examination.Endoscopic ultrasonography showed gastric varices entwined with an artery,which greatly increased the difficulty of treatment.We successfully treated the patient with endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection.CONCLUSION Endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection was safe and effective for the treatment of an IGV entwined with an artery.
基金Supported by Hangzhou Agricultural and Social Development Research Guidance Project,No.20220919Y037.
文摘BACKGROUND The stent embedded in the esophageal mucosa is one of the complications after stenting for esophageal stricture.We present a case of stent adjustment with the aid of a transparent cap after endoscopic injection of an esophageal varices stent.CASE SUMMARY A 61-year-old male patient came to the hospital with discomfort of the chest after the stent implanted for the stenosis because of endoscopic injection of esophageal varices.The gastroscopy was performed,and the stent embedded into the esophageal mucosa.At first,we pulled the recycling line for shrinking the stent,however,the mucosa could not be removed from the stent.Then a forceps was performed to remove the mucosa in the stent,nevertheless,the bleeding form the mucosa was obvious.And then,we used a transparent cap to scrape the mucosa along the stent,and the mucosa were removed successfully without bleeding.CONCLUSION A transparent cap helps gastroscopy to remove the mucosa embedded in the stent after endoscopic injection of the esophageal varices stent.
文摘BACKGROUND Liver cirrhosis is the end stage of progressive liver fibrosis as a consequence of chronic liver inflammation,wherein the standard hepatic architecture is replaced by regenerative hepatic nodules,which eventually lead to liver failure.Cirrhosis without any symptoms is referred to as compensated cirrhosis.Complications such as ascites,variceal bleeding,and hepatic encephalopathy indicate the onset of decompensated cirrhosis.Gastroesophageal varices are the hallmark of clini-cally significant portal hypertension.AIM To determine the accuracy of the platelet count-to-spleen diameter(PC/SD)ratio to evaluate esophageal varices(EV)in patients with cirrhosis.METHODS This retrospective observational study was conducted at Tikur Anbessa Specia-lized Hospital and Adera Medical Center from January 1,2019,to December 30,2023.Data were collected via chart review and direct patient interviews using structured questionnaires.The data were exported to the SPSS software version 26 for analysis and clearance.A receiver operating characteristic curve was plotted for splenic diameter,platelet count,and PC/SD ratio to obtain sensitivity,speci-ficity,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio.RESULTS Of the 140 participants,67%were men.Hepatitis B(38%)was the most common cause of cirrhosis,followed by cryptogenic cirrhosis(28%)and hepatitis C(16%).Approximately 83.6%of the participants had endoscopic evidence of EV,whereas 51.1%had gastric varices.Decompensated cirrhosis and PC were associated with the presence of EV with adjusted odds ratios of 12.63(95%CI:3.16-67.58,P=0.001)and 0.14(95%CI:0.037-0.52,P=0.004),respectively.A PC/SD ratio<1119 had a sensitivity of 86.32%and specificity of 70%with area under the curve of 0.835(95%CI:0.736-0.934,P<0.001).CONCLUSION A PC/SD ratio<1119 predicts EV in patients with cirrhosis.It is a valuable,noninvasive tool for EV risk assess-ment in resource-limited settings.
文摘The Baveno VII consensus,released in 2023,recommends that the endoscopic treatment of choice for managing bleeding gastric varices(GV)is endoscopic ultrasound(EUS)-guided treatment,specifically EUS-guided cyanoacrylate(CYA)glue injection.This approach has been endorsed due to its efficacy in controlling bleeding while reducing rebleeding rates,compared to other endoscopic techniques.Despite its efficacy,CYA injection for GV has been linked to rare but serious adverse events,such as glue embolization leading to pulmonary embolism,infection/bacteremia,splenic infarction,intra-procedural and post-procedural complications.The technique for endoscopic obliteration of GV was subsequently refined using EUS guidance,aiming to more accurately direct the injection into the varix,reduce the volume of injected glue,target the perforating vein when possible,and confirm obliteration of GV via Doppler examination.
