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 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
To assess“predictors”of esophageal varices(EV)and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis.METHODSOne hundred thirty-nine newly diagnosed cirrhotic patients wi...To assess“predictors”of esophageal varices(EV)and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis.METHODSOne hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis.Model for end-stage liver disease(MELD),aspartate aminotransferase(AST)to alanine aminotransferase(ALT)ratio(AST/ALT),AST to platelet ratio index(APRI),platelet count to spleen diameter(PC/SD),fibrosis-4-index(FIB-4),fibrosis index(FI)and King’s Score were measured for all participants.All patients underwent endoscopic assessment within two days of hospitalization.The major end point was the first esophageal variceal bleeding(EVB)event.The diagnostic performance of“predictors”for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure.RESULTSFIB-4 was the only strong and significant“predictor”of esophageal varices(multivariable-adjusted OR=1.57 for one unit increment;95%CI:1.15-2.14).Furthermore,a cut-off value of 3.23 for FIB-4 was a significant predictor of esophageal varices,with a sensitivity of 72%,a specificity of 58%and a proportion of area under the curve(AUC)of 66%(P=0.01).During the follow-up(median:31.5 mo;interquartile range:11-59 mo),34 patients(24%)experienced a first EVB.FIB-4 was a poor predictor of EVB(the AUC was only 51%)for a cut-off value of 5.02.Furthermore,the AUC of AST/ALT,APRI,PC/SD,FI,MELD and King’s Score ranged from 45%to 55%.None of the non-invasive markers turned out to be a useful predictor of EVB.CONCLUSIONDespite the low diagnostic accuracy,FIB-4 appears the most efficient non-invasive liver fibrosis marker which can be used as an initial screening tool for cirrhotic patients.展开更多
AIM： To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding. METHODS： Twenty-four patients （15 males, 9 females） with gastric variceal bleedi...AIM： To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding. METHODS： Twenty-four patients （15 males, 9 females） with gastric variceal bleeding underwent endoscopic treatment with cyanoacrylate injection. Successful hemostasis, rebleeding rate, and complications were retrospectively reviewed. Followed up endoscopy was performed and repeat cyanoacrylate injection was given until gastric varices were obliterated. RESULTS： Seventeen patients achieved definite hemostasis. Of these, 14 patients had primary success after initial endoscopic therapy. Ten patients developed recurrent bleeding. Repeated cyanoacrylate injection stopped rebleeding in three patients. Transjugular intrahepatic portosystemic shunt （TIPS） was performed to control rebleeding in one patient which occured after repeat endoscopic therapy. Six patients died （three from uncontrolled bleeding, two from sepsis, and one from mesenteric vein thrombosis）. Minor complications occurred in 11 patients （six epigastric discomfort and five post injection ulcers）. Cyanoacrylate embolism developed in two patients. One of these patients died from mesenteric vein thrombosis. The other had pulmonary embolism which resolved spontaneously. Advanced drrhosis and hepatocellular carcinoma （HCC） were major risk factors for uncontrolled bleeding. CONCLUSION： Endoscopic treatment for bleeding gastric varices with cyanoacrylate injection is effective for immediate hemostasis. Repeat cyanoacrylate injection has a lower success rate than the initial injection. Cyanoacrylate embolism is not a common serious complication.展开更多
BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized p...BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.展开更多
BACKGROUND Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension,most commonly caused by cirrhosis of various etiologies.Although a considerable body of research has been condu...BACKGROUND Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension,most commonly caused by cirrhosis of various etiologies.Although a considerable body of research has been conducted in this area,the complexity of the disease and the lack of standardized treatment strategies have led to fragmented findings,insufficient information,and a lack of systematic investigation.Bibliometric analysis can help clarify research trends,identify core topics,and reveal potential future directions.Therefore,this study aims to use bibliometric methods to conduct an in-depth exploration of research progress in this field,with the expectation of providing new insights for both clinical practice and scientific research.AIM To evaluate research trends and advancements in esophagogastric variceal bleeding(EGVB)over the past twenty years.METHODS Relevant publications on EGVB were retrieved from the Web of Science Core Collection.VOSviewer,Pajek,CiteSpace,and the bibliometrix package were then employed to perform bibliometric visualizations of publication volume,countries,institutions,journals,authors,keywords,and citation counts.RESULTS The analysis focused on original research articles and review papers.From 2004 to 2023,a total of 2097 records on EGVB were retrieved.The number of relevant publications has increased significantly over the past two decades,especially in China and the United States.The leading contributors in this field,in terms of countries,institutions,authors,and journals,were China,Assistance Publique-Hôpitaux de Paris,Bosch Jaime,and World Journal of Gastroenterology,respectively.Core keywords in this field include portal hypertension,management,liver cirrhosis,risk,prevention,and diagnosis.Future research directions may focus on optimizing diagnostic methods,personalized treatment,and multidisciplinary collaboration.CONCLUSION Using bibliometric methods,this study reveals the developmental trajectory and trends in research on EGVB,underscoring risk assessment and diagnostic optimization as the core areas of current focus.The study provides an innovative and systematic perspective for this field,indicating that future research could center on multidisciplinary collaboration,personalized treatment approaches,and the development of new diagnostic tools.Moreover,this work offers practical research directions for both the academic community and clinical practice,driving continued advancement in this domain.展开更多
