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Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis.
Hepatology. 2004 Jun; 39(6):1623-30.Hep

Abstract

During variceal bleeding, several factors may increase portal pressure, which in turn may precipitate further bleeding. This study investigates the early effects of endoscopic injection sclerotherapy (EIS) and endoscopic band ligation (EBL) on hepatic venous pressure gradient (HVPG) during acute bleeding and the possible influence in outcome. In 50 cirrhotic patients with bleeding esophageal varices treated with EIS (n = 25) or EBL (n = 25), we performed repeated HVPG measurements before and immediately after endoscopic treatment (time 0) and every 24 hours for a 5-day period. Endotherapy was continued until the varices were too small for further treatment. Both groups were comparable with regard to age, gender, Child-Turcotte-Pugh grade, and HVPG. In the EBL and EIS groups, a significant (P <.0001) increase was observed in mean portal pressure (20.7 mm Hg +/- 4.4 SD and 21.5 mm Hg +/- 4.5 SD, respectively) immediately after treatment (time 0) as compared with pretreatment (18.1 +/- 4.5 and 18.1 +/- 4.0). However, HVPG in the EBL group returned to baseline values within 48 hours after treatment, while in the EIS group it remained high during the 120-hour study period (P <.0001). Bleeding stopped in all patients after endotherapy. During the 42-day follow-up period, the rebleeding rate over time was lower in the EBL group compared with the EIS group (P =.024). Patients with an initial HVPG greater than 16 mm Hg had, despite endoscopic treatment, a significantly higher likelihood of death (P =.024) and overall failure (P =.037) [correction]. In conclusion, during acute variceal bleeding EIS, but not EBL, causes a sustained increase in HVPG, which is followed by a higher rebleeding rate.

Authors+Show Affiliations

2nd Department of Gastroenterology, Athens University, Evangelismos Hospital, Athens, Greece. alavger@hol.grNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15185303

Citation

Avgerinos, Alec, et al. "Sustained Rise of Portal Pressure After Sclerotherapy, but Not Band Ligation, in Acute Variceal Bleeding in Cirrhosis." Hepatology (Baltimore, Md.), vol. 39, no. 6, 2004, pp. 1623-30.
Avgerinos A, Armonis A, Stefanidis G, et al. Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis. Hepatology. 2004;39(6):1623-30.
Avgerinos, A., Armonis, A., Stefanidis, G., Mathou, N., Vlachogiannakos, J., Kougioumtzian, A., Triantos, C., Papaxoinis, C., Manolakopoulos, S., Panani, A., & Raptis, S. A. (2004). Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis. Hepatology (Baltimore, Md.), 39(6), 1623-30.
Avgerinos A, et al. Sustained Rise of Portal Pressure After Sclerotherapy, but Not Band Ligation, in Acute Variceal Bleeding in Cirrhosis. Hepatology. 2004;39(6):1623-30. PubMed PMID: 15185303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis. AU - Avgerinos,Alec, AU - Armonis,Anastasios, AU - Stefanidis,Gerasimos, AU - Mathou,Nikoleta, AU - Vlachogiannakos,Jiannis, AU - Kougioumtzian,Anastasios, AU - Triantos,Christos, AU - Papaxoinis,Costas, AU - Manolakopoulos,Spilios, AU - Panani,Anna, AU - Raptis,Sotiris A, PY - 2004/6/9/pubmed PY - 2004/8/31/medline PY - 2004/6/9/entrez SP - 1623 EP - 30 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 39 IS - 6 N2 - During variceal bleeding, several factors may increase portal pressure, which in turn may precipitate further bleeding. This study investigates the early effects of endoscopic injection sclerotherapy (EIS) and endoscopic band ligation (EBL) on hepatic venous pressure gradient (HVPG) during acute bleeding and the possible influence in outcome. In 50 cirrhotic patients with bleeding esophageal varices treated with EIS (n = 25) or EBL (n = 25), we performed repeated HVPG measurements before and immediately after endoscopic treatment (time 0) and every 24 hours for a 5-day period. Endotherapy was continued until the varices were too small for further treatment. Both groups were comparable with regard to age, gender, Child-Turcotte-Pugh grade, and HVPG. In the EBL and EIS groups, a significant (P <.0001) increase was observed in mean portal pressure (20.7 mm Hg +/- 4.4 SD and 21.5 mm Hg +/- 4.5 SD, respectively) immediately after treatment (time 0) as compared with pretreatment (18.1 +/- 4.5 and 18.1 +/- 4.0). However, HVPG in the EBL group returned to baseline values within 48 hours after treatment, while in the EIS group it remained high during the 120-hour study period (P <.0001). Bleeding stopped in all patients after endotherapy. During the 42-day follow-up period, the rebleeding rate over time was lower in the EBL group compared with the EIS group (P =.024). Patients with an initial HVPG greater than 16 mm Hg had, despite endoscopic treatment, a significantly higher likelihood of death (P =.024) and overall failure (P =.037) [correction]. In conclusion, during acute variceal bleeding EIS, but not EBL, causes a sustained increase in HVPG, which is followed by a higher rebleeding rate. SN - 0270-9139 UR - https://www.unboundmedicine.com/medline/citation/15185303/Sustained_rise_of_portal_pressure_after_sclerotherapy_but_not_band_ligation_in_acute_variceal_bleeding_in_cirrhosis_ L2 - https://doi.org/10.1002/hep.20236 DB - PRIME DP - Unbound Medicine ER -