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Kumar N, Srivastava A, Kumari N, Mittal S, Yachha SK, Nayez Z, Poddar U. Prevalence, nature, and predictors of colonic changes in children with extrahepatic portal vein obstruction. Gastrointest Endosc 2020; 91:849-858. [PMID: 31816313 DOI: 10.1016/j.gie.2019.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The medical literature on colonic changes in children with extrahepatic portal venous obstruction (EHPVO) is limited. We evaluated EHPVO children for prevalence, nature, and relation of colonic changes with disease duration, extent of splenoportal axis (SPA) thrombosis, portal hypertensive gastropathy (PHG), and esophageal varices (EVs). The correlation between histologic and endoscopic changes was studied. METHODS Subjects were evaluated by colonoscopy with ileoscopy and biopsy sampling, clinico-laboratory profiles, and SPA imaging. Colonic changes were classified as varices (rectal/colonic) and portal hypertensive colopathy (PHC; colitis-like or vascular lesions). Morphometric analysis of colonic biopsy specimens was performed. RESULTS Fifty-four children (median age, 12 years [range, 8-15]; hematochezia in 9 [16.6%]) were evaluated. Rectal and colonic varices were seen in 51 (94%) and 2 (3.7%) cases, respectively. Seventy-five percent of patients had PHC, and colitis-like lesions were more common than vascular lesions (36/40 vs 23/40; P = .001). Colopathy changes were pancolonic in 52.5%, left-sided in 42.5%, and right-sided in 5% of cases. Sixteen percent of patients (8/49) had ileal changes. Children with PHC had PHG more often (90% vs 57%; P = .01), more endotherapy sessions (mean 6 [range, 4-8] vs 2 [range, 1-4]; P = .03), and large EVs less often (12.5% vs 43%; P = .02) than those without colopathy. The extent of SPA thrombosis was similar in patients with and without PHC. The number of capillaries per crypt was higher in EHPVO than in control subjects. Morphometric changes had no correlation with endoscopy. CONCLUSIONS Most EHPVO children had colonic changes, and 16% had ileopathy. "Colitis-like" changes and left-side involvement were more common. Patients with PHG and eradicated EVs had a higher risk of PHC.
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Affiliation(s)
- Nagendra Kumar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Niraj Kumari
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Somit Mittal
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Surender K Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Zafar Nayez
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
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Abstract
Complications of portal hypertension include portal hypertensive gastropathy and colopathy. These disorders may cause chronic or acute gastrointestinal bleeding. The diagnosis is made endoscopically; therefore, there is great variability in their assessment. Portal hypertensive gastropathy can range from a mosaic-like pattern resembling snakeskin mucosa to frankly bleeding petechial lesions. Portal hypertensive colopathy has been less well-described and is variably characterized (erythema, vascular lesions, petechiae). Treatment is challenging and results are inconsistent. Currently, available evidence does not support the use of beta-blockers for primary prevention. Further investigation of the pathogenesis, natural history, and treatment of these disorders is needed.
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Oho K. Diagnosis and Endoscopic Classification of Portal Hypertensive Gastroenteropathy. CLINICAL INVESTIGATION OF PORTAL HYPERTENSION 2019:463-472. [DOI: 10.1007/978-981-10-7425-7_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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Shalaby H, El-Meghawry ES, Al-Azhary S, Elfayoumy KN, Zeid ESA. Portal hypertensive colopathy in Egyptian cirrhotic patients: an endoscopic study. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_42_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Branco JC, Carvalho R, Alberto SF, Reis J. Long-acting octreotide is effective in the treatment of portal hypertensive colopathy. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:536-537. [PMID: 28012579 DOI: 10.1016/j.gastrohep.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Joana C Branco
- Serviço de Gastrenterologia - Hospital Professor Doutor Fernando da Fonseca, Amadora, Lisboa, Portugal.