BACKGROUND Acute variceal bleeding(AVB)represents a life-threatening complication in hepatocellular carcinoma(HCC)patients undergoing systemic therapy,mainly including immune checkpoint inhibitors(ICIs)and antivascula...BACKGROUND Acute variceal bleeding(AVB)represents a life-threatening complication in hepatocellular carcinoma(HCC)patients undergoing systemic therapy,mainly including immune checkpoint inhibitors(ICIs)and antivascular drugs used alone or in combination.The pathogenesis of AVB in this population may involve tumor-related factors,treatment-induced effects,or progression of underlying portal hypertension.Identifying high-risk factors for AVB is crucial for the management of this patient population.AIM To develop and validate a risk prediction model for AVB occurrence in cirrhotic HCC patients receiving ICI-based systemic therapy.METHODS This retrospective study analyzed 286 HCC patients(2021-2022)receiving ICIs(mono-/combination therapy),randomly split into training(n=184)and validation(n=102)cohorts.In the training cohort,bleeding vs nonbleeding groups were compared for general information,etiological data,laboratory indicators,tumor staging,systemic treatment drugs,variceal bleeding history,and endoscopic treatment history.Risk factors for AVB were identified and used to establish a logistic regression model for predicting bleeding,which was further validated in the validation cohort.RESULTS The bleeding group had significantly higher proportions of patients with platelet count≥100×10^(9)/L,alphafetoprotein≥400 ng/mL,tumor diameter≥5 cm,portal vein tumor thrombosis,ascites,bleeding history,prior endoscopic treatment,albumin-bilirubin grade level 2-3,fibrosis-4 index(FIB-4)≥4.57,and prognostic nutritional index<45 compared to the non-bleeding group.Multivariate analysis identified tumor diameter≥5 cm,portal vein thrombosis,bleeding history,and elevated FIB-4 as independent risk factors for bleeding(P<0.05).A predictive model based on these factors showed good discrimination,with area under the receiver operating characteristic curve values of 0.861(training)and 0.816(validation).CONCLUSION A history of pre-ICI bleeding significantly increases recurrent bleeding risk,necessitating close monitoring.The FIB-4 fibrosis model,combined with tumor features,can also serve as a predictive factor for bleeding.展开更多
A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic...A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.展开更多
BACKGROUND Globally,Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.AIM To investigate the effects of a multidisciplinary collaboration model on postoperative recovery...BACKGROUND Globally,Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.AIM To investigate the effects of a multidisciplinary collaboration model on postoperative recovery and psychological stress in patients with liver cirrhosis undergoing esophageal variceal bleeding(EVB)surgery within an integrated healthcare system.METHODS Between January 2022 and March 2024,a total of 180 patients with cirrhosis and EVB were admitted and randomly assigned to either a control group(standard care)or an observation group(standard care plus the multidisciplinary collaboration model),with 90 patients in each group.Postoperative recovery indicators(time to symptom improvement,time to start eating,time to bowel sound recovery,time to first flatus,and hospital stay),psychological stress responses[selfrating anxiety scale(SAS);self-rating depression scale(SDS)],subjective wellbeing,and incidence of complications were compared between the two groups.RESULTS Compared to the control group,the observation group showed earlier symptom improvement,earlier return to eating,bowel sound recovery,first flatus,and a shorter hospital stay.Pre-intervention SAS and SDS scores were not significantly different between the groups,but post-intervention scores were significantly lower in the observation group.Similarly,there was no significant difference in the subjective well-being scores before the intervention between the two groups.After the intervention,both groups showed improved scores,with the observation group scoring significantly higher than the control group.CONCLUSION The observation group also had a lower incidence of complications.Therefore,for patients with liver cirrhosis undergoing EVB surgery,a multidisciplinary collaboration model within an integrated healthcare system can promote early postoperative recovery,reduces psychological stress,improves subjective well-being,and reduces complications and rebleeding.展开更多
BACKGROUND Acute variceal bleeding(AVB)in patients with cirrhosis remains life-threatening;moreover,the current risk stratification methods have certain limitations.Rebleeding and mortality after AVB remain major chal...BACKGROUND Acute variceal bleeding(AVB)in patients with cirrhosis remains life-threatening;moreover,the current risk stratification methods have certain limitations.Rebleeding and mortality after AVB remain major challenges.Although preemptive transjugular intrahepatic portosystemic shunt(p-TIPS)can improve outcomes,not all patients benefit equally.Accurate risk stratification is needed to guide treatment decisions and identify those most likely to benefit from p-TIPS.AIM To develop an artificial intelligence(AI)-driven model to guide AVB treatment decisions,and identify candidates eligible for p-TIPS.METHODS Patients with cirrhosis and AVB,from two multicenter retrospective cohorts in China,who received endoscopic variceal ligation plus pharmacotherapy(n=1227)or p-TIPS(n=1863)were included.Baseline data within 24 hours of hospital admission were obtained.The AI-AVB model,based on the six-week failure and one-year mortality rates,was developed to predict treatment efficacy and compared with standard risk scores.Outcomes and adverse events of the treatments were compared across the high-and low-risk subgroups stratified using the AI-AVB model.RESULTS The AI-AVB model demonstrated superior predictive performance compared to traditional risk stratification methods.In the internal validation cohort,the model achieved an area under the curve(AUC)of 0.842 for predicting six-week treatment failure and 0.954 for one-year mortality.In the external validation cohort,the AUCs were 0.814 and 0.889,respectively.The model effectively identified patients at high risk of first-line treatment failure who may benefit from aggressive interventions such as p-TIPS.In contrast,advancing the treatment strategy for low-risk patients did not notably improve the short-term prognosis.CONCLUSION The AI-AVB model can predict treatment outcomes,stratify the failure risk in cirrhotic patients with AVB,aid in clinical decisions,identify p-TIPS beneficiaries,and optimize personalized treatment strategies.展开更多
BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establ...BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establish a diagnostic nomogram.METHODS Patients with liver cirrhosis who met the inclusion criteria were randomly divided into training and validation cohorts in a 6:4 ratio in this retrospective research.Univariate analysis,least absolute shrinkage and selection operator regression,and multivariate analysis were employed to establish the nomogram model.Calibration curve,the area under the receiver operating characteristic curve(AUC),and decision curve analysis(DCA)were applied to assess the discrimination,accuracy,and clinical practicability of the nomogram,respectively.RESULTS A total of 1115 patients were enrolled in this study.The nomogram was established based on white blood cells(P<0.001),hemoglobin(P<0.001),fibrinogen(P<0.001),total bilirubin(P=0.007),activated partial thromboplastin time(P=0.002),total bile acid(P=0.012),and ascites(P=0.006).The calibration curve indicated that the actual observation results were in good agreement with the prediction results of the model.The AUC values of the diagnostic model were 0.861 and 0.859 in the training and validation cohorts,respectively,which were higher than that of the aspartate aminotransferase-to-platelet ratio index,fibrosis index based on 4 factors,and aspartate aminotransferase-to-alanine aminotransferase ratio.Additionally,DCA indicated that the net benefit value of the model was higher than that of the other models.CONCLUSION This research constructed and validated a nomogram with perfect performance for predicting EGVB events in patients with liver cirrhosis,which could help clinicians with timely diagnosis,individualized treatment,and follow-up.展开更多
BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain uncle...BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain unclear.AIM To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.METHODS We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023.The primary outcome was overall survival(OS).RESULTS A total of 37 patients with AVB underwent early TIPS,while 65 patients received standard treatment.Compared with the standard treatment group,the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower(10.8%vs 50.8%,P<0.001).Over a median follow-up of 46 months,no statistically significant differences were observed in terms of OS(P=0.507).The presence of comorbidities was identified as an independent predictor of OS(adjusted hazard ratio=3.81;95%confidence interval:1.16-12.46).Notably,new or worsening ascites occurred less frequently in the early TIPS group(13.5%vs 38.5%,P=0.008).There was no significant difference in the rate of overt hepatic encephalopathy between the two groups(45.9%vs 36.9%,P=0.372).CONCLUSION While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB,it is associated with reduced risks of rebleeding and ascites.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal pressure and preventing rebleeding,TIPS is associated with a considerable risk of overt hepatic encephalopathy(OHE),a complication that significantly elevates mortality rates.AIM To develop a machine learning(ML)model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset.METHODS This retrospective single-center study included 218 patients with AVB who underwent TIPS.The dataset was divided into training(70%)and testing(30%)sets.Critical features were identified using embedded methods and recursive feature elimination.Three ML algorithms-random forest,extreme gradient boosting,and logistic regression-were validated via 10-fold cross-validation.SHapley Additive exPlanations analysis was employed to interpret the model’s predictions.Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival(OS)between patients with and without OHE.RESULTS The median OS of the study cohort was 47.83±22.95 months.Among the models evaluated,logistic regression demonstrated the highest performance with an area under the curve(AUC)of 0.825.Key predictors identified were Child-Pugh score,age,and portal vein thrombosis.Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS(P=0.005).The 5-year survival rate was 78.4%,with an OHE incidence of 15.1%.Both actual OHE status and predicted OHE value were significant predictors in each Cox model,with model-predicted OHE achieving an AUC of 88.1 in survival prediction.CONCLUSION The ML model accurately predicts post-TIPS OHE and outperforms traditional models,supporting its use in improving outcomes in patients with AVB.展开更多
BACKGROUND Esophageal-gastro varices bleeding(EGVB)is the most widely known cause of mortality in individuals with cirrhosis,with an occurrence rate of 5%to 15%.Among them,gastric varices bleeding(GVB)is less frequent...BACKGROUND Esophageal-gastro varices bleeding(EGVB)is the most widely known cause of mortality in individuals with cirrhosis,with an occurrence rate of 5%to 15%.Among them,gastric varices bleeding(GVB)is less frequent than esophageal varices bleeding(EVB),but the former is a more critical illness and has a higher mortality rate.At present,endoscopic variceal histoacryl injection therapy(EVHT)is safe and effective,and it has been recommended by relevant guidelines as the primary method for the treatment of GVB.However,gastric varices after endoscopic treatment still have a high rate of early rebleeding,which is mainly related to complications of its treatment,such as bleeding from drained ulcers,rebleeding of varices etc.Therefore,preventing early postoperative rebleeding is very important to improve the quality of patient survival and outcomes.AIM To assess the efficacy of aluminium phosphate gel(APG)combined with proton pump inhibitor(PPI)in preventing early rebleeding after EVHT in individuals with GVB.METHODS Medical history of 196 individuals with GVB was obtained who were diagnosed using endoscopy and treated with EVHT in Shenzhen People's Hospital from January 2016 to December 2021.Based on the selection criteria,101 patients were sorted into the PPI alone treatment group,and 95 patients were sorted into the PPI combined with the APG treatment group.The incidences of early rebleeding and corresponding complications within 6 wk after treatment were compared between both groups.Statistical methods were performed by two-sample t-test,Wilcoxon rank sum test andχ2 test.RESULTS No major variations were noted between the individuals of the two groups in terms of age,gender,Model for End-Stage Liver Disease score,coagulation function,serum albumin,hemoglobin,type of gastric varices,the dose of tissue glue injection and EV that needed to be treated simultaneously.The early rebleeding rate in PPI+APG group was 3.16%(3/95),which was much lower than that in the PPI group(12.87%,13/101)(P=0.013).Causes of early rebleeding:the incidence of gastric ulcer bleeding in the PPI+APG group was 2.11%(2/95),which was reduced in comparison to that in the PPI group(11.88%,12/101)(P=0.008);the incidence of venous bleeding in PPI+APG group and PPI group was 1.05%(1/95)and 0.99%(1/101),respectively,and there was no significant difference between them(0.999).The early mortality rate was 0 in both groups within 6 wk after the operation,and the low mortality rate was related to the timely hospitalization and active treatment of all patients with rebleeding.The overall incidence of complications in the PPI+APG group was 12.63%(12/95),which was not significantly different from 13.86%(14/101)in the PPI group(P=0.800).of abdominal pain in the PPI+APG group was 3.16%(3/95),which was lower than that in the PPI group(11.88%,12/101)(P=0.022).However,due to aluminum phosphate gel usage,the incidence of constipation in the PPI+APG group was 9.47%(9/95),which was higher than that in the PPI group(1.98%,2/101)(P=0.023),but the health of the patients could be improved by increasing drinking water or oral lactulose.No patients in either group developed spontaneous peritonitis after taking PPI,and none developed hepatic encephalopathy and ectopic embolism within 6 wk of EVHT treatment.CONCLUSION PPI combined with APG can significantly reduce the incidence of early rebleeding and postoperative abdominal pain in cirrhotic patients with GVB after taking EVHT.展开更多
