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Endoscopic treatment of esophagogastric variceal bleeding in patients with noncirrhotic extrahepatic portal vein thrombosis: a long-term follow-up study.
Gastrointest Endosc. 2008 May; 67(6):821-7.GE

Abstract

BACKGROUND

Esophagogastric variceal bleeding is the most important complication of extrahepatic portal vein thrombosis (EPVT) and is usually treated endoscopically. Little is known about the prognosis of these patients.

OBJECTIVES

To investigate the long-term clinical outcome and efficacy of endoscopic treatment in patients with esophagogastric variceal bleeding secondary to EPVT.

DESIGN

Retrospective observational study.

SETTINGS

Single university center.

PATIENTS

Twenty-seven consecutive patients with esophagogastric variceal bleeding, secondary to noncirrhotic, nonmalignant EPVT, who underwent endoscopic treatment between 1982 and 2005.

INTERVENTIONS

Endoscopic band ligation and/or endoscopic sclerotherapy.

MAIN OUTCOME MEASUREMENTS

The overall rebleeding risk, overall survival, complications of the endoscopic procedures, and predictive values of rebleeding. Analyses were performed by the Kaplan-Meier method and univariate Cox regression.

RESULTS

All patients were followed-up after the first endoscopically treated variceal bleeding. A total of 241 endoscopic procedures were performed. In all patients, initial control of bleeding was obtained. The overall rebleeding risk was 23% (95% CI, 0%-24%) at 1 year and 37% (95% CI, 43%-83%) at 5 years. Extension of thrombosis into the splenic vein and the presence of fundal varices were significant predictors of rebleeding, with a nearly 5-fold increased risk for patients with EPVT and fundal varices at the time of the first variceal hemorrhage (hazard ratio 5.07, P = .01). A portosystemic shunt procedure was performed in 5 patients: 4 for variceal bleeding and in one patient for refractory ascites. Seven patients died, none from variceal bleeding. Overall 5-year and 10-year survivals were 100% and 62% (95% CI, 38%-96%), respectively.

LIMITATIONS

Retrospective design.

CONCLUSIONS

In patients with variceal bleeding secondary to EPVT endoscopic treatment, in particular, band ligation appears safe and effective. EPVT-related mortality is primarily determined by other causes than variceal bleeding.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18206153

Citation

Spaander, Manon C W., et al. "Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients With Noncirrhotic Extrahepatic Portal Vein Thrombosis: a Long-term Follow-up Study." Gastrointestinal Endoscopy, vol. 67, no. 6, 2008, pp. 821-7.
Spaander MC, Darwish Murad S, van Buuren HR, et al. Endoscopic treatment of esophagogastric variceal bleeding in patients with noncirrhotic extrahepatic portal vein thrombosis: a long-term follow-up study. Gastrointest Endosc. 2008;67(6):821-7.
Spaander, M. C., Darwish Murad, S., van Buuren, H. R., Hansen, B. E., Kuipers, E. J., & Janssen, H. L. (2008). Endoscopic treatment of esophagogastric variceal bleeding in patients with noncirrhotic extrahepatic portal vein thrombosis: a long-term follow-up study. Gastrointestinal Endoscopy, 67(6), 821-7. https://doi.org/10.1016/j.gie.2007.08.023
Spaander MC, et al. Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients With Noncirrhotic Extrahepatic Portal Vein Thrombosis: a Long-term Follow-up Study. Gastrointest Endosc. 2008;67(6):821-7. PubMed PMID: 18206153.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic treatment of esophagogastric variceal bleeding in patients with noncirrhotic extrahepatic portal vein thrombosis: a long-term follow-up study. AU - Spaander,Manon C W, AU - Darwish Murad,Sarwa, AU - van Buuren,Henk R, AU - Hansen,Bettina E, AU - Kuipers,Ernst J, AU - Janssen,Harry L A, Y1 - 2008/01/18/ PY - 2007/04/25/received PY - 2007/08/09/accepted PY - 2008/1/22/pubmed PY - 2008/8/22/medline PY - 2008/1/22/entrez SP - 821 EP - 7 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 67 IS - 6 N2 - BACKGROUND: Esophagogastric variceal bleeding is the most important complication of extrahepatic portal vein thrombosis (EPVT) and is usually treated endoscopically. Little is known about the prognosis of these patients. OBJECTIVES: To investigate the long-term clinical outcome and efficacy of endoscopic treatment in patients with esophagogastric variceal bleeding secondary to EPVT. DESIGN: Retrospective observational study. SETTINGS: Single university center. PATIENTS: Twenty-seven consecutive patients with esophagogastric variceal bleeding, secondary to noncirrhotic, nonmalignant EPVT, who underwent endoscopic treatment between 1982 and 2005. INTERVENTIONS: Endoscopic band ligation and/or endoscopic sclerotherapy. MAIN OUTCOME MEASUREMENTS: The overall rebleeding risk, overall survival, complications of the endoscopic procedures, and predictive values of rebleeding. Analyses were performed by the Kaplan-Meier method and univariate Cox regression. RESULTS: All patients were followed-up after the first endoscopically treated variceal bleeding. A total of 241 endoscopic procedures were performed. In all patients, initial control of bleeding was obtained. The overall rebleeding risk was 23% (95% CI, 0%-24%) at 1 year and 37% (95% CI, 43%-83%) at 5 years. Extension of thrombosis into the splenic vein and the presence of fundal varices were significant predictors of rebleeding, with a nearly 5-fold increased risk for patients with EPVT and fundal varices at the time of the first variceal hemorrhage (hazard ratio 5.07, P = .01). A portosystemic shunt procedure was performed in 5 patients: 4 for variceal bleeding and in one patient for refractory ascites. Seven patients died, none from variceal bleeding. Overall 5-year and 10-year survivals were 100% and 62% (95% CI, 38%-96%), respectively. LIMITATIONS: Retrospective design. CONCLUSIONS: In patients with variceal bleeding secondary to EPVT endoscopic treatment, in particular, band ligation appears safe and effective. EPVT-related mortality is primarily determined by other causes than variceal bleeding. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/18206153/Endoscopic_treatment_of_esophagogastric_variceal_bleeding_in_patients_with_noncirrhotic_extrahepatic_portal_vein_thrombosis:_a_long_term_follow_up_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(07)02559-X DB - PRIME DP - Unbound Medicine ER -