Navegando por Palavras-chave "esophageal varices"

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    Endoscopic treatment of esophageal varices in advanced liver disease patients: band ligation versus cyanoacrylate injection
    (Lippincott Williams & Wilkins, 2011-01-01) Martins Santos, Marcus Melo [UNIFESP]; Lenz Tolentino, Luciano Henrique [UNIFESP]; Rodrigues, Rodrigo Azevedo [UNIFESP]; Nakao, Frank Shigueo [UNIFESP]; Silveira Rohr, Maria Rachel da [UNIFESP]; Paulo, Gustavo Andrade de [UNIFESP]; Kondo, Mario [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Della Libera, Ermelindo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background the results of variceal band ligation (VBL) in patients with advanced liver disease are unknown. Cyanoacrylate injection (CI) might have a better outcome than VBL in the treatment of esophageal varices (EV) in these patients.Aim To compare VBL and CI in the treatment of EV in patients with advanced liver disease.Patients and methods Thirty-eight patients with medium or large EV and Child-Pugh index of at least eight were randomized into two groups: VBL (n = 20) and CI (n = 18). the patients were followed-up for at least 6 months after the end of treatment. Main outcomes were eradication, bleeding, mortality, complication, and recurrence rates.Results Variceal eradication rates were similar in the VBL and CI groups (90 vs. 72%, P = 0.39). Mean number of sessions until eradication was 3.17 and 3, respectively. Bleeding episodes until eradication were equally observed in both groups (P = 0.17). Mortality (55 vs. 56%, P = 0.52) and major complication rates (5 and 17%, P = 0.32) were similar. Chest pain with dysphagia was more frequent in the CI group (55.6 vs. 10%, P = 0.004). A higher risk of variceal recurrence was observed in the CI group (33 vs. 57%, P = 0.04).Conclusion No significant differences between the VBL and CI groups were observed in the treatment of EV in patients with advanced liver disease regarding mortality, variceal eradication, and major complications rates. However, minor complications and variceal recurrence were significantly more common in the CI group. in addition, there was a clear trend toward more bleeding episodes in patients included in the CI group. Eur J Gastroenterol Hepatol 23:60-65 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
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    Late clinical, biochemical, endoscopic and electroencephalographic evaluation of patients with schistosomal portal hypertension treated with distal splenorenal shunt
    (Edizioni Minerva Medica, 1998-01-01) Lopes, G. D.; Haddad, Chibly Michel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The authors performed a late evaluation of a distal splenorenal anastomosis minimum of five years following operation on 13 patients with schistosomiasis of the compensated liver-splenic type. The study of the anastomosis had been proven patent when the evaluation took place. Each patient underwent clinical,laboratorial, endoscopic and electroencephalographic assessment. The results demonstrated that no patient had shown any sign of recurrence of upper gastrointestinal hemorrhage,Among the endoscopic aspects, esophageal varices disappeared in 46.1% of the cases. There was reduction in the number, extent and volume of esophageal varices in 46.1%, 38.4% and 53.8% of the cases. Gastric varices disappeared in 91.6% of the cases. Only one patient (7.6%) had shown clinical and electroencephalographic signs of hepatic encephalopathy in the late final evaluation (non-significant), Only one patient (7.6%) had shown late postoperative ascites (non-significant), There were no significant alterations in serum levels of sodium, potassium, urea and creatinine in all the 13 patients. The values of indirect serum bilirubin increased in 92.3% of the patients. There was regression of splenomegaly in all 13 patients, as well as a significant improvement in their hematological values. There were no significant changes in the serum levels of aspartate aminotransferase and alanine aminotransferase or in the activity of the plasma prothrombin, The authors concluded that the distal splenorenal anastomosis became a protection factor against upper gastrointestinal hemorrhage and led to long-term improvement in the endoscopic aspects of esophagogastric varices, a significant improvement in the laboratorial aspects of hypersplenism and a marked reduction of splenomegaly with no significant changes in the hydroelectrolytic metabolism, renal function and hepatic function and had not compromised,long term, the quality of life of the majority of patients.