Digestive hemorrhage by rupture of esophageal Varices is common and has a pejorative prognosis in our context. <strong>Purpose:</strong> The main purpose of this work was to study the digestive bleeding by...Digestive hemorrhage by rupture of esophageal Varices is common and has a pejorative prognosis in our context. <strong>Purpose:</strong> The main purpose of this work was to study the digestive bleeding by esophageal varices and prognosis value of blood transfusion in the Hospital of Gabriel Touré. <strong>Methodology:</strong> It was a prospective study that took place in the service of Hepato-gastroenterology of Gabriel Touré Hospital from June 2016 to May 2017 and from November 2017 to August 2018. <strong>Results:</strong> At the end of the study, 77 patients met the inclusion criteria out of 1396 patients hospitalized during the same period. Varices bleeding represented a prevalence of 5.5% among hospitalized patients during the same period. The average age of our patients was 46.58 ± 15.09 years. The male sex was more reported in our study with a prevalence of 67.5%. At admission, 63.2% had clinical anemia, 58.4% low arterial pressure and 50.6% hemoglobin rate less than 7 g/dL. Blood transfusion was indicated in 47 patients (61%). The mortality rate was 23.4% and was comparable in both groups (p = 0.0990). Early rebleeding was significantly observed in the case of transfusion (p = 0.0452). Hepatic encephalopathy was the leading cause of death of our patients with 72.2%. <strong>Conclusion:</strong> Digestive bleeding by esophageal varices is a worsen complication in cirrhosis in hospital setting. Transfusion has not significantly improved the prognosis of our patients.展开更多
BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or ga...BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.展开更多
Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or largesized varices can be treated for primary prophylaxis of va...Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or largesized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers(NSBBs) or endoscopic variceal ligation(EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt(TIPS) with polytetrafluoroethylene(PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred option in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompanying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclusion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events.展开更多
AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or...AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.RESULTS: The incidence of early rebleeding after EVL was 7.60%,and the morbidity of rebleeding was 26.9%.Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83,95% CI: 9.39-420.56,P < 0.001],the number of bands placed (OR 17.36,95% CI: 4.00-75.34,P < 0.001),the extent of varices (OR 15.41,95% CI: 2.84-83.52,P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35,95% CI: 1.93-66.70,P = 0.007).CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites,number of rubber bands used to ligate,severity of varices and prolonged PT.Effective measures for prevention and treatment should be adopted before and after EVL.展开更多
Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial ...Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection.However,mortality from variceal bleeding is largely determined by the severity of liver disease.Besides a higher Child-Pugh score,patients with hepatocellular carcinoma are particularly susceptible to infections.Despite several hypotheses that include increased use of instruments,greater risk of aspiration pneumonia and higher bacterial translocation,it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis.Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures,but more recently,gram positives and quinolone-resistant organisms are increasingly seen,even though their clinical significance is unclear.Fluoroquinolones(including ciprofloxacin and norfloxacin)used for short term(7 d)have the most robust evidence and are recommended in most expert guidelines.Short term intravenous cephalosporin(especially ceftriaxone),given in a hospital setting with prevalent quinolone-resistant organisms,has been shown in studies to be beneficial,particularly in high risk patients with advanced cirrhosis.展开更多
BACKGROUND Esophagogastric variceal bleeding(EGVB)is a serious complication of patients with decompensated cirrhosis and is associated with high mortality and morbidity.Early diagnosis and screening of cirrhotic patie...BACKGROUND Esophagogastric variceal bleeding(EGVB)is a serious complication of patients with decompensated cirrhosis and is associated with high mortality and morbidity.Early diagnosis and screening of cirrhotic patients at risk for EGVB is crucial.Currently,there is a lack of noninvasive predictive models widely available in clinical practice.AIM To develop a nomogram based on clinical variables and radiomics to facilitate the noninvasive prediction of EGVB in cirrhotic patients.METHODS A total of 211 cirrhotic patients hospitalized between September 2017 and December 2021 were included in this retrospective study.Patients were divided into training(n=149)and validation(n=62)groups at a 7:3 ratio.Participants underwent three-phase computed tomography(CT)scans before endoscopy,and radiomic features were extracted from portal venous phase CT images.The independent sample t-test and least absolute shrinkage and selection operator logistic regression were used to screen out the best features and establish a radiomics signature(RadScore).Univariate and multivariate analyses were performed to determine the independent predictors of EGVB in clinical settings.A noninvasive predictive nomogram for the risk of EGVB was built using independent clinical predictors and RadScore.Receiver operating characteristic,calibration,clinical decision,and clinical impact curves were applied to evaluate the model’s performance.RESULTS Albumin(P=0.001),fibrinogen(P=0.001),portal vein thrombosis(P=0.002),aspartate aminotransferase(P=0.001),and spleen thickness(P=0.025)were selected as independent clinical predictors of EGVB.RadScore,constructed with five CT features of the liver region and three of the spleen regions,performed well in training(area under the receiver operating characteristic curve(AUC)=0.817)as well as in validation(AUC=0.741)cohorts.There was excellent predictive performance in both the training and validation cohorts for the clinical-radiomics model(AUC=0.925 and 0.912,respectively).Compared with the existing noninvasive models such as ratio of aspartate aminotransferase to platelets and Fibrosis-4 scores,our combined model had better predictive accuracy with the Delong's test less than 0.05.The Nomogram had a good fit in the calibration curve(P>0.05),and the clinical decision curve further supported its clinical utility.CONCLUSION We designed and validated a clinical-radiomics nomogram able to noninvasively predict whether cirrhotic patients will develop EGVB,thus facilitating early diagnosis and treatment.展开更多
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 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.