| | - Rita Carvalho
- Serviço de Gastrenterologia - Hospital Professor Doutor Fernando da Fonseca, Amadora, Lisboa, Portugal
| | - Sara F Alberto
- Serviço de Gastrenterologia - Hospital Professor Doutor Fernando da Fonseca, Amadora, Lisboa, Portugal
| | - Jorge Reis
- Serviço de Gastrenterologia - Hospital Professor Doutor Fernando da Fonseca, Amadora, Lisboa, Portugal
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Guimarães RAP, Perazzo H, Machado L, Terra C, Perez RM, Figueiredo FAF. Prevalence, variability, and outcomes in portal hypertensive colopathy: a study in patients with cirrhosis and paired controls. Gastrointest Endosc 2015; 82:469-76.e2. [PMID: 25841578 DOI: 10.1016/j.gie.2015.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of portal hypertensive colopathy (PHC) has been challenged by controversial results in its prevalence and clinical relevance. OBJECTIVE To describe the PHC prevalence and to evaluate the variability in diagnosis, the relation to severity of liver disease, and the incidence of severe outcomes. DESIGN Cross-sectional study. SETTING Endoscopic unit of a tertiary-care academic center in Rio de Janeiro, Brazil. PATIENTS Patients with cirrhosis with portal hypertension and controls paired for age and sex. INTERVENTIONS All patients were submitted to standard and image-enhanced colonoscopies, which were recorded in a coded video file and analyzed twice by a blinded endoscopist. MAIN OUTCOME MEASUREMENTS The prevalence of PHC. RESULTS A total of 51 patients with cirrhosis (55% male, mean age 59 years) and 51 healthy controls (43% male, mean age 61 years) were included. The top ranking colonoscopic findings were angiodysplasia-like lesions, nonspecific vascular pattern, red spots, and colorectal varices, all significantly more frequent in patients with cirrhosis compared with controls. PHC prevalence was 71% in patients with cirrhosis. For PHC, interobserver and intraobserver agreement (k values [standard error]) were 0.68 (0.09) and 0.63 (0.10), respectively. Intraobserver agreement for colonoscopic findings was satisfactory. PHC was not related to more severe liver disease or liver stiffness. Only 5 patients developed severe outcomes during follow-up. LIMITATIONS The exclusion of patients with cirrhosis without esophageal varices and the absence of an interobserver agreement analysis by double-blinded endoscopists. CONCLUSION PHC was highly prevalent in patients with cirrhosis, and its diagnostic agreement was satisfactory. PHC is not associated with relevant severe outcomes in a 12-month follow-up.
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Affiliation(s)
- Raquel A P Guimarães
- Gastroenterology and Hepatology Department, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hugo Perazzo
- Laboratory of Clinical Research on STD/AIDS, National Institute of Infectious Disease-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Lilian Machado
- Gastroenterology and Hepatology Department, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Terra
- Gastroenterology and Hepatology Department, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata M Perez
- Gastroenterology and Hepatology Department, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fatima A F Figueiredo
- Gastroenterology and Hepatology Department, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Rodríguez-Castro KI, Antonello A, Ferrarese A. Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most? World J Hepatol 2015; 7:1818-1827. [PMID: 26207163 PMCID: PMC4506939 DOI: 10.4254/wjh.v7.i14.1818] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/30/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
The more modern and accurate concept of a rebalanced hemostatic status in cirrhosis is slowly replacing the traditional belief of patients with cirrhosis being “auto-anticoagulated”, prone only to bleeding complications, and protected from thrombotic events. With greater attention to clinical thrombotic events, their impact on the natural history of cirrhosis, and with the emergence and increased use of point-of-care and global assays, it is now understood that cirrhosis results in profound hemostatic alterations that can lead to thrombosis as well as to bleeding complications. Although many clinical decisions are still based on traditional coagulation parameters such as prothrombin (PT), PT, and international normalized ratio, it is increasingly recognized that these tests do not adequately predict the risk of bleeding, nor they should guide pre-emptive interventions. Moreover, altered coagulation tests should not be considered as a contraindication to the use of anticoagulation, although this therapeutic or prophylactic approach is not at present routinely undertaken. Gastroesophageal variceal bleeding continues to be one of the most feared and deadly complications of cirrhosis and portal hypertension, but great progresses have been made in prevention and treatment strategies. Other bleeding sites that are frequently part of end-stage liver disease are similar to clinical manifestations of thrombocytopenia, with gum bleeding and epistaxis being very common but fortunately only rarely a cause of life-threatening bleeding. On the contrary, manifestations of coagulation factor deficiencies like soft tissue bleeding and hemartrosis are rare in patients with cirrhosis. As far as thrombotic complications are concerned, portal vein thrombosis is the most common event in patients with cirrhosis, but venous thromboembolism is not infrequent, and results in important morbidity and mortality in patients with cirrhosis, especially those with decompensated disease. Future studies and the more widespread use of point-of-care tests in evaluating hemostasis will aid the clinician in decision making when facing the patient with bleeding or with thrombotic complications, with both ends of a continuum being potentially fatal.
