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A. K. Burroughs - One of the best experts on this subject based on the ideXlab platform.
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Prophylactic sclerotherapy: yes or no!
HPB Surgery, 1996Co-Authors: A. K. BurroughsAbstract:Controlled trials of endoscopic sclerotherapy for the prevention of the first variceal hemorrhage have given controversial results. We continued a previously reported study and randomly assigned 141 patients with esophageal varics and no prior gastrointestinal bleeding to either prophylactic sclerotherapy (n=70) or no treatment (n=71). Sclerotherapy was performed until complete eradication of the Varices was achieved; recurrent varics were treated with repeat sclerotherapy. The groups were well balanced in terms of demographic and clinical characteristics. Patients in both groups who bled from Varices received sclerotherapy whenever possible.During a median follow-up of 56 months, variceal bleeding occurred in 7% in sclerotherapy patients and 44% on control patients (p < 0.01). In the sclerotherapy group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate increased with the severity of liver function impairment. Sclerotherapy was not found to improve survival in patients, irrespective of the etiology of cirrhosis (alcoholic or nonalcoholic) or variceal size (low-grade or high-grade). We conclude that sclerotherapy is a suitable method to reduce the occurrence of the first variceal hemorrhage, but it does not appear to have an effect on survival.
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The natural history of Varices.
Journal of hepatology, 1993Co-Authors: A. K. BurroughsAbstract:Variceal bleeding and its ensuing complications correlate positively with the severity of liver disease. The average risk of bleeding in patients with cirrhosis who have not previously bled is 30%, with a 50% mortality rate within 6 weeks. This mortality rate is the rationale for prophylaxis. However, although fatal bleeding causes 35% of all deaths, patients who die after the first episode of bleeding represent only 15% of patients with cirrhosis and Varices. Portal and intravariceal pressure, the appearance of oesophageal Varices on endoscopic examination, severity of liver disease and alcohol abuse are independent risk factors for the occurrence of the first bleeding episode. In sinusoidal portal hypertension, the presence of Varices indicates a hepatic venous pressure gradient > or = 12 mmHg. Although hepatic venous pressure gradient tends to be higher in patients who bleed or have large Varices, bleeding risk is not related linearly to pressure above this threshold. Tension on the variceal wall relative to varix radius may be critical and increasing variceal size, in conjunction with wall thinness, may favour rupture at lower intraluminal pressures. The North Italian Endoscopic Club's simplified index for the risk of a first bleeding episode is based on Child class, variceal size and presence of red wale markings, although there may be other independent risk factors. Abstention from alcohol can decrease variceal size and the number of cherry-red spots. Because large Varices are unlikely to develop de novo within 2 years, biennial endoscopic screening is sufficient for patients without Varices; annual endoscopy is recommended for those with small Varices.(ABSTRACT TRUNCATED AT 250 WORDS)
Andrew K. Burroughs - One of the best experts on this subject based on the ideXlab platform.
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Management of Varices in cirrhosis.
Expert opinion on pharmacotherapy, 2011Co-Authors: Ulrich Thalheimer, Christos Triantos, John Goulis, Andrew K. BurroughsAbstract:Introduction: Acute variceal bleeding is a medical emergency and one of the main causes of mortality in patients with cirrhosis. Timely and effective treatment of the acute bleeding episode results in increased survival, and appropriate prophylactic treatment can prevent bleeding or rebleeding from Varices. Areas covered: We discuss the prevention of development and growth of Varices, the primary and secondary prophylaxis of bleeding, the treatment of acute bleeding, and the management of gastric Varices. We systematically reviewed studies, without time limits, identified through Medline and searches of reference lists, and provide an overview of the evidence underlying the -treatment options in the management of Varices in cirrhosis. Expert opinion: The management of variceal hemorrhage relies on nonspecific interventions (e.g., adequate fluid resuscitation, airway protection) and on specific interventions. These are routine prophylactic antibiotics, vasoactive drugs and endoscopic treatment. Procedures ...
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The natural history of Varices.
Journal of Hepatology, 1993Co-Authors: Andrew K. BurroughsAbstract:Variceal bleeding and its ensuing complications correlate positively with the severity of liver disease. The average risk of bleeding in patients with cirrhosis who have not previously bled is 30%, with a 50% mortality rate within 6 weeks. This mortality rate is the rationale for prophylaxis. However, although fatal bleeding causes 35% of all deaths, patients who die after the first episode of bleeding represent only 15% of patients with cirrhosis and Varices. Portal and intravariceal pressure, the appearance of oesophageal Varices on endoscopic examination, severity of liver disease and alcohol abuse are independent risk factors for the occurrence of the first bleeding episode. In sinusoidal portal hypertension, the presence of Varices indicates a hepatic venous pressure gradient ≥12 mmHg. Although hepatic venous pressure gradient tends to be higher in patients who bleed or have large Varices, bleeding risk is not related linearly to pressure above this threshold. Tension on the variceal wall relative to varix radius may be critical and increasing variceal size, in conjunction with wall thinness, may favour rupture at lower intraluminal pressures. The North Italian Endoscopic Club's simplified index for the risk of a first bleeding episode is based on Child class, variceal size and presence of red wale markings, although there may be other independent risk factors. Abstention from alcohol can decrease variceal size and the number of cherry-red spots. Because large Varices are unlikely to develop de novo within 2 years, biennial endoscopic screening is sufficient for patients without Varices; annual endoscopy is recommended for those with small Varices. The risk of bleeding is highest in the first year after entry into a clinical trial but nonlinear thereafter — an important consideration for prophylactic therapy. Presumably, patients with a history of Varices that have not bled have a different risk profile from those whose Varices are discovered on initial diagnosis of liver disease.