文摘To assess“predictors”of esophageal varices(EV)and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis.METHODSOne hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis.Model for end-stage liver disease(MELD),aspartate aminotransferase(AST)to alanine aminotransferase(ALT)ratio(AST/ALT),AST to platelet ratio index(APRI),platelet count to spleen diameter(PC/SD),fibrosis-4-index(FIB-4),fibrosis index(FI)and King’s Score were measured for all participants.All patients underwent endoscopic assessment within two days of hospitalization.The major end point was the first esophageal variceal bleeding(EVB)event.The diagnostic performance of“predictors”for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure.RESULTSFIB-4 was the only strong and significant“predictor”of esophageal varices(multivariable-adjusted OR=1.57 for one unit increment;95%CI:1.15-2.14).Furthermore,a cut-off value of 3.23 for FIB-4 was a significant predictor of esophageal varices,with a sensitivity of 72%,a specificity of 58%and a proportion of area under the curve(AUC)of 66%(P=0.01).During the follow-up(median:31.5 mo;interquartile range:11-59 mo),34 patients(24%)experienced a first EVB.FIB-4 was a poor predictor of EVB(the AUC was only 51%)for a cut-off value of 5.02.Furthermore,the AUC of AST/ALT,APRI,PC/SD,FI,MELD and King’s Score ranged from 45%to 55%.None of the non-invasive markers turned out to be a useful predictor of EVB.CONCLUSIONDespite the low diagnostic accuracy,FIB-4 appears the most efficient non-invasive liver fibrosis marker which can be used as an initial screening tool for cirrhotic patients.
文摘AIM： To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding. METHODS： Twenty-four patients （15 males, 9 females） with gastric variceal bleeding underwent endoscopic treatment with cyanoacrylate injection. Successful hemostasis, rebleeding rate, and complications were retrospectively reviewed. Followed up endoscopy was performed and repeat cyanoacrylate injection was given until gastric varices were obliterated. RESULTS： Seventeen patients achieved definite hemostasis. Of these, 14 patients had primary success after initial endoscopic therapy. Ten patients developed recurrent bleeding. Repeated cyanoacrylate injection stopped rebleeding in three patients. Transjugular intrahepatic portosystemic shunt （TIPS） was performed to control rebleeding in one patient which occured after repeat endoscopic therapy. Six patients died （three from uncontrolled bleeding, two from sepsis, and one from mesenteric vein thrombosis）. Minor complications occurred in 11 patients （six epigastric discomfort and five post injection ulcers）. Cyanoacrylate embolism developed in two patients. One of these patients died from mesenteric vein thrombosis. The other had pulmonary embolism which resolved spontaneously. Advanced drrhosis and hepatocellular carcinoma （HCC） were major risk factors for uncontrolled bleeding. CONCLUSION： Endoscopic treatment for bleeding gastric varices with cyanoacrylate injection is effective for immediate hemostasis. Repeat cyanoacrylate injection has a lower success rate than the initial injection. Cyanoacrylate embolism is not a common serious complication.
基金Supported by National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.
基金Supported by the National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension,most commonly caused by cirrhosis of various etiologies.Although a considerable body of research has been conducted in this area,the complexity of the disease and the lack of standardized treatment strategies have led to fragmented findings,insufficient information,and a lack of systematic investigation.Bibliometric analysis can help clarify research trends,identify core topics,and reveal potential future directions.Therefore,this study aims to use bibliometric methods to conduct an in-depth exploration of research progress in this field,with the expectation of providing new insights for both clinical practice and scientific research.AIM To evaluate research trends and advancements in esophagogastric variceal bleeding(EGVB)over the past twenty years.METHODS Relevant publications on EGVB were retrieved from the Web of Science Core Collection.VOSviewer,Pajek,CiteSpace,and the bibliometrix package were then employed to perform bibliometric visualizations of publication volume,countries,institutions,journals,authors,keywords,and citation counts.RESULTS The analysis focused on original research articles and review papers.From 2004 to 2023,a total of 2097 records on EGVB were retrieved.The number of relevant publications has increased significantly over the past two decades,especially in China and the United States.The leading contributors in this field,in terms of countries,institutions,authors,and journals,were China,Assistance Publique-Hôpitaux de Paris,Bosch Jaime,and World Journal of Gastroenterology,respectively.Core keywords in this field include portal hypertension,management,liver cirrhosis,risk,prevention,and diagnosis.Future research directions may focus on optimizing diagnostic methods,personalized treatment,and multidisciplinary collaboration.CONCLUSION Using bibliometric methods,this study reveals the developmental trajectory and trends in research on EGVB,underscoring risk assessment and diagnostic optimization as the core areas of current focus.The study provides an innovative and systematic perspective for this field,indicating that future research could center on multidisciplinary collaboration,personalized treatment approaches,and the development of new diagnostic tools.Moreover,this work offers practical research directions for both the academic community and clinical practice,driving continued advancement in this domain.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-034AHebei Province 2025 Traditional Chinese Medicine Scientific Research Project Plan,No.T2025008.