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Abstract
Portal hypertensive gastropathy (PHG) and colopathy (PHC) are considered complications of portal hypertension. Both entities are clinically relevant because they may cause insidious blood loss or even acute massive gastrointestinal hemorrhage. Endoscopic evaluation is necessary for the diagnosis of PHG and PHC. The existence of different endoscopic criteria for PHG and PHC makes consensus difficult and results in a broad range of reported prevalence. Therapy targeted at reduction of portal pressure and mucosal blood flow has been used to treat acute bleeding; nonselective β-blockers are the most frequently used agents. Further studies are needed to clarify the natural history, pathogenesis, and treatment of PHG and PHC.
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Affiliation(s)
- Nathalie H. Urrunaga
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 22 S. Greene Street, N3W156, Baltimore, MD 21201, USA
| | - Don C. Rockey
- Department of Internal Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, Charleston, SC 29425, USA,Corresponding author.
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Gad YZ, Zeid AA. Portal hypertensive colopathy and haematochezia in cirrhotic patients: an endoscopic study. Arab J Gastroenterol 2011; 12:184-8. [PMID: 22305498 DOI: 10.1016/j.ajg.2011.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 09/25/2011] [Accepted: 11/14/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS In patients with liver cirrhosis, portal hypertensive colopathy (PHC) and anorectal varices (ARVs) are thought to cause lower gastrointestinal (GI) bleeding. In the present work, we studied the diagnostic yield of colonoscopy in cirrhotic patients and haematochezia. PATIENTS AND METHODS The current study was conducted on 77 consecutive cirrhotic patients who underwent colonoscopy at Mansoura Emergency Hospital, Egypt, between May 2007 and May 2011. Following rapid evaluation and adequate resuscitation, a thorough history was obtained with complete physical examination including digital rectal examination and routine laboratory investigations. Colonoscopic evaluation was performed for the included patients by recording endoscopic abnormalities and obtaining biopsies from lesions. RESULTS There was no significant difference between the PHC-positive group when compared with the PHC-negative group regarding patients' age, sex, severity of haematochezia, positive family history and the history of intake of non-steroidal anti-inflammatory drugs (NSAIDs). Significant difference was noted regarding the Child-Pugh class (p<0.05), history of splenectomy (p<0.05), prior history of endoscopic sclerotherapy (EST) or endoscopic variceal ligation (EVL) (p<0.05), prior history of upper gut bleeding (p<0.05), the presence of gastric varices (GVs) (p<0.05), presence of portal hypertensive gastropathy (PHG) (p<0.05), presence of haemorrhoids (p<0.05) and rectal varices (<0.05) and therapy with β-blockers (p<0.05). Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group (p<0.05). All the PHC-related sources of bleeding (7/32 cases (21.87%)) were successfully managed with argon plasma coagulation. Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group (p<0.05). All the PHC-related sources of bleeding (7/32 cases (21.87%)) were successfully managed with argon plasma coagulation. CONCLUSION Our data revealed that it is not only PHC which is involved in haematochezia in cirrhotic patients despite the significant association. Instead, a high prevalence of inflammatory lesions came on the top of the list. Complete colonoscopy is highly advocated to detect probable proximal neoplastic lesions.
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Affiliation(s)
- Yahia Z Gad
- Internal Medicine, Hepatogastroenterology Unit, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt.
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Zaher T, Ibrahim I, Ibrahim A. Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension. Arab J Gastroenterol 2011; 12:11-4. [PMID: 21429448 DOI: 10.1016/j.ajg.2011.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 07/25/2010] [Accepted: 09/25/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Portal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation (EBL) of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy (SH) in Egyptian patients with portal hypertension. PATIENTS AND METHODS In this study, 26 portal hypertensive patients (with oesophageal and/or fundal varices) with a grade 2-4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL (13 patients) or SH (13 patients) after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12months. RESULTS Goligher's grades of internal haemorrhoids improved significantly (p=0.018) 12weeks after SH (from 2.9±0.8 to 0.4±0.5; p=0.001) and after EBL (from 2.8±0.8 to 1.1±0.8; p=0.001). Symptom (bleeding and prolapse) scores significantly improved 4weeks after both EBL (from 1.6±0.8 to 0.6±0.8; p<0.001 and from 1.6±0.9 to 0.5±0.5; p=0.002, respectively) and SH (from 1.8±0.8 to 0.2±0.4; p=0.002 and from 1.5±0.9 to 0.2±0.4; p=0.001, respectively). The differences after 4weeks between EBL and SH were not significant (p=0.168 and p=0.225). Pain requiring analgesics occurred in five patients (38.5%) after EBL, compared with six (46.2%) after SH (p=0.691). Minimal bleeding occurred in two patients (15.4%) after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH. CONCLUSION For portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However further studies are needed to evaluate EBL in different grades of cirrhosis.
