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
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
Objective To evaluate the effect of Wuhuang Tongluo Formula(WTF)on rebleeding and its therapeutic and preventive effects in patients with liver cirrhosis and esophagogastric variceal bleeding(EGVB).Methods A total of ...Objective To evaluate the effect of Wuhuang Tongluo Formula(WTF)on rebleeding and its therapeutic and preventive effects in patients with liver cirrhosis and esophagogastric variceal bleeding(EGVB).Methods A total of 169 patients with cirrhotic EGVB were enrolled and assigned to a control group(74 cases)and an experimental group(95 cases)based on whether they received WTF.展开更多
Aims:The endoscopic treatment of esophagogastric varices is challenging,and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains uncl...Aims:The endoscopic treatment of esophagogastric varices is challenging,and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains unclear.This study investigated the use of endoscopic therapy for portal hypertension in China.Methods:This study used a questionnaire survey initiated by the Liver Health Consortium in China to investigate the use of endoscopic therapies for portal hypertension.Questionnaires were released online from January 30,2023 to February 28,2023 and filled out by chief physicians or senior instructors responsible for endoscopic therapies in participating hospitals across 31 provinces(autonomous regions and municipalities)in China.Comparisons of guideline adherence between primary and referral medical centers were performed using the chi‐square test or Fisher's exact test.Results:In total,836 hospitals participated in the survey.For primary and secondary prophylaxis of esophagogastric variceal bleeding(EGVB),adherence to the national guidelines was 72.5%(606/836)and 39.2%(328/836),respectively.Significant differences were observed in the rate of adherence between the primary and referral centers for primary(79.9%[111/139]vs.71.0%[495/697],p=0.033)and secondary prophylaxis(27.3%[38/139]vs.41.6%[290/697],p=0.002).Of the hospitals,78.2%(654/836)preferred endoscopic therapies for acute EGVB,and the timing of endoscopy was usually within 12 h(48.5%,317/654)and 12-24 h(36.9%,241/654)after bleeding.Endoscopic therapy was more likely to be the first choice of treatment for acute EGVB in referral centers than in primary centers(82.6%[576/697]vs.56.1%[78/139],p<0.001).Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1,the most prevalent procedures were cyanoacrylate injection combined with sclerotherapy(48.2%[403/836]and 29.9%[250/836],respectively);however,substantial hospitals preferred clip-assisted therapies(12.4%[104/836]and 26.4%[221/836],respectively).Nonselective beta‐blockers were routinely used in 73.4%(614/836)of hospitals during the perioperative period of EGVB management,and propranolol(88.8%,545/614)and carvedilol(37.5%,230/614)were the most widely used nonselective beta-blockers.Conclusions:This survey clarified that various endoscopic procedures have been implemented nationwide in China.Participating hospitals have actively performed emergent endoscopy for acute EGVB;however,these hospitals do not adequately follow recommendations regarding primary and secondary prophylaxis of EGVB.In the future,standardizing the selection of endoscopic procedures and improving compliance with guidelines is crucial.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
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 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 Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in China.Splenectomy plus pericardial devasculari...BACKGROUND Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in China.Splenectomy plus pericardial devascularization(SPD)and transjugular intrahepatic portosystemic shunt(TIPS)are effective treatments for EGVB.However,a comparison of the effectiveness and safety of those methods is lacking.AIM To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding(VRB)in patients with HBV-related cirrhosis combined with portal hypertension.METHODS This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during 2009-2013.Propensity score-matched analysis(PSM),the Kaplan-Meier method,and multivariate Cox regression analysis were used to compare overall survival,VRB rate,liver function abnormality rate,and hepatocellular carcinoma(HCC)incidence between the two patient groups.RESULTS The median age was 45.0 years(n=318;226(71.1%)males).During a median follow-up duration of 43.0 mo,18(11.1%)and 33(21.2%)patients died in the SPD and TIPS groups,respectively.After PSM,SPD was significantly associated with better overall survival(OS)(P=0.01),lower rates of abnormal liver function(P<0.001),and a lower incidence of HCC(P=0.02)than TIPS.The VRB rate did not differ significantly between the two groups(P=0.09).CONCLUSION Compared with TIPS,SPD is associated with higher postoperative OS rates,lower rates of abnormal liver function and HCC,and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal hypertension.There is no significant between-group difference in VRB rates.展开更多
BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features...BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.RESULTS The RC model yielded the best predictive performance and accurately predicted the EVB risk of patients with cirrhosis.Ascites,portal vein thrombosis,and plasma prothrombin time were identified as independent clinical risk factors.The area under the receiver operating characteristic curve(AUC)values for the RC model,Rad-score(liver+spleen+esophagus),Rad-score(liver),Rad-score(spleen),Rad-score(esophagus),and clinical model in the training cohort were 0.951,0.930,0.801,0.831,0.864,and 0.727,respectively.The corresponding AUC values in the validation cohort were 0.930,0.886,0.763,0.792,0.857,and 0.692.CONCLUSION In patients with cirrhosis,combined multi-organ radiomics and clinical model can be used to non-invasively predict the probability of the first secondary EVB.展开更多
BACKGROUND Whether hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)and acute esophagogastric variceal bleeding(EGVB)can improve the success rate of endoscopic hemostasis and overall survival(OS)from ...BACKGROUND Whether hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)and acute esophagogastric variceal bleeding(EGVB)can improve the success rate of endoscopic hemostasis and overall survival(OS)from transjugular intrahepatic portosystemic shunt(TIPS)remains controversial.AIM To compare the clinical outcomes between TIPS and standard treatment for such HCC patients.METHODS This monocenter,retrospective cohort study included patients diagnosed as HCC with PVTT and upper gastrointestinal bleeding.Patients were grouped by the treatment(TIPS or standard conservative treatment).The success rate of en-doscopic hemostasis,OS,rebleeding rates,and main causes of death were ana-lyzed.RESULTS Between July 2015 and September 2021,a total of 77 patients(29 with TIPS and 48 with standard treatment)were included.The success rate of endoscopic hemostasis was 96.6%in the TIPS group and 95.8%in the standard treatment group.All the 29 patients in TIPS group successful underwent TIPS procedure and had a better OS compared with standard treatment within the first 160 days after treatment(68 days vs 43 days,P=0.022),but shorter OS after 160 days(298 days vs 472 days, P = 0.022). Cheng’s Classification of PVTT, total bilirubin and Child-Pugh class wereindependently negative associated with OS (all P < 0.05). The main causes of death were liver failure or hepaticencephalopathy (75.9%) in the TIPS group and rebleeding (68.8%) in the standard treatment.CONCLUSIONTIPS could reduce the risk of early death due to rebleeding and prolong short-term survival in HCC patients withPVTT and acute EGVB, which deserves further investigation.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assiste...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.展开更多
We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopi...We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). He was then referred to our hospital. Abdominal computed tomography revealed a lowdensity lesion in the posterior segment of the liver and an intratumoral APS, which caused portal hypertension. Although the patient underwent EVL, EIS, Hassab’s operation, and transcatheter arterial embolization for APS, he vomited blood due to rupture of esophagogastric varices. Right hepatectomy was performed for the treatment of HCC and APS, although the indocyanine green retention value at 15 min after intravenous injection was poor (30%). The patient’s postoperative course was uneventful. Eventually, APS disappeared and the esophagogastric varices improved.展开更多
Background:Patients who survive initial esophagogastric variceal bleeding(EVB)are at an increased risk of recurrent bleeding and death;however,a reliable predictive model is lacking.We aimed to develop a model for reb...Background:Patients who survive initial esophagogastric variceal bleeding(EVB)are at an increased risk of recurrent bleeding and death;however,a reliable predictive model is lacking.We aimed to develop a model for rebleeding prediction in patients with EVB after modified percutaneous transhepatic variceal embolization(PTVE)with cyanoacrylate.Methods:A total of 122 patients with EVB who underwent PTVE from January 2015 to November 2020 were enrolled.Multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction.The discrimination,calibration,and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease score(MELD)and the Child–Pugh model.Risk stratification was performed according to the nomogram.Results:Rebleeding within 3 months of PTVE occurred in 32 patients(26.2%).Independent rebleeding indicators included prior history of endoscopic therapy,Child–Pugh score,partial splenic embolization,and creatinine level.The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities,with a concordance index of 0.85,which was confirmed to be 0.83 through bootstrapping validation.The nomogram demonstrated superior discrimination and clinical applicability than the MELD and Child–Pugh models.As shown in the Kaplan–Meier curves,high-risk patients had a high probability of rebleeding(P<0.001).Conclusions:The creatinine-based nomogram had a superior ability to predict rebleeding after PTVE in patients with EVB.Risk stratification may help identify high-risk patients and lead to the earlier implementation of aggressive treatments and formulation of intensive follow-up plans.展开更多