文摘BACKGROUND Acute variceal bleeding(AVB)represents a life-threatening complication in hepatocellular carcinoma(HCC)patients undergoing systemic therapy,mainly including immune checkpoint inhibitors(ICIs)and antivascular drugs used alone or in combination.The pathogenesis of AVB in this population may involve tumor-related factors,treatment-induced effects,or progression of underlying portal hypertension.Identifying high-risk factors for AVB is crucial for the management of this patient population.AIM To develop and validate a risk prediction model for AVB occurrence in cirrhotic HCC patients receiving ICI-based systemic therapy.METHODS This retrospective study analyzed 286 HCC patients(2021-2022)receiving ICIs(mono-/combination therapy),randomly split into training(n=184)and validation(n=102)cohorts.In the training cohort,bleeding vs nonbleeding groups were compared for general information,etiological data,laboratory indicators,tumor staging,systemic treatment drugs,variceal bleeding history,and endoscopic treatment history.Risk factors for AVB were identified and used to establish a logistic regression model for predicting bleeding,which was further validated in the validation cohort.RESULTS The bleeding group had significantly higher proportions of patients with platelet count≥100×10^(9)/L,alphafetoprotein≥400 ng/mL,tumor diameter≥5 cm,portal vein tumor thrombosis,ascites,bleeding history,prior endoscopic treatment,albumin-bilirubin grade level 2-3,fibrosis-4 index(FIB-4)≥4.57,and prognostic nutritional index<45 compared to the non-bleeding group.Multivariate analysis identified tumor diameter≥5 cm,portal vein thrombosis,bleeding history,and elevated FIB-4 as independent risk factors for bleeding(P<0.05).A predictive model based on these factors showed good discrimination,with area under the receiver operating characteristic curve values of 0.861(training)and 0.816(validation).CONCLUSION A history of pre-ICI bleeding significantly increases recurrent bleeding risk,necessitating close monitoring.The FIB-4 fibrosis model,combined with tumor features,can also serve as a predictive factor for bleeding.
文摘A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.
文摘BACKGROUND Globally,Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.AIM To investigate the effects of a multidisciplinary collaboration model on postoperative recovery and psychological stress in patients with liver cirrhosis undergoing esophageal variceal bleeding(EVB)surgery within an integrated healthcare system.METHODS Between January 2022 and March 2024,a total of 180 patients with cirrhosis and EVB were admitted and randomly assigned to either a control group(standard care)or an observation group(standard care plus the multidisciplinary collaboration model),with 90 patients in each group.Postoperative recovery indicators(time to symptom improvement,time to start eating,time to bowel sound recovery,time to first flatus,and hospital stay),psychological stress responses[selfrating anxiety scale(SAS);self-rating depression scale(SDS)],subjective wellbeing,and incidence of complications were compared between the two groups.RESULTS Compared to the control group,the observation group showed earlier symptom improvement,earlier return to eating,bowel sound recovery,first flatus,and a shorter hospital stay.Pre-intervention SAS and SDS scores were not significantly different between the groups,but post-intervention scores were significantly lower in the observation group.Similarly,there was no significant difference in the subjective well-being scores before the intervention between the two groups.After the intervention,both groups showed improved scores,with the observation group scoring significantly higher than the control group.CONCLUSION The observation group also had a lower incidence of complications.Therefore,for patients with liver cirrhosis undergoing EVB surgery,a multidisciplinary collaboration model within an integrated healthcare system can promote early postoperative recovery,reduces psychological stress,improves subjective well-being,and reduces complications and rebleeding.
基金Supported by Key Research and Development Program of Jiangsu Province,No.BE2023767Xuzhou Key Research and Development Program under Grant,No.KC23273+1 种基金Affiliated Hospital of Xuzhou Medical University,No.2022ZL26Construction Project of High-Level Hospital of Jiangsu Province,No.GSPSJ20240802.
文摘BACKGROUND Acute variceal bleeding(AVB)in patients with cirrhosis remains life-threatening;moreover,the current risk stratification methods have certain limitations.Rebleeding and mortality after AVB remain major challenges.Although preemptive transjugular intrahepatic portosystemic shunt(p-TIPS)can improve outcomes,not all patients benefit equally.Accurate risk stratification is needed to guide treatment decisions and identify those most likely to benefit from p-TIPS.AIM To develop an artificial intelligence(AI)-driven model to guide AVB treatment decisions,and identify candidates eligible for p-TIPS.METHODS Patients with cirrhosis and AVB,from two multicenter retrospective cohorts in China,who received endoscopic variceal ligation plus pharmacotherapy(n=1227)or p-TIPS(n=1863)were included.Baseline data within 24 hours of hospital admission were obtained.The AI-AVB model,based on the six-week failure and one-year mortality rates,was developed to predict treatment efficacy and compared with standard risk scores.Outcomes and adverse events of the treatments were compared across the high-and low-risk subgroups stratified using the AI-AVB model.RESULTS The AI-AVB model demonstrated superior predictive performance compared to traditional risk stratification methods.In the internal validation cohort,the model achieved an area under the curve(AUC)of 0.842 for predicting six-week treatment failure and 0.954 for one-year mortality.In the external validation cohort,the AUCs were 0.814 and 0.889,respectively.The model effectively identified patients at high risk of first-line treatment failure who may benefit from aggressive interventions such as p-TIPS.In contrast,advancing the treatment strategy for low-risk patients did not notably improve the short-term prognosis.CONCLUSION The AI-AVB model can predict treatment outcomes,stratify the failure risk in cirrhotic patients with AVB,aid in clinical decisions,identify p-TIPS beneficiaries,and optimize personalized treatment strategies.
基金Supported by the National Natural Science Foundation of China,No.82270594the National Natural Science Foundation for Youths of China,No.82103151+1 种基金the Fundamental Research Funds for the Central Universities of Central South University,No.2022ZZTS0265the Graduate Research Innovation Project of Hunan Province,No.CX20220347.