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Affiliation(s)
- Tarik Zaher
- Gastrointestinal Endoscopy Unit, Endemic and Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Yang SX, Zhao JM, Xu SS. Correlation of D-xylose absorption rate with portal pressure in rats with portal hypertension. Shijie Huaren Xiaohua Zazhi 2010; 18:9-13. [DOI: 10.11569/wcjd.v18.i1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the dynamic changes in D-xylose absorption rate during the progression of portal hypertension to find a noninvasive and practical method to evaluate portal pressure.
METHODS: Eighty male Sprague-Dawley rats, weighing 180-220 g, were randomly divided into two groups: normal control group (n = 5) and model group (n = 75). Fifty-five model rats were randomly divided into 11 subgroups (n = 5). The normal control group was given normal drinking water, while the model group was given 0.03% thioacetamide (TAA) for 5 weeks and 0.04% TAA for another 5 weeks. The pathological changes in the liver and portal pressure were monitored until 6 weeks after withdrawal of TAA. The D-xylose content of the urine and portal pressure were determined at weeks 2, 4, 6, 8, 10, 11, 12, 13, 14, 15, and 16, respectively. The correlation between D-xylose absorption rate and portal pressure was analyzed.
RESULTS: At week 8, apparent fibrous septum hyperplasia, disorganized hepatic lobule architecture, and even pseudolobules were observed. Meanwhile, portal vein pressure and D-xylose absorption rate began to show significant changes. The D-xylose absorption rate is inversely correlated with portal vein pressure (P < 0.01). The correlation coefficient is -0.697, and the linear equation is: y = -0.01x + 0.2791.
CONCLUSION: D-xylose absorption rate can reflect the changes in hepatic portal pressure and can be used to predict portal hypertension pressure and evaluate therapeutic effects in clinical practice.
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Diaz-Sanchez A, Nuñez-Martinez O, Gonzalez-Asanza C, Matilla A, Merino B, Rincon D, Beceiro I, Catalina MV, Salcedo M, Bañares R, Clemente G. Portal hypertensive colopathy is associated with portal hypertension severity in cirrhotic patients. World J Gastroenterol 2009; 15:4781-7. [PMID: 19824111 PMCID: PMC2761555 DOI: 10.3748/wjg.15.4781] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the prevalence of portal hypertension (PH) related colorectal lesions in liver transplant candidates, and to evaluate its association with the severity of PH.
METHODS: Between October 2004 and December 2005, colonoscopy was performed in 92 cirrhotic liver transplant candidates. We described the lesions resulting from colorectal PH and their association with the grade of PH in 77 patients who underwent measurement of hepatic venous pressure gradient (HVPG).
RESULTS: Mean age was 55 years and 80.7% of patients were men. The main etiology of cirrhosis was alcoholism (45.5%). Portal hypertensive colopathy (PHC) was found in 23.9%, colonic varices in 7.6% and polyps in 38% of patients (adenomatous type 65.2%). One asymptomatic patient had a well-differentiated adenocarcinoma. The manifestations of colorectal PH were not associated with the etiology of liver disease or with the Child-Pugh grade. Ninety percent of patients with colopathy presented with gastroesophageal varices (GEV), and 27.5% of patients with GEV presented with colopathy (P = 0.12). A relationship between higher values of HVPG and presence of colopathy was observed (19.9 ± 6.2 mmHg vs 16.8 ± 5.4 mmHg, P = 0.045), but not with the grade of colopathy (P = 0.13). Preneoplastic polyps and neoplasm (P = 0.02) and spontaneous bacterial peritonitis (P = 0.006) were more prevalent in patients with colopathy. We did not observe any association between previous β-blocker therapy and the presence of colorectal portal hypertensive vasculopathy.
CONCLUSION: PHC is common in cirrhotic liver transplant candidates and is associated with higher portal pressure.