Sydney C.s. Chung - One of the best experts on this subject based on the ideXlab platform.
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Large paraesophageal Varices on endosonography predict recurrence of esophageal Varices and rebleeding.
Gastroenterology, 1997Co-Authors: Vincent K S Leung, Joseph J.y. Sung, Anil T. Ahuja, I Tumala, Yuk Tong Lee, James Y.w. Lau, Sydney C.s. ChungAbstract:Abstract BACKGROUND & AIMS: Recurrence of Varices and rebleeding after endoscopic therapy is very common. Data on the prediction of recurrent Varices after initial obliteration by endoscopic therapy are few. The aim of this study was to correlate the presence and the size of paraesophageal Varices (PEVs) in patients after endoscopic variceal ligation with recurrent Varices and rebleeding. METHODS: Forty patients who underwent endoscopic banding ligation for esophageal variceal bleeding were studied by endosonography within 4 weeks after obliteration of Varices. PEVs were classified as none, small, or large (maximum diameter, > or=0.5 cm). Esophagoscopy and endosonography were then repeated every 6 months for up to 1 year. RESULTS: Two patients (5%) were not detected to have PEVs. Small and large PEVs were identified in 24 (60%) and 14 (35%) patients, respectively. During the follow-up period of 1-year, recurrent submucosal esophageal Varices were detected in 24 patients, including 13 patients (93%) with large PEVs and 11 patients (46%) with no or small PEVs (P = 0.0019). Recurrent bleeding occurred in 6 patients (43%) with large PEVs and in 3 patients (12%) with small PEVs (P = 0.044). CONCLUSIONS: Patients with large PEVs have a higher risk of developing recurrent Varices and rebleeding. (Gastroenterology 1997 Jun;112(6):1811-6)
Vincent K S Leung - One of the best experts on this subject based on the ideXlab platform.
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Large paraesophageal Varices on endosonography predict recurrence of esophageal Varices and rebleeding.
Gastroenterology, 1997Co-Authors: Vincent K S Leung, Joseph J.y. Sung, Anil T. Ahuja, I Tumala, Yuk Tong Lee, James Y.w. Lau, Sydney C.s. ChungAbstract:Abstract BACKGROUND & AIMS: Recurrence of Varices and rebleeding after endoscopic therapy is very common. Data on the prediction of recurrent Varices after initial obliteration by endoscopic therapy are few. The aim of this study was to correlate the presence and the size of paraesophageal Varices (PEVs) in patients after endoscopic variceal ligation with recurrent Varices and rebleeding. METHODS: Forty patients who underwent endoscopic banding ligation for esophageal variceal bleeding were studied by endosonography within 4 weeks after obliteration of Varices. PEVs were classified as none, small, or large (maximum diameter, > or=0.5 cm). Esophagoscopy and endosonography were then repeated every 6 months for up to 1 year. RESULTS: Two patients (5%) were not detected to have PEVs. Small and large PEVs were identified in 24 (60%) and 14 (35%) patients, respectively. During the follow-up period of 1-year, recurrent submucosal esophageal Varices were detected in 24 patients, including 13 patients (93%) with large PEVs and 11 patients (46%) with no or small PEVs (P = 0.0019). Recurrent bleeding occurred in 6 patients (43%) with large PEVs and in 3 patients (12%) with small PEVs (P = 0.044). CONCLUSIONS: Patients with large PEVs have a higher risk of developing recurrent Varices and rebleeding. (Gastroenterology 1997 Jun;112(6):1811-6)
Burhan Sahin - One of the best experts on this subject based on the ideXlab platform.
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Effects of esophageal varice eradication on portal hypertensive gastropathy and fundal Varices: a retrospective and comparative study.
Digestive diseases and sciences, 2006Co-Authors: Osman Yüksel, Seyfettin Köklü, Mehmet Arhan, Ömer Faruk Yolcu, Ibrahim Ertugrul, Bülent Ödemiş, Emin Altiparmak, Burhan SahinAbstract:Esophageal varice eradication results in gastric hemodynamic changes. The aim of this study was to detect the influence of variceal eradication on portal hypertensive gastropathy (PHG) and fundal Varices and to compare the results of two therapeutic methods (endoscopic variceal ligation and endoscopic sclerotherapy). A total of 114 consecutive patients with cirrhosis and portal hypertension who underwent elective endoscopic variceal ligation (EVL) (85 patients) or endoscopic sclerotherapy (EST) (29 patients) for obliteration of esophageal Varices were selected for this study. Both groups were compared for PHG and fundal varice formation before and after eradication. Fifty-eight (68.2%) patients in the EVL and 18 (62.1%) patients in the EST group had PHG before esophageal varice eradication (P > 0.05). PHG grade after eradication of esophageal Varices by both EVL and EST was significantly higher compared to pre-eradication. PHG grade and aggregation were similar in both groups. Thirty-seven patients (34 F1, 3 F2) in the EVL group and 13 patients (10 F1, 3 F2) in the EST group had fundal Varices before variceal eradication (P > 0.05). Fundal Varices were detected in 46 (35 F1, 11F2) and 19 (11F1, 8F2) patients in the EVL and EST groups after eradication, respectively. There was a statistically significant increment in occurrence of fundal Varices after eradication with EVL and EST groups. There was no significant difference regarding fundal varice development after esophageal variceal eradication in both groups. After varical eradication, PHG was found in 57 (87.7%) and 39 (79.6%) patients with and without fundal Varices, respectively (P > 0.05). Esophageal eradication with EVL and EST increases both the incidence and the severity of PHG and fundal varice formation. Both methods have comparable influences on PHG and fundal Varices.