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    Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers
    (Lippincott Williams & Wilkins, 2011-09-01) Tafarel, Jean Rodrigo [UNIFESP]; Lenz Tolentino, Luciano Henrique [UNIFESP]; Correa, Lucianna Motta [UNIFESP]; Bonilha, Danielle Rossana [UNIFESP]; Piauilino, Patricia [UNIFESP]; Martins, Fernanda Prata [UNIFESP]; Rodrigues, Rodrigo Azevedo [UNIFESP]; Nakao, Frank Shigeo [UNIFESP]; Della Libera, Ermelindo [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Silveira Roehr, Maria Rachel da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective To determine whether Model for End-stage Liver Disease (MELD) Child-Turcotte-Pugh (CTP) classification, AST to platelet ratio index (APRI), and laboratory tests could predict the presence of esophageal varices (EV) or varices which need prophylactic therapy (medium or large size EV).Methods Three hundred patients with cirrhosis (193 men; mean age 53.1 years; majority with chronic C hepatitis) were prospectively analyzed. the presence of EV (any size and medium or large EV) was correlated with patients' characteristics (MELD, CTP classification, APRI, platelets count, and liver tests).Results One hundred and seventy-one patients (57%) had EV, of whom 35% (105) had varices which need prophylactic therapy (VPT). the distribution of EV according to CTP classification was as follows: A, 49%; B, 75.3% and C, 80%. Independent predictors of EV were: MELD higher than 8 (P = 0.02); APRI higher than 1.64 (P = 0.01); platelet count lower than 93 000/mm(3) (P < 0.01); aspartate aminotransferase higher than 1.34 x UNL (P = 0.01), and total bilirubin higher than 1 mg/dl (P = 0.04). MELD higher than 8 had the highest discriminative value for presence of EV (sensitivity = 80.1%; specificity = 51.2%; area under receiver operating characteristics = 0.68). Factors independently associated with VPT were: thrombocytopenia (< 92 000/mm(3); P < 0.01) and aspartate aminotransferase higher than 1.47 x UNL (P = 0.03). Platelet count lower than 92 000/mm(3) had sensitivity of 65.7%, specificity of 57.9%, and an area under receiver operating characteristics of 0.62 for the presence of VPT.Conclusion High values on MELD are associated with EV and thrombocytopenia, with varices which need prophylactic therapy. As a result of their low sensitivity and specificity, it is suggested to maintain the recommendation of upper gastrointestinal endoscopy for all patients with cirhosis. Eur J Gastroenterol Hepatol 23: 754-758 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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    Propranolol associated with endoscopic band ligation reduces recurrence of esophageal varices for primary prophylaxis of variceal bleeding: a randomized-controlled trial
    (Lippincott Williams & Wilkins, 2015-01-01) Bonilha, Danielle Queiroz [UNIFESP]; Lenz, Luciano [UNIFESP]; Correia, Lucianna Motta [UNIFESP]; Rodrigues, Rodrigo Azevedo [UNIFESP]; Paulo, Gustavo Andrade de [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Della Libera, Ermelindo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Fleury Med & Saude; Hosp Israelita Albert Einstein
    Objective the aim of this study was to compare the recurrence of esophageal varices (EVs) after endoscopic band ligation (EBL) associated with propranolol (PP) versus EBL alone.Patients and methods Sixty-six cirrhotic outpatients (EBL group, n= 32 and EBL+PP group, n= 34) with high-risk EVs without previous bleeding were studied.Main outcome measurements the primary outcome was recurrence of EV. the secondary outcomes were EV eradication, bleeding before EV eradication, mortality, and adverse events.Results Demographic characteristics and the initial endoscopic findings were similar. EV eradication was achieved in all patients. Three patients presented gastrointestinal bleeding before variceal eradication, two in the EBL group and one in the EBL+PP group (P=0.13). Six patients died (liver failure), two in the EBL group and four in the EBL+PP group (P=0.27). Twelve (38%) patients in the EBL group and three (9%) patients in the EBL+PP group had variceal recurrence. the risk of recurrence of EVs after eradication was significantly higher among patients in the EBL group (P=0.003).Conclusion EBL alone and EBL+PP were effective in the primary prophylaxis of bleeding from EVs in cirrhotic patients (EV eradication, bleeding before EV eradication, mortality, and adverse events were similar in both groups). However, variceal recurrence was lower in the EBL+PP group than band ligation alone. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.