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At least 19 recordsLinked to original sources
PubMed1994

Optimized analysis of recurrent bleeding and death in patients with cirrhosis and esophageal varices. Copenhagen Esophageal Varices Sclerotherapy Project.

The course of cirrhosis after the first episode of variceal bleeding is characterized by recurrent episodes of bleeding and bleeding-free periods, with each new stage being associated with an initially high mortality rate. Analysis of the course of this disease is usually based on traditional survival models measuring observation time from admission to hospital. This approach cannot provide valid answers to the following clinically relevant questions: 1) what is the risk of death while bleeding? 2) what is the risk of continuing bleeding? 3) what is the risk of death after bleeding has stopped? 4) what is the risk of a new bleeding episode among those who remain alive and do not bleed? and 5) do the answers to the former four questions depend on the number of previous bleeding episodes or on the time since the first episode? These questions may be addressed using the multistage, competing risks model presented here. By measuring time from the start of each new bleeding or bleeding-free period, this model synchronizes the patients with respect to disease development and, hence, to level of the rate of new clinical events. This reduces the heterogeneity of risk levels in the patient group at any given time. In an analysis of 94 patients with cirrhosis admitted for their first episode of variceal bleeding, we estimated the mortality rates during bleeding and without current bleeding, the rate of cessation of bleeding and the rate of rebleeding. The influence of number of previous rebleedings and of the time since the first bleeding was examined using a Cox regression model for competing risks.(ABSTRACT TRUNCATED AT 250 WORDS)

Disease Progression↗
PubMed1990

[Pathogenetic factors of hemorrhage from esophageal varices].

Esophageal varices nearly always rupture at or just above the gastro-esophageal junction. Mucosal changes on top of the varices, the so-called red colour sign, are found in the majority of patients with a positive bleeding history. An increase of intraabdominal pressure and consequently a sudden pressure rise in the varices is thought of as a trigger cause. The larger the esophageal varices the higher the intravariceal and the transmural varix pressures. The portal pressure in patients with portal hypertension is subjected to considerable changes. Therefore, hemodynamic measurements at rest may have a prognostic value with regard to predisposition to hemorrhage, but they are less significant than endoscopic parameters. Disturbances of blood hemostasis and ascites indicating an impaired liver function are essential predisponable factors for the onset of bleedings. A peptic lesion caused by acid gastric-esophageal reflux is of less importance for the occurrence of variceal hemorrhage.

Esophageal and Gastric Varices↗
PubMed1998

Portal hypertensive gastropathy and gastric varices before esophageal variceal sclerotherapy and after obliteration.

OBJECTIVES: To evaluate the frequency and clinical importance of portal hypertensive gastropathy (PHG) and gastric varices (GV) before endoscopic sclerotherapy (EST) and after esophageal variceal obliteration. METHODS: Patients with portal hypertension (PHT) with variceal bleed were prospectively evaluated for PHG and GV before EST with intravariceal injection of absolute alcohol and after esophageal variceal obliteration. Gastric varices and PHG were characterized and graded according to previously established criteria. Patients were followed up for 12-48 (mean 37) months after variceal obliteration. RESULTS: Of 70 patients with PHT 26 had PHG before (severe in two) [18/37 in cirrhosis, 6/20 in non-cirrhotic portal fibrosis (NCPF), and 2/13 in extrahepatic portal vein obstruction (EHPVO)] and 50 had PHG after variceal obliteration (severe in 22) (27/37 in cirrhosis, p = 0.03 before versus after esophageal variceal obliteration; 16/20 in NCPF, p < 0.01; and 7/13 in EHPVO, p = ns). Type I GV (continuation of esophageal varix into the stomach) was found in 25/70 before and 5/70 after esophageal variceal obliteration (p < 0.001); in contrast, other types of GV were seen in 14/70 before and 29/70 after (p < 0.01). Overt bleeding from GV and PHG during follow-up after variceal obliteration occurred in 6 and 4 patients, respectively. CONCLUSIONS: Esophageal variceal obliteration by EST increases the frequency of PHG and GV (except type I GV which get obliterated); both PHG and GV have potential to cause rebleeding.

Adolescent↗
PubMed1980

EEA esophageal stapling for control of bleeding esophageal varices.

Esophageal transection with the EEA stapler was performed in five patients with bleeding esophageal varices. Bleeding from varices has not recurred in surviving patients during follow-up of up to 27 months. One death occurred during the postoperative period. Esophageal transection with the EEA stapler is an effective means of preventing recurrent variceal hemorrhage. This technique is best suited for patients requiring emergency operation to prevent exsanguination and for those in whom a major shunting procedure is contraindicated because of the severity of hepatic disease or other medical illness.

Adult↗
PubMed1993

[Recent aspects in diagnosis and therapy of esophageal varices].