Aims:Post-transjugular intrahepatic portosystemic shunt(TIPS)hepatic encephalopathy and stent dysfunction remain the principal clinical problems restricting the procedure's application.Establishing TIPS in the lef...Aims:Post-transjugular intrahepatic portosystemic shunt(TIPS)hepatic encephalopathy and stent dysfunction remain the principal clinical problems restricting the procedure's application.Establishing TIPS in the left branch of the portal vein,as opposed to the right branch,can reduce the incidence of hepatic encephalopathy post-TIPS.This study aimed to analyze the effects of shunt position(including the puncture site of the portal vein and stent position)on the prognosis of patients undergoing TIPS for cirrhotic esophagogastric variceal bleeding(EGVB).Methods:Data from 169 patients who underwent TIPS-covered stenting between November 2015 and December 2021 for portal hypertension with EGVB at the First Affiliated Hospital of Soochow University were retrospectively analyzed.The patients were divided into three groups according to the puncture site of the portal vein,named left branch(n=92),right branch(n=27),and bifurcation(n=50)groups,respectively.The patients were also divided into the optimal stent position(O-SP)group(n=102)and the suboptimal stent position(S-O-SP)group(n=67)according to the stent position.The primary outcome was the overt hepatic encephalopathy(OHE)rate,and the secondary outcomes were the shunt dysfunction,variceal rebleeding,and liver transplant-free survival rates.Quantitative data are represented as means±standard deviations or medians(interquartile ranges),and categorical data are expressed as proportions and percentages.Categorical variables were analyzed using theχ^(2)or rank-sum test,while normally distributed continuous variables were compared using the independent samples t-test or one-way analysis of variance,and non-normally distributed continuous variables were assessed using the Mann-Whitney U test or Kruskal-Wallis test.Results:TIPS shunts were successfully created in all patients in this study,with a procedural success rate of 100%.The median follow-up time in this study was 30.5(17.6-48.6)months,and no patients lost follow-up.Based on the puncture site,the left branch group versus the right branch group(32%vs.67%,χ^(2)=14.529,p<0.001)and the bifurcation group versus the right branch group(34%vs.67%,χ^(2)=9.131,p=0.003)were significantly different in terms of OHE rate,and the right branch group was worse than the other two groups.There was no significant difference in the OHE rate between the left branch and the bifurcation groups(32%vs.34%,χ^(2)=0.165,p=0.684).The median times to OHE were 58.3(95%confidence interval[CI]:51.6-65.0)months in the O-SP group and 38.2(95%CI:29.6-46.8)months in the S-O-SP group,with significant difference between them(χ^(2)=8.890,p=0.003).The median times to shunt dysfunction were 68.4(95%CI:62.2-74.6)months for the O-SP group and 48.9(95%CI:40.8-57.0)months for the S-O-SP group,with significant difference between them(χ^(2)=12.717,p<0.001).In our study,no differences were observed in the variceal rebleeding rate,liver transplant-free survival rate,and postoperative blood ammonia level among the different puncture sites and stent positions(p>0.05).Univariate and multivariate Cox regression analyses showed that age,intraoperative puncture of the right branch of the portal vein,stent position,prothrombin time,international normalized ratio,and blood sodium were independent risk factors for the postoperative OHE rate.Conclusion:TIPS controls cirrhotic EGVB.Puncturing the right portal vein to establish a TIPS shunt may increase the risk of postoperative OHE and impairment of the liver functional reserve.A suboptimal stent position may increase the risk of OHE and shunt dysfunction after TIPS.Both ends of the stent should be optimally positioned whenever possible.展开更多
BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modalit...BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive characteristics.However,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains controversial.METHODS A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022.Based on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were compared.RESULTS Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts.Notably,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST levels either preoperatively or postoperatively(P<0.05).Postoperative scores across all dimensions of life quality surpassed preoperative scores,with the study cohort achieving higher scores(P<0.05).At 22.00%,the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group(42.86%;P<0.05);conversely,no marked difference was obser-ved in the 1-year postoperative survival rate between the two cohorts(P>0.05).CONCLUSION TIPS,which has demonstrated robust efficacy in managing cirrhotic EGVB,remarkably alleviates varicosity and improves hemodynamics in patients.This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.展开更多
Background Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fun...Background Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fundus vadces combined with endoscopic variceal ligation （EVL） of esophageal varices for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis. Methods Totally 172 patients were diagnosed by endoscopic examination within 24 hours of hospitalization with active gastric fundus variceal bleeding and grade II above esophageal varices caused by cirrhosis. Other causes leading to upper digestive tract bleeding were excluded. Patients were randomly divided into a control group （n=82） and a therapy group （n=-90） following a random number table method. For the former, embolization for gastric fundus varices was performed, then an EVL for esophageal varices was performed 2 months later. For the therapy group, embolization for gastric fundus varices and EVL for esophageal varices were performed at the same time. Results The rate of emergency hemostasis in the therapy group was 100.0%, higher than that in the control group （87.8%, P〈0.05）. The rate of early rebleeding in the therapy group was 6.7% while the rate in the control group was 23.6% （P〈0.05）. No complications related to treatment occurred in both groups. Conclusion Embolization for gastric fundus varices combined with EVL for esophageal varices is a safe and effective method for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis.展开更多
Background and aims:Esophagogastric varices(EGV)are common complications of primary biliary cholangitis(PBC).We examined the risk factors for variceal bleeding-related liver transplantation(LT)or death.Methods:This pr...Background and aims:Esophagogastric varices(EGV)are common complications of primary biliary cholangitis(PBC).We examined the risk factors for variceal bleeding-related liver transplantation(LT)or death.Methods:This prospective observational cohort study involved PBC in our hospital from 1 January 2005 to 1 January 2020.The clinical endpoints were variceal bleeding-related LT and death.Survival analysis was performed using the Kaplan-Meier estimate,cox regression analysis was performed to investigate risk factors.Results:PBC with EGV had significantly shorter survival than those without(p?0.002).Endoscopic prophylaxis significantly improved poor outcomes in PBC with EGV(p<0.001).Risk factors in patients with EGV included:cholinesterase(CHE)of<1.0upper limit of normal(ULN),international normalized ratio(INR)of>1.2ULN at baseline,total bilirubin of>1.2ULN,aspartate aminotransferase(AST)of>2.3ULN after 1 year of ursodeoxycholic acid(UDCA)treatment,non-biochemical responders according to the Paris criteria,and no history of endoscopic therapy.In PBC without EGV,risk factors included AST of>2.3ULN,INR of>1.2ULN at baseline,CHE of<1.0ULN after 1 year of UDCA treatment,and GLOBE score of>1.125.Conclusion:This study provides evidence that AST,INR and CHE are major risk factors for variceal bleedingrelated poor outcomes in PBC.For PBC with EGV,a good biochemical response to UDCA and endoscopic prophylaxis may improve survival.These findings can aid for guiding initial PBC risk stratification and screening endoscopy in patients without EGV.展开更多
To standardize the diagnosis,treatment,and management of esophagogastric variceal bleeding(EVB)in patients with cirrhotic portal hypertension,the Chinese Society of Hepatology,the Chinese Society of Gastroenterology,a...To standardize the diagnosis,treatment,and management of esophagogastric variceal bleeding(EVB)in patients with cirrhotic portal hypertension,the Chinese Society of Hepatology,the Chinese Society of Gastroenterology,and the Chinese Society of Digestive Endoscopy of the Chinese Medical Association brought together relevant experts,reviewed the latest national and international progress in clinical research on EVB in cirrhotic portal hypertension,and followed evidencebased medicine to update the Guidelines on the Management of EVB in Cirrhotic Portal Hypertension.The guidelines provide recommendations for the diagnosis,treatment,and management of EVB in cirrhotic portal hypertension and with the aim to improve the level of clinical treatment of EVB in patients with cirrhotic portal hypertension.展开更多
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.