文摘BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establish a diagnostic nomogram.METHODS Patients with liver cirrhosis who met the inclusion criteria were randomly divided into training and validation cohorts in a 6:4 ratio in this retrospective research.Univariate analysis,least absolute shrinkage and selection operator regression,and multivariate analysis were employed to establish the nomogram model.Calibration curve,the area under the receiver operating characteristic curve(AUC),and decision curve analysis(DCA)were applied to assess the discrimination,accuracy,and clinical practicability of the nomogram,respectively.RESULTS A total of 1115 patients were enrolled in this study.The nomogram was established based on white blood cells(P<0.001),hemoglobin(P<0.001),fibrinogen(P<0.001),total bilirubin(P=0.007),activated partial thromboplastin time(P=0.002),total bile acid(P=0.012),and ascites(P=0.006).The calibration curve indicated that the actual observation results were in good agreement with the prediction results of the model.The AUC values of the diagnostic model were 0.861 and 0.859 in the training and validation cohorts,respectively,which were higher than that of the aspartate aminotransferase-to-platelet ratio index,fibrosis index based on 4 factors,and aspartate aminotransferase-to-alanine aminotransferase ratio.Additionally,DCA indicated that the net benefit value of the model was higher than that of the other models.CONCLUSION This research constructed and validated a nomogram with perfect performance for predicting EGVB events in patients with liver cirrhosis,which could help clinicians with timely diagnosis,individualized treatment,and follow-up.
基金Supported by the Natural Science Foundation of the Science and Technology Commission of Shanghai Municipality,No.23ZR1458300the Key Discipline Project of Shanghai Municipal Health System,No.2024ZDXK0004the Doctoral Innovation Talent Base Project for Diagnosis and Treatment of Chronic Liver Diseases,No.RCJD2021B02.
文摘BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain unclear.AIM To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.METHODS We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023.The primary outcome was overall survival(OS).RESULTS A total of 37 patients with AVB underwent early TIPS,while 65 patients received standard treatment.Compared with the standard treatment group,the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower(10.8%vs 50.8%,P<0.001).Over a median follow-up of 46 months,no statistically significant differences were observed in terms of OS(P=0.507).The presence of comorbidities was identified as an independent predictor of OS(adjusted hazard ratio=3.81;95%confidence interval:1.16-12.46).Notably,new or worsening ascites occurred less frequently in the early TIPS group(13.5%vs 38.5%,P=0.008).There was no significant difference in the rate of overt hepatic encephalopathy between the two groups(45.9%vs 36.9%,P=0.372).CONCLUSION While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB,it is associated with reduced risks of rebleeding and ascites.
基金Natural Science Foundation of Guangdong Province,No.2024A1515013069.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal pressure and preventing rebleeding,TIPS is associated with a considerable risk of overt hepatic encephalopathy(OHE),a complication that significantly elevates mortality rates.AIM To develop a machine learning(ML)model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset.METHODS This retrospective single-center study included 218 patients with AVB who underwent TIPS.The dataset was divided into training(70%)and testing(30%)sets.Critical features were identified using embedded methods and recursive feature elimination.Three ML algorithms-random forest,extreme gradient boosting,and logistic regression-were validated via 10-fold cross-validation.SHapley Additive exPlanations analysis was employed to interpret the model’s predictions.Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival(OS)between patients with and without OHE.RESULTS The median OS of the study cohort was 47.83±22.95 months.Among the models evaluated,logistic regression demonstrated the highest performance with an area under the curve(AUC)of 0.825.Key predictors identified were Child-Pugh score,age,and portal vein thrombosis.Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS(P=0.005).The 5-year survival rate was 78.4%,with an OHE incidence of 15.1%.Both actual OHE status and predicted OHE value were significant predictors in each Cox model,with model-predicted OHE achieving an AUC of 88.1 in survival prediction.CONCLUSION The ML model accurately predicts post-TIPS OHE and outperforms traditional models,supporting its use in improving outcomes in patients with AVB.
基金Supported by Clinical Research and Cultivation Project of Shenzhen People's Hospital,No.SYLCYJ202116.
文摘BACKGROUND Esophageal-gastro varices bleeding(EGVB)is the most widely known cause of mortality in individuals with cirrhosis,with an occurrence rate of 5%to 15%.Among them,gastric varices bleeding(GVB)is less frequent than esophageal varices bleeding(EVB),but the former is a more critical illness and has a higher mortality rate.At present,endoscopic variceal histoacryl injection therapy(EVHT)is safe and effective,and it has been recommended by relevant guidelines as the primary method for the treatment of GVB.However,gastric varices after endoscopic treatment still have a high rate of early rebleeding,which is mainly related to complications of its treatment,such as bleeding from drained ulcers,rebleeding of varices etc.Therefore,preventing early postoperative rebleeding is very important to improve the quality of patient survival and outcomes.AIM To assess the efficacy of aluminium phosphate gel(APG)combined with proton pump inhibitor(PPI)in preventing early rebleeding after EVHT in individuals with GVB.METHODS Medical history of 196 individuals with GVB was obtained who were diagnosed using endoscopy and treated with EVHT in Shenzhen People's Hospital from January 2016 to December 2021.Based on the selection criteria,101 patients were sorted into the PPI alone treatment group,and 95 patients were sorted into the PPI combined with the APG treatment group.The incidences of early rebleeding and corresponding complications within 6 wk after treatment were compared between both groups.Statistical methods were performed by two-sample t-test,Wilcoxon rank sum test andχ2 test.RESULTS No major variations were noted between the individuals of the two groups in terms of age,gender,Model for End-Stage Liver Disease score,coagulation function,serum albumin,hemoglobin,type of gastric varices,the dose of tissue glue injection and EV that needed to be treated simultaneously.The early rebleeding rate in PPI+APG group was 3.16%(3/95),which was much lower than that in the PPI group(12.87%,13/101)(P=0.013).Causes of early rebleeding:the incidence of gastric ulcer bleeding in the PPI+APG group was 2.11%(2/95),which was reduced in comparison to that in the PPI group(11.88%,12/101)(P=0.008);the incidence of venous bleeding in PPI+APG group and PPI group was 1.05%(1/95)and 0.99%(1/101),respectively,and there was no significant difference between them(0.999).The early mortality rate was 0 in both groups within 6 wk after the operation,and the low mortality rate was related to the timely hospitalization and active treatment of all patients with rebleeding.The overall incidence of complications in the PPI+APG group was 12.63%(12/95),which was not significantly different from 13.86%(14/101)in the PPI group(P=0.800).of abdominal pain in the PPI+APG group was 3.16%(3/95),which was lower than that in the PPI group(11.88%,12/101)(P=0.022).However,due to aluminum phosphate gel usage,the incidence of constipation in the PPI+APG group was 9.47%(9/95),which was higher than that in the PPI group(1.98%,2/101)(P=0.023),but the health of the patients could be improved by increasing drinking water or oral lactulose.No patients in either group developed spontaneous peritonitis after taking PPI,and none developed hepatic encephalopathy and ectopic embolism within 6 wk of EVHT treatment.CONCLUSION PPI combined with APG can significantly reduce the incidence of early rebleeding and postoperative abdominal pain in cirrhotic patients with GVB after taking EVHT.