文摘BACKGROUND Esophageal stricture is one of the complications after esophageal varices sclero-therapy injection(ESI),and the incidence rate is between 2%-10%.AIM To explore the efficacy of self-expanding metal stent(SEMS)for the stricture after endoscopic injection with cyanoacrylate(CYA)and sclerotherapy for esophageal varices.METHODS We retrospectively analyzed the efficacy of SEMS to improve the stricture after endoscopic injection with CYA and sclerotherapy for esophageal varices in 4 patients from February 2023 to June 2023.RESULTS The strictures were improved in four patients after stenting.The stent was removed after two weeks because of chest pain with embedding into esophageal mucosa in one patient.The stent was removed after one month,however,the stent was reinserted because of the strictures happening again in two patients.The stent was removed after three months,however,the stent was reinserted because of the strictures happening again in one patient.The stent embedded into esophageal mucosa in three patients.There were 3 patients suffered reflux esophagitis,and the acid reflux was relieved by taking hydrotalcite.There was no other complication of esophageal perforation,bleeding from varices or infection.CONCLUSION SEMS may relieve the stricture which happened after endoscopic injection with CYA and sclerotherapy for esophageal varices.However,when we should remove the stent still needs to be explored.
文摘Rectal varices are an uncommon manifestation of portal hypertension.Although hemorrhoids can be seen in cirrhotic patients,distinguishing between rectal varices and hemorrhoids can be challenging.Furthermore,the underlying mechanism and treatment options vary.Hence,the correct identification is of utmost important.Through this letter,we highlight the features of both and listed the distinguishing points between the two etiologies.
文摘BACKGROUND To avoid acute variceal bleeding in cirrhosis,current guidelines recommend screening for high-risk esophageal varices(EVs)by determining variceal size and identifying red wale markings.However,visual measurements of EV during routine endoscopy are often inaccurate.AIM To determine whether biopsy forceps(BF)could be used as a reference to improve the accuracy of binary classification of variceal size.METHODS An in vitro self-made EV model with sizes ranging from 2 to 12 mm in diameter was constructed.An online image-based survey comprising 11 endoscopic images of simulated EV without BF and 11 endoscopic images of EV with BF was assembled and sent to 84 endoscopists.The endoscopists were blinded to the actual EV size and evaluated the 22 images in random order.RESULTS The respondents included 48 academic and four private endoscopists.The accuracy of EV size estimation was low in both the visual(13.81%)and BF-based(20.28%)groups.The use of open forceps improved the ability of the endoscopists to correctly classify the varices by size(small≤5 mm,large>5 mm)from 71.85%to 82.17%(P<0.001).CONCLUSION BF may improve the accuracy of EV size assessment,and its use in clinical practice should be investigated.
文摘With increasing burden of compensated cirrhosis,we desperately need noninvasive methods for assessment of clinically significant portal hypertension.The use of liver and spleen stiffness measurement helps in deferring unnecessary endoscopies for low risk esophageal varices.This would reduce cost and patient discomfort.However,these special techniques may not be feasible at remote areas where still we need only biochemical parameters.More prospective studies validating the non-invasive risk prediction models are definitely needed.
文摘Background: upper digestive endoscopy is the best method for detecting esophageal varices, but its invasiveness and cost make it inaccessible to certain social classes. Aim: to evaluate the performance of non-invasive methods for the presumptive diagnosis of esophageal varices in cirrhotic patients in Togo. Patients and method: this was a cross-sectional descriptive and analytical retrospective data collection conducted over 2 years. It included medical records of cirrhotic patients hospitalized in the Hepato-gastroenterology who undergone transaminase assay, blood count, abdominal ultrasound and an upper GI endoscopy. Results: A total of 114 patients were included, 84 of them were men (sex ratio: 2.8). The mean age of patients was 48±14 years. The most frequent reason for admission was abdominal distension (86%). According to the Child-Pugh classification, cirrhosis was decompensated in 109 patients (95.6%). Esophageal varices were present in 71.1% of patients. At a cutoff value of 110 mm for spleen diameter, the sensitivity for prediction of esophageal esophageal varices was 70.4%, with an area under the ROC curve of 0.63. The areas under the ROC curve for prediction of esophageal varices were 0.27;0.29;0.29 respectively for platelet count, platelet/spleen diameter ratio and the [platelets²/spleen diameter] x AST level. A low [platelets²/spleen diameter] x AST level ratio correlated with the presence of esophageal varices at endoscopy. Conclusion: Spleen diameter is a performant non-invasive tool for the prediction of esophageal varices.