Esophageal varices are of ominous significance in patients with cirrhosis. Diagnostic procedures are undertaken for evaluation of the bleeding risk. Whereas after a recent bleeding event the risk of rebleeding is high (up to 70%) and rebleeding prophylaxis is obligatory, the risk of first bleeding in patients who never bled depends on the presence of bleeding risk indicators. Endoscopy is the most powerful tool for assessment of the bleeding risk. Variceal size, the presence of the red color sign and the presence of concomitant fundic varices indicate a high risk of first bleeding. Currently used endoscopic or medical prophylaxis has a high rate of failure. On the other hand, operative measures prevent bleeding in most patients. However, the perioperative morbidity and mortality is high. Controlled studies will show whether the patients will benefit from new experimental treatment approaches (endoscopic obliteration of varices, endoscopic ligation of varices, TIPS and liver transplantation.

Esophageal and Gastric Varices↗
PubMed1982

Absence of disseminated intravascular coagulation with endoscopic sclerosis of esophageal varices.

Esophageal varices were injected with 5% sodium morrhuate and a solution containing thrombin, concentrated dextrose, and cephalothin sodium using the flexible gastroscope with balloon cuff modification. Hematologic and coagulating parameters were checked before and after the procedure to look for evidence of disseminated intravascular coagulation. No effect was noted on hematocrit, hemoglobin, platelet count, haptoglobin, prothrombin time, partial thromboplastin time, fibrinogen, fibrin split products, factor V, or factor VIII. Injection sclerotherapy with currently available solutions appears to have no effect on the systemic coagulation system.

Blood Coagulation Tests↗
PubMed1996

[Effect of endoscopic sclerotherapy with esophageal varices on esophageal motility].

We investigated esophageal motility in 12 patients with esophageal varices by esophagography, scintigraphy and manometry before and after endoscopic sclerotherapy. In the manometric study, the appearance rates of the primary wave and the deglutitive relaxation decreased gradually after sclerotherapy, and the former improved within 3 months after discharge, while the latter tended to have a prolonged recovery period. The pressure of the lower esophageal sphincter was not significantly different before and after sclerotherapy. The length of the lower esophageal high pressure zone was greater than normal range before sclerotherapy, but it gradually shortened after sclerotherapy and improved by 3 months after sclerotherapy. The inducing rates of gastroesophageal reflux by abdominal compression was significantly higher at 3 months after sclerotherapy than before. In radiologic study, the esophageal transit time tended to prolong early after sclerotherapy, and it improved only slowly. We concluded that we need contrive to prevent from motility disorder of esophagus at the time of endoscopic sclerotherapy for patients with esophageal varices.

Adult↗
PubMed1989

Esophageal motility in cirrhotics with and without esophageal varices.

Esophageal manometry was performed in 45 cirrhotics with varices, in 15 cirrhotics without varices, and in 20 normal subjects, to define the effect of varices on esophageal motility. Cirrhotics with varices showed a decreased amplitude of motor waves in the lower half of the esophagus (p less than 0.01), an increased duration of primary peristaltic waves along the entire length of the esophagus (upper esophagus, p less than 0.05; lower esophagus, p less than 0.01), and an increased peak-to-peak speed of primary peristaltic waves (p less than 0.01). Resting lower esophageal sphincter pressure and duration of sphincter relaxation were similar in patients and controls. The above-mentioned abnormalities might be due to the mechanical effect of the presence of varices.

Adolescent↗
PubMed1994

Clinical significance of esophageal variceal pressure in patients with esophageal varices.

In 40 patients with esophageal varices, esophageal variceal pressure was assessed endoscopically using a pneumatic pressure sensor. The effects of vasopressin or nitroglycerin on variceal pressure and endoscopic findings were also assessed in two groups of seven patients. The results were as follows: (1) Variceal pressure was increased above 250 mmH2O in all patients who had bled, and the mean variceal pressure was significantly higher in patients who had bled than in those who had not (301 +/- 47 vs. 230 +/- 58 mmH2O respectively, p < 0.001). (2) Variceal pressure correlated with endoscopic findings, determined using the criteria of the Japanese Research Society for Portal Hypertension. It was significantly higher when varices with a feature of F2-F3 or RC(+2)-RC(+3) were compared to those with a feature of F1 or RC(-)-RC(+), respectively. (3) Both groups given vasopressin or nitroglycerin had significant reductions in variceal pressure; however, there was little improvement in endoscopic findings in those given nitroglycerin, compared to the improvement in those given vasopressin. Thus, use of a pneumatic pressure sensor proved to be a pertinent tool for assessing esophageal varices, along with endoscopic signs.

Aged↗
PubMed1988

Food impaction and strictures after sclerotherapy of esophageal varices.