文摘Digestive hemorrhage by rupture of esophageal Varices is common and has a pejorative prognosis in our context. <strong>Purpose:</strong> The main purpose of this work was to study the digestive bleeding by esophageal varices and prognosis value of blood transfusion in the Hospital of Gabriel Touré. <strong>Methodology:</strong> It was a prospective study that took place in the service of Hepato-gastroenterology of Gabriel Touré Hospital from June 2016 to May 2017 and from November 2017 to August 2018. <strong>Results:</strong> At the end of the study, 77 patients met the inclusion criteria out of 1396 patients hospitalized during the same period. Varices bleeding represented a prevalence of 5.5% among hospitalized patients during the same period. The average age of our patients was 46.58 ± 15.09 years. The male sex was more reported in our study with a prevalence of 67.5%. At admission, 63.2% had clinical anemia, 58.4% low arterial pressure and 50.6% hemoglobin rate less than 7 g/dL. Blood transfusion was indicated in 47 patients (61%). The mortality rate was 23.4% and was comparable in both groups (p = 0.0990). Early rebleeding was significantly observed in the case of transfusion (p = 0.0452). Hepatic encephalopathy was the leading cause of death of our patients with 72.2%. <strong>Conclusion:</strong> Digestive bleeding by esophageal varices is a worsen complication in cirrhosis in hospital setting. Transfusion has not significantly improved the prognosis of our patients.
文摘BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.
文摘Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or largesized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers(NSBBs) or endoscopic variceal ligation(EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt(TIPS) with polytetrafluoroethylene(PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred option in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompanying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclusion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events.
文摘AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.RESULTS: The incidence of early rebleeding after EVL was 7.60%,and the morbidity of rebleeding was 26.9%.Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83,95% CI: 9.39-420.56,P < 0.001],the number of bands placed (OR 17.36,95% CI: 4.00-75.34,P < 0.001),the extent of varices (OR 15.41,95% CI: 2.84-83.52,P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35,95% CI: 1.93-66.70,P = 0.007).CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites,number of rubber bands used to ligate,severity of varices and prolonged PT.Effective measures for prevention and treatment should be adopted before and after EVL.
文摘Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection.However,mortality from variceal bleeding is largely determined by the severity of liver disease.Besides a higher Child-Pugh score,patients with hepatocellular carcinoma are particularly susceptible to infections.Despite several hypotheses that include increased use of instruments,greater risk of aspiration pneumonia and higher bacterial translocation,it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis.Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures,but more recently,gram positives and quinolone-resistant organisms are increasingly seen,even though their clinical significance is unclear.Fluoroquinolones(including ciprofloxacin and norfloxacin)used for short term(7 d)have the most robust evidence and are recommended in most expert guidelines.Short term intravenous cephalosporin(especially ceftriaxone),given in a hospital setting with prevalent quinolone-resistant organisms,has been shown in studies to be beneficial,particularly in high risk patients with advanced cirrhosis.
基金The study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University(No.2022-149).
文摘BACKGROUND Esophagogastric variceal bleeding(EGVB)is a serious complication of patients with decompensated cirrhosis and is associated with high mortality and morbidity.Early diagnosis and screening of cirrhotic patients at risk for EGVB is crucial.Currently,there is a lack of noninvasive predictive models widely available in clinical practice.AIM To develop a nomogram based on clinical variables and radiomics to facilitate the noninvasive prediction of EGVB in cirrhotic patients.METHODS A total of 211 cirrhotic patients hospitalized between September 2017 and December 2021 were included in this retrospective study.Patients were divided into training(n=149)and validation(n=62)groups at a 7:3 ratio.Participants underwent three-phase computed tomography(CT)scans before endoscopy,and radiomic features were extracted from portal venous phase CT images.The independent sample t-test and least absolute shrinkage and selection operator logistic regression were used to screen out the best features and establish a radiomics signature(RadScore).Univariate and multivariate analyses were performed to determine the independent predictors of EGVB in clinical settings.A noninvasive predictive nomogram for the risk of EGVB was built using independent clinical predictors and RadScore.Receiver operating characteristic,calibration,clinical decision,and clinical impact curves were applied to evaluate the model’s performance.RESULTS Albumin(P=0.001),fibrinogen(P=0.001),portal vein thrombosis(P=0.002),aspartate aminotransferase(P=0.001),and spleen thickness(P=0.025)were selected as independent clinical predictors of EGVB.RadScore,constructed with five CT features of the liver region and three of the spleen regions,performed well in training(area under the receiver operating characteristic curve(AUC)=0.817)as well as in validation(AUC=0.741)cohorts.There was excellent predictive performance in both the training and validation cohorts for the clinical-radiomics model(AUC=0.925 and 0.912,respectively).Compared with the existing noninvasive models such as ratio of aspartate aminotransferase to platelets and Fibrosis-4 scores,our combined model had better predictive accuracy with the Delong's test less than 0.05.The Nomogram had a good fit in the calibration curve(P>0.05),and the clinical decision curve further supported its clinical utility.CONCLUSION We designed and validated a clinical-radiomics nomogram able to noninvasively predict whether cirrhotic patients will develop EGVB,thus facilitating early diagnosis and treatment.