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Objective To evaluate the effect of Wuhuang Tongluo Formula(WTF)on rebleeding and its therapeutic and preventive effects in patients with liver cirrhosis and esophagogastric variceal bleeding(EGVB).Methods A total of 169 patients with cirrhotic EGVB were enrolled and assigned to a control group(74 cases)and an experimental group(95 cases)based on whether they received WTF.
基金National Natural Science Foundation of China,Grant/Award Number:82070574Natural Science Foundation of Guangdong Province Team Project,Grant/Award Number:2018B030312009+1 种基金Tianjin Health Research Project,Grant/Award Number:TJWJ2022XK029Tianjin Key Medical Discipline(Specialty)Construction Project,Grant/Award Number:TJYXZDXK-034A。
文摘Aims:The endoscopic treatment of esophagogastric varices is challenging,and the nationwide application of endoscopic therapies for various types of esophagogastric varices and different clinical scenarios remains unclear.This study investigated the use of endoscopic therapy for portal hypertension in China.Methods:This study used a questionnaire survey initiated by the Liver Health Consortium in China to investigate the use of endoscopic therapies for portal hypertension.Questionnaires were released online from January 30,2023 to February 28,2023 and filled out by chief physicians or senior instructors responsible for endoscopic therapies in participating hospitals across 31 provinces(autonomous regions and municipalities)in China.Comparisons of guideline adherence between primary and referral medical centers were performed using the chi‐square test or Fisher's exact test.Results:In total,836 hospitals participated in the survey.For primary and secondary prophylaxis of esophagogastric variceal bleeding(EGVB),adherence to the national guidelines was 72.5%(606/836)and 39.2%(328/836),respectively.Significant differences were observed in the rate of adherence between the primary and referral centers for primary(79.9%[111/139]vs.71.0%[495/697],p=0.033)and secondary prophylaxis(27.3%[38/139]vs.41.6%[290/697],p=0.002).Of the hospitals,78.2%(654/836)preferred endoscopic therapies for acute EGVB,and the timing of endoscopy was usually within 12 h(48.5%,317/654)and 12-24 h(36.9%,241/654)after bleeding.Endoscopic therapy was more likely to be the first choice of treatment for acute EGVB in referral centers than in primary centers(82.6%[576/697]vs.56.1%[78/139],p<0.001).Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1,the most prevalent procedures were cyanoacrylate injection combined with sclerotherapy(48.2%[403/836]and 29.9%[250/836],respectively);however,substantial hospitals preferred clip-assisted therapies(12.4%[104/836]and 26.4%[221/836],respectively).Nonselective beta‐blockers were routinely used in 73.4%(614/836)of hospitals during the perioperative period of EGVB management,and propranolol(88.8%,545/614)and carvedilol(37.5%,230/614)were the most widely used nonselective beta-blockers.Conclusions:This survey clarified that various endoscopic procedures have been implemented nationwide in China.Participating hospitals have actively performed emergent endoscopy for acute EGVB;however,these hospitals do not adequately follow recommendations regarding primary and secondary prophylaxis of EGVB.In the future,standardizing the selection of endoscopic procedures and improving compliance with guidelines is crucial.
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.
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.
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the National Key R&D Program of China,No.2022YFC2503701the Science and Technological Supports Project of Sichuan Province,No.2022YFS0255the National Natural Science Foundation of China,No.81800449.