Esophageal stricture is a common complication of endoscopic variceal sclerotherapy (EVS). The belief was that it could be managed safely and easily by esophageal dilation. Of 103 patients treated at our institution with EVS, 31 developed strictures, and of these, five have presented with food impaction (16.1%), a previously unreported complication. Three of the five had undergone prior esophageal dilation. Our patients received an average of 89 ml of 1.5% sodium tetradecyl in 7.6 sessions, compared with 51 ml in three sessions in an earlier group of EVS-induced strictures without food impaction. Esophageal manometric abnormalities were seen in three of four patients studied, two with markedly impaired peristaltic activity. All patients had successful treatment of both esophageal stricture and bleeding varices. Further sclerotherapy continued in four of five patients without additional problems. Food impaction in EVS-induced esophageal stricture can occur, despite dilation therapy.

Catheterization↗
PubMed2001

Terlipressin for acute esophageal variceal hemorrhage.

BACKGROUND: Terlipressin (triglycyl lysine vasopressin) is a synthetic analogue of vasopressin, which has been used in the treatment of acute variceal hemorrhage. In contrast to vasopressin, terlipressin can be administered as intermittent injections instead of continuous intravenous infusion and it has a safer adverse reactions profile. However, its effectiveness remains uncertain. OBJECTIVES: To determine if treatment with terlipressin improves outcome in acute esophageal variceal hemorrhage and is safe. SEARCH STRATEGY: Randomized clinical trials were identified by searching the following databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, the Cochrane Hepato-Biliary Group Controlled Trials Register, Biosis, and Current Contents. The bibliographies of identified publications were checked. Experts in the field and the manufacturers of terlipressin were contacted. SELECTION CRITERIA: All randomized clinical trials which compared terlipressin with: (a) placebo or no treatment, (b) balloon tamponade, (c) endoscopic treatment, (d) octreotide, (e) somatostatin and (f) vasopressin, in the setting of acute variceal hemorrhage. DATA COLLECTION AND ANALYSIS: Eligibility, trial quality assessment and data extraction were done independently by two reviewers. The primary outcome measure was mortality. Secondary outcomes were failure of initial hemostasis, rebleeding, procedures required for uncontrolled bleeding or rebleeding, transfusion requirements and length of hospitalization. MAIN RESULTS: Twenty studies were identified for all the comparison groups, involving 1609 patients. There were seven studies (with 443 patients) comparing terlipressin to placebo, five of which were considered to be high quality studies based on the Jadad scale. The meta-analysis indicates that terlipressin was associated with a statistically significant reduction in all cause mortality compared to placebo (relative risk 0.66, 95% confidence interval 0.49 to 0.88). Three studies (with 302 patients) were identified comparing terlipressin to somatostatin, two of which were high quality studies; only one high quality study (219 patients) comparing terlipressin to endoscopic treatment was identified. Within the limited power provided by these small numbers of patients, no statistically significant difference was demonstrated between terlipressin and either somatostatin or endoscopic treatment in any of the outcomes. For the remaining comparison groups (terlipressin versus balloon tamponade, terlipressin versus octreotide and terlipressin versus vasopressin) only small, low quality studies were identified and no difference was demonstrated in any of the major outcomes. There was no difference between the terlipressin group and any of the comparison groups in the number of adverse events that caused death or withdrawal of medication. REVIEWER'S CONCLUSIONS: On the basis of a 34% relative risk reduction in mortality, terlipressin should be considered to be effective in the treatment of acute variceal hemorrhage. Further, since no other vasoactive agent has been shown to reduce mortality in single studies or meta-analyses, terlipressin might be the vasoactive agent of choice in acute variceal bleeding.

Acute Disease↗
PubMed2005

A randomized control trial of bi-monthly versus bi-weekly endoscopic variceal ligation of esophageal varices.

Endoscopic variceal ligation (EVL) is a safe and simple procedure now being used on a widening scale. Yet most patients who undergo endoscopic treatment for esophageal varices eventually require additional treatment for recurrent varices. In this study, we investigated and compared the efficacy and long-term results of EVL performed in three treatments with a total of sixteen O-rings at two different intervals; bi-weekly (once every 2 wk: the conventional interval) and bi-monthly (once every 2 months). A total of 63 patients with esophageal varices were randomly assigned to groups receiving bi-weekly or bi-monthly EVL treatment. Optimal medical therapy was assessed by one medical doctor who was unaware of the patients' treatment assignments. Three parameters of treatment outcome were evaluated: the rate of recurrence, rate of additional treatment, and overall survival. The overall rates of variceal recurrence and additional treatment were both higher in the bi-weekly group than in the bi-monthly group (p < 0.001). In conclusion, EVL performed for the treatment of esophageal varices at bi-monthly intervals brought about better results than the same treatment performed at bi-weekly intervals. The treatments intercalated by the longer interval obtained a higher total eradication rate, lower recurrence rate, and lower rate of additional treatment.

Esophageal and Gastric Varices↗