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Sharma S, Gurakar A, Jabbour N. Avoiding pitfalls: what an endoscopist should know in liver transplantation--part 1. Dig Dis Sci 2008; 53:1757-73. [PMID: 17990105 DOI: 10.1007/s10620-007-0079-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 10/14/2007] [Indexed: 02/07/2023]
Abstract
Cirrhosis is associated with global homodynamic changes, but the majority of the complications are usually manifested through the gastrointestinal tract. Therefore, Gastrointestinal Endoscopy has become an important tool in the multidisciplinary approach in the management of these patients. With the ever growing number of cirrhotic patients requiring pre-transplant endoscopic management, it is imperative that the community endoscopists are well aware of the pathologies that can be potentially noted on Gastrointestinal Endoscopy. Their timely management is also considered to have the utmost importance in being able to stabilize the patient until their transfer to a Liver Transplant Center. The aim of this manuscript is to give a comprehensive update and review of various endoscopic findings that a non-transplant endoscopist will encounter in the pre-transplant setting.
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Affiliation(s)
- Sharad Sharma
- Baptist Medical Center, Nazih Zuhdi Transplant Institute, 3300 North West Expressway, Oklahoma City, OK 73112, USA.
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Huang WS, Lin PY, Chin CC, Yeh CH, Hsieh CC, Chang TS, Wang JY. Stapled hemorrhoidopexy for prolapsed hemorrhoids in patients with liver cirrhosis; a preliminary outcome for 8-case experience. Int J Colorectal Dis 2007; 22:1083-9. [PMID: 17334772 DOI: 10.1007/s00384-007-0271-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2007] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the efficacy and safety of stapled hemorrhoidopexy in treating prolapsed hemorrhoids in patients with liver cirrhosis. PATIENTS AND METHODS Eight consecutive cases of patients with prolapsed hemorrhoids comorbid with liver cirrhosis, who had intractable response to other interventions, were enrolled in this retrospective study between January 2002 and June 2006 at our institute. Six patients (75%) had Child-Pugh class A liver cirrhosis, whereas only two patients (25%) had class B disease. Rectal varices were identified in three patients (37.5%), and esophageal varices were identified in six patients (75%). Concurrent rectal and esophageal varices existed in three patients (37.5%). The patients underwent stapled hemorrhoidopexy with Proximate PPH-03 in a lithotomy position under spinal/intravenous general anesthesia. RESULTS There was no procedure-related mortality or major complications except hemorrhage. Two patients (25%) were complicated with postoperative staple-line bleeding, which was managed with conservative treatment without reoperation. There were no leading symptoms of relapsing during a follow-up period of at least 6 months. CONCLUSIONS This study may prove that stapled hemorrhoidopexy is a feasible and safe approach for prolapsed hemorrhoids concurrent with liver cirrhosis.
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Affiliation(s)
- Wen-Shih Huang
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, 6, Sec. West, Chia-Pu Road, Putz, Chiayi 613, Taiwan
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Marrero RJ, Barkin JS. Wireless capsule endoscopy and portal hypertensive intestinal vasculopathy. Gastrointest Endosc 2005; 62:535-7. [PMID: 16185967 DOI: 10.1016/j.gie.2005.06.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 06/29/2005] [Indexed: 02/08/2023]
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Abstract
AIM: In patients with liver cirrhosis and portal hypertension, portal hypertensive colopathy is thought to be an important cause of lower gastrointestinal hemorrhage. In this study, we evaluated the prevalence of colonic mucosal changes in patients with liver cirrhosis and its clinical significance.
METHODS: We evaluated the colonoscopic findings and liver function of 47 patients with liver cirrhosis over a 6-year period. The main cause of liver cirrhosis was post-viral hepatitis (68%) related to hepatitis B (6%) or C (62%) infection. All patients underwent upper gastrointestinal endoscopy to examine the presence of esophageal varices, cardiac varices, and congestive gastropathy, as well as a full colonoscopy to observe changes in colonic mucosa. Portal hypertensive colopathy was defined endoscopically in patients with vascular ectasia, redness, and blue vein. Vascular ectasia was classified into two types: type 1, solitary vascular ectasia; and type 2, diffuse vascular ectasia.
RESULTS: Overall portal hypertensive colopathy was present in 31 patients (66%), including solitary vascular ectasia in 17 patients (36%), diffuse vascular ectasia in 20 patients (42%), redness in 10 patients (21%) and blue vein in 6 patients (12%). As the Child-Pugh class increased in severity, the prevalence of portal hypertensive colopathy rose. Child-Pugh class B and C were significantly associated with portal hypertensive colopathy. Portal hypertensive gastropathy, esophageal varices, ascites and hepatocellular carcinoma were not related to occurrence of portal hypertensive colopathy. Platelet count was significantly associated with portal hypertensive colopathy, but prothrombin time, serum albumin level, total bilirubin level and serum ALT level were not related to occurrence of portal hypertensive colopathy.