文摘BACKGROUND Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in China.Splenectomy plus pericardial devascularization(SPD)and transjugular intrahepatic portosystemic shunt(TIPS)are effective treatments for EGVB.However,a comparison of the effectiveness and safety of those methods is lacking.AIM To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding(VRB)in patients with HBV-related cirrhosis combined with portal hypertension.METHODS This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during 2009-2013.Propensity score-matched analysis(PSM),the Kaplan-Meier method,and multivariate Cox regression analysis were used to compare overall survival,VRB rate,liver function abnormality rate,and hepatocellular carcinoma(HCC)incidence between the two patient groups.RESULTS The median age was 45.0 years(n=318;226(71.1%)males).During a median follow-up duration of 43.0 mo,18(11.1%)and 33(21.2%)patients died in the SPD and TIPS groups,respectively.After PSM,SPD was significantly associated with better overall survival(OS)(P=0.01),lower rates of abnormal liver function(P<0.001),and a lower incidence of HCC(P=0.02)than TIPS.The VRB rate did not differ significantly between the two groups(P=0.09).CONCLUSION Compared with TIPS,SPD is associated with higher postoperative OS rates,lower rates of abnormal liver function and HCC,and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal hypertension.There is no significant between-group difference in VRB rates.
文摘BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.RESULTS The RC model yielded the best predictive performance and accurately predicted the EVB risk of patients with cirrhosis.Ascites,portal vein thrombosis,and plasma prothrombin time were identified as independent clinical risk factors.The area under the receiver operating characteristic curve(AUC)values for the RC model,Rad-score(liver+spleen+esophagus),Rad-score(liver),Rad-score(spleen),Rad-score(esophagus),and clinical model in the training cohort were 0.951,0.930,0.801,0.831,0.864,and 0.727,respectively.The corresponding AUC values in the validation cohort were 0.930,0.886,0.763,0.792,0.857,and 0.692.CONCLUSION In patients with cirrhosis,combined multi-organ radiomics and clinical model can be used to non-invasively predict the probability of the first secondary EVB.
文摘BACKGROUND Whether hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)and acute esophagogastric variceal bleeding(EGVB)can improve the success rate of endoscopic hemostasis and overall survival(OS)from transjugular intrahepatic portosystemic shunt(TIPS)remains controversial.AIM To compare the clinical outcomes between TIPS and standard treatment for such HCC patients.METHODS This monocenter,retrospective cohort study included patients diagnosed as HCC with PVTT and upper gastrointestinal bleeding.Patients were grouped by the treatment(TIPS or standard conservative treatment).The success rate of en-doscopic hemostasis,OS,rebleeding rates,and main causes of death were ana-lyzed.RESULTS Between July 2015 and September 2021,a total of 77 patients(29 with TIPS and 48 with standard treatment)were included.The success rate of endoscopic hemostasis was 96.6%in the TIPS group and 95.8%in the standard treatment group.All the 29 patients in TIPS group successful underwent TIPS procedure and had a better OS compared with standard treatment within the first 160 days after treatment(68 days vs 43 days,P=0.022),but shorter OS after 160 days(298 days vs 472 days, P = 0.022). Cheng’s Classification of PVTT, total bilirubin and Child-Pugh class wereindependently negative associated with OS (all P < 0.05). The main causes of death were liver failure or hepaticencephalopathy (75.9%) in the TIPS group and rebleeding (68.8%) in the standard treatment.CONCLUSIONTIPS could reduce the risk of early death due to rebleeding and prolong short-term survival in HCC patients withPVTT and acute EGVB, which deserves further investigation.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.
文摘We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). He was then referred to our hospital. Abdominal computed tomography revealed a lowdensity lesion in the posterior segment of the liver and an intratumoral APS, which caused portal hypertension. Although the patient underwent EVL, EIS, Hassab’s operation, and transcatheter arterial embolization for APS, he vomited blood due to rupture of esophagogastric varices. Right hepatectomy was performed for the treatment of HCC and APS, although the indocyanine green retention value at 15 min after intravenous injection was poor (30%). The patient’s postoperative course was uneventful. Eventually, APS disappeared and the esophagogastric varices improved.
