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| 1/2017 Artykuł oryginalny Burak Suvak , Murat Kekilli , Yavuz Beyazit , Sarper Okten , Alpaslan Tanoglu , Nurgul Sasmaz Data publikacji online: 2016/10/26 Plik artykułu: - is computerised.pdf[0.11 MB] ENWEndNoteBIBJabRef, MendeleyRISPapers, Reference Manager, RefWorks, Zotero AMA APA Chicago Harvard MLA Vancouver IntroductionLiver cirrhosis is frequently complicated by the development of portal hypertension. Depending on the severity of liver disease, between 50% and 80% of patients with cirrhosis will finally develop oesophageal or gastric varices [1]. Because of the significant morbidity and mortality associated with bleeding from varices, patients with cirrhosis undergo screening for oesophageal varices (EVs) and gastric varices (GVs) using upper gastrointestinal endoscopy [2, 3]. Gastric varices are less common than EVs, occurring in approximately 20% of patients with portal hypertension (PHT) [4]. Although GVs bleed less frequently than EVs, bleeding tends to be more severe, to require more transfusions, and to have a higher mortality rate than EV bleeding [5]. AimWe carried out a retrospective comparison of CT imaging against upper gastrointestinal endoscopy for the detection of gastric varices. Thus, the goal of this study was to investigate the value of CT examination in the early detection of GVs. Material and methodsIn this retrospective study, a total of 216 consecutive patients with cirrhosis were evaluated at Turkiye Yuksek Ihtisas Training and Research Hospital between September 2008 and March 2011. Diagnosis of liver cirrhosis was based on a previous liver biopsy or compatible clinical, laboratory, and imaging findings. Exclusion criteria included an inability to provide consent, a recent history (7 days) of upper gastrointestinal bleeding, previous portosystemic shunt procedure, or previous liver transplantation. In addition, patients with thyroid hormone abnormalities or renal insufficiency, defined as a serum creatinine of 1.7 mg/dl in non-diabetics or 1.5 mg/dl in diabetics, were excluded given concerns regarding the requirement of intravenous contrast during CT. One hundred and thirty patients met the inclusion criteria for screening for oesophageal varices. All patients were scheduled to undergo upper gastrointestinal endoscopy. Statistical analysisThe Statistical Package for Social Sciences (SPSS) 18.0 for Windows was used to analyse the data. Data were expressed as mean ± SD for normally distributed variables, as median and range for non-normally distributed variables, and count and percentage for categorical variables. Categorical variables were compared with the 2 test or Fisher’s exact test, and continuous variables were compared with Student’s t-test or the Mann-Whitney test as appropriate. A p-value < 0.05 indicated statistical significance. ResultsOne hundred and thirty patients with cirrhosis were enrolled in the study. The mean age of the male (88 cases) patients was 59.45 ±2.42 years, and the mean age of the female (42 cases) patients was 56.29 ±1.14 years. Patient characteristics are detailed in Table I. The aetiologies of liver cirrhosis were cryptogenic (37 cases), hepatitis B (63 cases), alcohol (2 cases), hepatitis C (15 cases), hepatoportal sclerosis (4 cases), portal vein thrombosis (5 cases), primary biliary cirrhosis (2 cases), Wilson’s disease (1 case), and Budd-Chiari syndrome (1 case). Table I shows the performance of CT in detecting GVs identified on endoscopy. Computerised tomography identified EVs in 103/130 patients, and endoscopy identified EVs in 103/130 patients. Computerised tomography identified GVs in 86/130 patients, and endoscopy identified GVs in 26/130 patients. After endoscopic elastic band ligation (EBL), CT identified GVs in 22/26 patients, and endoscopy identified GVs in 7/26 patients. Although there were no significant differences in the model for end-stage liver disease (MELD) score between cirrhotic patients with and without GVs on screening endoscopy, a significant difference was observed between these groups in respect to MELD scores. DiscussionGastric varices are a common and serious complication of portal hypertension [5]. Gastric varices are discovered most commonly during screening of patients with PHT for varices or at the time of the first variceal bleed, at which time the bleeding is usually caused by associated EVs [8]. Standard video endoscopy underestimates the true prevalence of gastric varices in patients with PHT. Gastric varices lie in the submucosa, deeper than EVs, and distinguishing GVs from gastric rugae may be difficult with video endoscopy. However, not all gastric varices have a serpiginous form or a venous colour, which can make it challenging to distinguish among gastric varices, submucosal tumours, and thickened mucosal folds with endoscopic imaging alone [9]. Radiographic imaging modalities such as splenoportography, magnetic resonance venography or CT angiography, and endoscopic ultrasonography have shown that a significant number of GVs are not evident at endoscopy [10, 11]. The goal of this retrospective study was to investigate the value of CT examination in the early detection of gastric varices. Conflict of interestThe authors declare no conflict of interest. References1.D’Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis 1999; 19: 475-505. Received: 20.04.2015 Copyright: © 2016 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
FAQs
What is the best imaging for esophageal varices? ›
Imaging modalities. The gold-standard for evaluation of esophageal varices is esophagogastroduodenoscopy, but radiographic modalities, such as CT, MRI, and ultrasonography, have been studied as noninvasive means of diagnosing esophageal varices and evaluating the risk of bleeding.
What is gastric varices endoscopic? ›Gastric varices (GV) are a bunch of vessels in the mucosa/submucosa of the stomach and part of a complex collection of vascular shunts between the portal and systemic circulation. 1.
What is the best scan for esophagus? ›Computed tomography (CT) scan
This test can help tell if esophageal cancer has spread to nearby organs and lymph nodes (bean-sized collections of immune cells to which cancers often spread first) or to distant parts of the body. Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast.
Nuclear scintigraphy (Tc-99m-labeled red cell scan) is the most sensitive modality in detecting occult GI bleeding.
How long is life expectancy with esophageal varices? ›At the end of the study, 60.1% of the patients had died at a median age of 69 years (range 26-95). One patient was lost to follow-up. Median survival from the time of variceal diagnosis was 59 months (CI 95%: 45-73 months).
Can you recover from esophageal varices? ›Varices sometimes reduce with treatment, especially if portal hypertension can be reduced. But they rarely go away completely. Once you've been diagnosed with esophageal varices, your healthcare provider will want to keep a close eye on your condition. Even with treatment, new bleeding is always a risk.
What is the best treatment for gastric varices? ›Cyanoacrylate glues: Cyanoacrylate can polymerize rapidly with blood or tissue fluids. Hence, it is used as a tissue adhesive technique for treating gastric varices. In combination with N-butyl-cyanoacrylate and isobutyl-2-cyanoacrylate, it is injected into the veins through a needle by endoscopy.
Esophageal varices on computed tomography ...National Institutes of Health (NIH) (.gov)https://www.ncbi.nlm.nih.gov ›Esophageal varices on computed tomography ...
A prospective evaluation of computerized ...
Esophageal Varices in Patients with Cirrhosis ...
Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices.
Can you see esophageal varices on a CT scan? ›Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices. An ultrasound test called transient elastography may be used to measure scarring in the liver.
What is the best imaging test to evaluate for varicose veins? ›
An ultrasound for varicose veins can confirm your diagnosis and ensure other vascular disorders are not the cause of your pain or discomfort.
What is the best modality of imaging for the esophagus? ›The imaging modalities- CT, EUS, PET/CT and MRI, are usually complementary in the staging of esophageal cancer. EUS is the modality of choice for T staging, while CT and PET/CT are most effective at detecting metastasis.