CONCLUSION: As the Child-Pugh class worsens and platelet count decreases, the prevalence of portal hypertensive colopathy increases in patients with liver cirrhosis. A colonoscopic examination in patients with liver cirrhosis is indicated, especially those with worsening Child-Pugh class and/or decreasing platelet count, to prevent complications such as lower gastrointestinal bleeding.
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Affiliation(s)
- Keiichi Ito
- First Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2003; 11:1569-1571. [DOI: 10.11569/wcjd.v11.i10.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Yoshie K, Fujita Y, Moriya A, Kawana I, Miyamoto K, Umemura S. Octreotide for severe acute bleeding from portal hypertensive colopathy: a case report. Eur J Gastroenterol Hepatol 2001; 13:1111-3. [PMID: 11564965 DOI: 10.1097/00042737-200109000-00020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 56-year-old man developed severe lower gastrointestinal bleeding. He was classified as Child-Pugh grade C. Colonoscopy revealed multiple angiodysplasia-like lesions and mucosal friability throughout the entire colon (portal hypertensive colopathy, PHC). Haemostasis was immediately achieved with octreotide treatment, although melaena recurred after discontinuation of the infusion. Propranolol treatment before discontinuation of octreotide infusin prevented the recurrence of bleeding from PHC. Octreotide is a safe and effective treatment for severe acute bleeding from PHC, especially if the patient is not a candidate for transjugular intrahepatic portosystemic shunt (TIPS) or treatment with a beta-blocker due to the severity of liver disease or haemodynamic instability. However, a sufficient reduction of portal pressure by propranolol or other medical treatment may be needed in order to discontinue octreotide infusion without the recurrence of bleeding.
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Affiliation(s)
- K Yoshie
- Second Department of Internal Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City 236-004, Japan.
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Leone N, Debernardi-Venon W, Marzano A, Garino M, DePaolis P, Grosso M, Fronda GR, Rizzetto M. Portal hypertensive colopathy and hemorrhoids in cirrhotic patients. J Hepatol 2000; 33:1026-7. [PMID: 11131443 DOI: 10.1016/s0168-8278(00)80144-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Motoyama H, Ueki J, Baba Y, Asakura H. Endoscopic Evaluation of Rectal Mucosal Reddening in Patients with Liver Cirrhosis. Dig Endosc 2000. [DOI: 10.1046/j.1443-1661.2000.00049.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Hirotaka Motoyama
- *Third Department of Internal Medicine, Niigata University School of Medicine, Niigata and † Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan
| | - Junichi Ueki
- *Third Department of Internal Medicine, Niigata University School of Medicine, Niigata and † Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan
| | - Yasuyuki Baba
- *Third Department of Internal Medicine, Niigata University School of Medicine, Niigata and † Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan
| | - Hitoshi Asakura
- *Third Department of Internal Medicine, Niigata University School of Medicine, Niigata and † Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan
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Balzer C, Lotterer E, Kleber G, Fleig WE. Transjugular intrahepatic portosystemic shunt for bleeding angiodysplasia-like lesions in portal-hypertensive colopathy. Gastroenterology 1998; 115:167-72. [PMID: 9649472 DOI: 10.1016/s0016-5085(98)70378-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Portal-hypertensive colopathy has attracted interest in recent years because such lesions can cause life-threatening hemorrhage. In contrast to upper gastrointestinal bleeding from varices, there is no established therapy for bleeding from angiodysplasia-like lesions. This case report describes the first successful use of transjugular intrahepatic portosystemic shunt (TIPS) for long-term control of bleeding from angiodysplasia-like colonic lesions in a patient with cirrhosis caused by chronic hepatitis B infection. During an 18-month course after TIPS, angiodysplasia-like lesions disappeared without any further evidence of recurrent hematochezia. TIPS may be helpful as second-line treatment in patients with recurrent portal-hypertensive bleeding from colonic angiodysplasia-like lesions who do not tolerate or are unresponsive to treatment with beta-adrenergic blockers.
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Affiliation(s)
- C Balzer
- First Department of Medicine, Martin-Luther-University Halle-Wittenberg, Germany
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