基金the Key Scientific Research Project of Colleges and Universities in Henan Province,China(grant number 17A320011)。
文摘Background:Patients who survive initial esophagogastric variceal bleeding(EVB)are at an increased risk of recurrent bleeding and death;however,a reliable predictive model is lacking.We aimed to develop a model for rebleeding prediction in patients with EVB after modified percutaneous transhepatic variceal embolization(PTVE)with cyanoacrylate.Methods:A total of 122 patients with EVB who underwent PTVE from January 2015 to November 2020 were enrolled.Multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction.The discrimination,calibration,and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease score(MELD)and the Child–Pugh model.Risk stratification was performed according to the nomogram.Results:Rebleeding within 3 months of PTVE occurred in 32 patients(26.2%).Independent rebleeding indicators included prior history of endoscopic therapy,Child–Pugh score,partial splenic embolization,and creatinine level.The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities,with a concordance index of 0.85,which was confirmed to be 0.83 through bootstrapping validation.The nomogram demonstrated superior discrimination and clinical applicability than the MELD and Child–Pugh models.As shown in the Kaplan–Meier curves,high-risk patients had a high probability of rebleeding(P<0.001).Conclusions:The creatinine-based nomogram had a superior ability to predict rebleeding after PTVE in patients with EVB.Risk stratification may help identify high-risk patients and lead to the earlier implementation of aggressive treatments and formulation of intensive follow-up plans.
基金funded by National Natural Science Foundation of China(82472083).
文摘Aims:Post-transjugular intrahepatic portosystemic shunt(TIPS)hepatic encephalopathy and stent dysfunction remain the principal clinical problems restricting the procedure's application.Establishing TIPS in the left branch of the portal vein,as opposed to the right branch,can reduce the incidence of hepatic encephalopathy post-TIPS.This study aimed to analyze the effects of shunt position(including the puncture site of the portal vein and stent position)on the prognosis of patients undergoing TIPS for cirrhotic esophagogastric variceal bleeding(EGVB).Methods:Data from 169 patients who underwent TIPS-covered stenting between November 2015 and December 2021 for portal hypertension with EGVB at the First Affiliated Hospital of Soochow University were retrospectively analyzed.The patients were divided into three groups according to the puncture site of the portal vein,named left branch(n=92),right branch(n=27),and bifurcation(n=50)groups,respectively.The patients were also divided into the optimal stent position(O-SP)group(n=102)and the suboptimal stent position(S-O-SP)group(n=67)according to the stent position.The primary outcome was the overt hepatic encephalopathy(OHE)rate,and the secondary outcomes were the shunt dysfunction,variceal rebleeding,and liver transplant-free survival rates.Quantitative data are represented as means±standard deviations or medians(interquartile ranges),and categorical data are expressed as proportions and percentages.Categorical variables were analyzed using theχ^(2)or rank-sum test,while normally distributed continuous variables were compared using the independent samples t-test or one-way analysis of variance,and non-normally distributed continuous variables were assessed using the Mann-Whitney U test or Kruskal-Wallis test.Results:TIPS shunts were successfully created in all patients in this study,with a procedural success rate of 100%.The median follow-up time in this study was 30.5(17.6-48.6)months,and no patients lost follow-up.Based on the puncture site,the left branch group versus the right branch group(32%vs.67%,χ^(2)=14.529,p<0.001)and the bifurcation group versus the right branch group(34%vs.67%,χ^(2)=9.131,p=0.003)were significantly different in terms of OHE rate,and the right branch group was worse than the other two groups.There was no significant difference in the OHE rate between the left branch and the bifurcation groups(32%vs.34%,χ^(2)=0.165,p=0.684).The median times to OHE were 58.3(95%confidence interval[CI]:51.6-65.0)months in the O-SP group and 38.2(95%CI:29.6-46.8)months in the S-O-SP group,with significant difference between them(χ^(2)=8.890,p=0.003).The median times to shunt dysfunction were 68.4(95%CI:62.2-74.6)months for the O-SP group and 48.9(95%CI:40.8-57.0)months for the S-O-SP group,with significant difference between them(χ^(2)=12.717,p<0.001).In our study,no differences were observed in the variceal rebleeding rate,liver transplant-free survival rate,and postoperative blood ammonia level among the different puncture sites and stent positions(p>0.05).Univariate and multivariate Cox regression analyses showed that age,intraoperative puncture of the right branch of the portal vein,stent position,prothrombin time,international normalized ratio,and blood sodium were independent risk factors for the postoperative OHE rate.Conclusion:TIPS controls cirrhotic EGVB.Puncturing the right portal vein to establish a TIPS shunt may increase the risk of postoperative OHE and impairment of the liver functional reserve.A suboptimal stent position may increase the risk of OHE and shunt dysfunction after TIPS.Both ends of the stent should be optimally positioned whenever possible.
文摘BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive characteristics.However,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains controversial.METHODS A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022.Based on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were compared.RESULTS Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts.Notably,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST levels either preoperatively or postoperatively(P<0.05).Postoperative scores across all dimensions of life quality surpassed preoperative scores,with the study cohort achieving higher scores(P<0.05).At 22.00%,the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group(42.86%;P<0.05);conversely,no marked difference was obser-ved in the 1-year postoperative survival rate between the two cohorts(P>0.05).CONCLUSION TIPS,which has demonstrated robust efficacy in managing cirrhotic EGVB,remarkably alleviates varicosity and improves hemodynamics in patients.This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.
文摘Background Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fundus vadces combined with endoscopic variceal ligation （EVL） of esophageal varices for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis. Methods Totally 172 patients were diagnosed by endoscopic examination within 24 hours of hospitalization with active gastric fundus variceal bleeding and grade II above esophageal varices caused by cirrhosis. Other causes leading to upper digestive tract bleeding were excluded. Patients were randomly divided into a control group （n=82） and a therapy group （n=-90） following a random number table method. For the former, embolization for gastric fundus varices was performed, then an EVL for esophageal varices was performed 2 months later. For the therapy group, embolization for gastric fundus varices and EVL for esophageal varices were performed at the same time. Results The rate of emergency hemostasis in the therapy group was 100.0%, higher than that in the control group （87.8%, P〈0.05）. The rate of early rebleeding in the therapy group was 6.7% while the rate in the control group was 23.6% （P〈0.05）. No complications related to treatment occurred in both groups. Conclusion Embolization for gastric fundus varices combined with EVL for esophageal varices is a safe and effective method for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis.
基金supported by the National Natural Science Foundation of China[Nos 82170538 and 81873564]the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine[No.ZYYCXTD-C-202005].
文摘Background and aims:Esophagogastric varices(EGV)are common complications of primary biliary cholangitis(PBC).We examined the risk factors for variceal bleeding-related liver transplantation(LT)or death.Methods:This prospective observational cohort study involved PBC in our hospital from 1 January 2005 to 1 January 2020.The clinical endpoints were variceal bleeding-related LT and death.Survival analysis was performed using the Kaplan-Meier estimate,cox regression analysis was performed to investigate risk factors.Results:PBC with EGV had significantly shorter survival than those without(p?0.002).Endoscopic prophylaxis significantly improved poor outcomes in PBC with EGV(p<0.001).Risk factors in patients with EGV included:cholinesterase(CHE)of<1.0upper limit of normal(ULN),international normalized ratio(INR)of>1.2ULN at baseline,total bilirubin of>1.2ULN,aspartate aminotransferase(AST)of>2.3ULN after 1 year of ursodeoxycholic acid(UDCA)treatment,non-biochemical responders according to the Paris criteria,and no history of endoscopic therapy.In PBC without EGV,risk factors included AST of>2.3ULN,INR of>1.2ULN at baseline,CHE of<1.0ULN after 1 year of UDCA treatment,and GLOBE score of>1.125.Conclusion:This study provides evidence that AST,INR and CHE are major risk factors for variceal bleedingrelated poor outcomes in PBC.For PBC with EGV,a good biochemical response to UDCA and endoscopic prophylaxis may improve survival.These findings can aid for guiding initial PBC risk stratification and screening endoscopy in patients without EGV.
文摘To standardize the diagnosis,treatment,and management of esophagogastric variceal bleeding(EVB)in patients with cirrhotic portal hypertension,the Chinese Society of Hepatology,the Chinese Society of Gastroenterology,and the Chinese Society of Digestive Endoscopy of the Chinese Medical Association brought together relevant experts,reviewed the latest national and international progress in clinical research on EVB in cirrhotic portal hypertension,and followed evidencebased medicine to update the Guidelines on the Management of EVB in Cirrhotic Portal Hypertension.The guidelines provide recommendations for the diagnosis,treatment,and management of EVB in cirrhotic portal hypertension and with the aim to improve the level of clinical treatment of EVB in patients with cirrhotic portal hypertension.
