This editorial describes the contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis(LC)patients according to the current guidelines.Gastroesophageal variceal bleedi...This editorial describes the contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis(LC)patients according to the current guidelines.Gastroesophageal variceal bleeding is the most dangerous complication of portal hypertension in LC patients.Risk stratification and determination of an individual approach to the choice of therapeutic measures aimed at their prevention and management has emerged as one of the top concerns in modern hepatology.According to the current guidelines,in the absence of clinically significant portal hypertension,etiological and nonetiological therapies of LC is advisable for the primary preventing gastroesophageal variceal bleeding,whereas its presence serves as an indication for the administration of non-selectiveβ-blockers,among which carvedilol is the drug of choice.Non-selectiveβ-blockers,as well as endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt can be used to prevent recurrence of gastroesophageal variceal bleeding.Pharmacotherapy with vasoactive drugs(terlipressin,somatostatin,octreotide),endoscopic variceal ligation,endovascular techniques and transjugular intrahepatic portosystemic shunt are recommended for the treatment of acute gastroesophageal variceal bleeding.Objective and accurate risk stratification of gastroesophageal variceal bleeding will allow developing individual strategies for their prevention and management,avoiding the first and further decompensation in LC,which will improve the prognosis and survival of patients suffering from it.展开更多
This editorial describes the milestones to optimize of transjugular intrahepatic portosystemic shunt(TIPS)technique,which have made it one of the main methods for the treatment of portal hypertension complications wor...This editorial describes the milestones to optimize of transjugular intrahepatic portosystemic shunt(TIPS)technique,which have made it one of the main methods for the treatment of portal hypertension complications worldwide.Innovative ideas,subsequent experimental studies and preliminary experience of use in cirrhotic patients contributed to the introduction of TIPS into clinical practice.At the moment,the main achievement in optimize of TIPS technique is progress in the qualitative characteristics of stents.The transition from bare metal stents to extended polytetrafluoroethylene–covered stent grafts made it possible to significantly prevent shunt dysfunction.However,the question of its preferred diameter,which contributes to an optimal reduction of portal pressure without the risk of developing post-TIPS hepatic encephalopathy,remains relevant.Currently,hepatic encephalopathy is one of the most common complications of TIPS,significantly affecting its effectiveness and prognosis.Careful selection of patients based on cognitive indicators,nutritional status,assessment of liver function,etc.,will reduce the incidence of post-TIPS hepatic encephalopathy and improve treatment results.Optimize of TIPS technique has significantly expanded the indications for its use and made it one of the main methods for the treatment of portal hypertension complications.At the same time,there are a number of limitations and unresolved issues that require further randomized controlled trials involving a large cohort of patients.展开更多
目的探讨食管胃静脉曲张出血后行内镜二级预防或TIPS二级预防的选择依据,评估肝静脉压力梯度(HVPG)协助临床决策的价值。方法回顾性分析了2016年1月-2018年2月解放军总医院第五医学中心食管胃静脉曲张出血后测得HVPG在12mm Hg以上并接...目的探讨食管胃静脉曲张出血后行内镜二级预防或TIPS二级预防的选择依据,评估肝静脉压力梯度(HVPG)协助临床决策的价值。方法回顾性分析了2016年1月-2018年2月解放军总医院第五医学中心食管胃静脉曲张出血后测得HVPG在12mm Hg以上并接受内镜或TIPS二级预防的患者148例,依据指南意见,HVPG>18 mm Hg是食管胃静脉曲张再出血的高危因素,将148例患者分为中压力组(HVPG 12~18 mm Hg)78例和高压力组(HVPG>18 mm Hg)70例,归纳两组的临床特点和内镜表现。再细化为12~16 mm Hg、>16~18 mm Hg、>18~20 mm Hg和>20 mm Hg 4组,对比各组行不同二级预防方式的安全性和有效性,重点关注再出血及预后情况。计量资料2组间比较采用独立样本t检验,计数资料2组间比较采用χ^2检验,等级资料多组间比较采用Kruskal-Wallis H检验。结果二级预防前中压力组和高压力组的血红蛋白、血小板、白蛋白、胆红素、肌酐、血氨和凝血酶原时间、Child-Pugh评分和MELD评分比较,差异均无统计学意义(P值均>0.05),中压力组有67.95%的患者存在侧支循环开放,显著多于高压力组的50.00%(χ^2=11.250,P=0.004)。中压力组和高压力组的食管胃静脉曲张LDRf分型差异无统计学意义(P>0.05)。高压力组选择TIPS的患者比例(28.57%)较中压力组患者(10.26%)显著增多(χ^2=8.067,P=0.005)。二级预防后,平均随访(28.66±11.20)个月,未发生严重并发症,各组各预防方式患者肝硬化病程没有明显进展,腹水情况好转。随着HVPG值的增高,内镜二级预防后的1年内再出血率呈现增高趋势,HVPG>20 mm Hg的患者中有41.03%在1年内追加预防治疗。HVPG 12~16 mm Hg的患者,内镜预防疗效好,一年内再出血率为14.63%。HVPG>20 mm Hg组内镜预防1年内再出血率为34.48%,TIPS预防1年内再出血率为10%。结论建议基于HVPG值指导静脉曲张出血二级预防方式的选择,制订不同HVPG值患者二级预防后的随访计划,开展个体化治疗。展开更多
文摘This editorial describes the contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis(LC)patients according to the current guidelines.Gastroesophageal variceal bleeding is the most dangerous complication of portal hypertension in LC patients.Risk stratification and determination of an individual approach to the choice of therapeutic measures aimed at their prevention and management has emerged as one of the top concerns in modern hepatology.According to the current guidelines,in the absence of clinically significant portal hypertension,etiological and nonetiological therapies of LC is advisable for the primary preventing gastroesophageal variceal bleeding,whereas its presence serves as an indication for the administration of non-selectiveβ-blockers,among which carvedilol is the drug of choice.Non-selectiveβ-blockers,as well as endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt can be used to prevent recurrence of gastroesophageal variceal bleeding.Pharmacotherapy with vasoactive drugs(terlipressin,somatostatin,octreotide),endoscopic variceal ligation,endovascular techniques and transjugular intrahepatic portosystemic shunt are recommended for the treatment of acute gastroesophageal variceal bleeding.Objective and accurate risk stratification of gastroesophageal variceal bleeding will allow developing individual strategies for their prevention and management,avoiding the first and further decompensation in LC,which will improve the prognosis and survival of patients suffering from it.
文摘This editorial describes the milestones to optimize of transjugular intrahepatic portosystemic shunt(TIPS)technique,which have made it one of the main methods for the treatment of portal hypertension complications worldwide.Innovative ideas,subsequent experimental studies and preliminary experience of use in cirrhotic patients contributed to the introduction of TIPS into clinical practice.At the moment,the main achievement in optimize of TIPS technique is progress in the qualitative characteristics of stents.The transition from bare metal stents to extended polytetrafluoroethylene–covered stent grafts made it possible to significantly prevent shunt dysfunction.However,the question of its preferred diameter,which contributes to an optimal reduction of portal pressure without the risk of developing post-TIPS hepatic encephalopathy,remains relevant.Currently,hepatic encephalopathy is one of the most common complications of TIPS,significantly affecting its effectiveness and prognosis.Careful selection of patients based on cognitive indicators,nutritional status,assessment of liver function,etc.,will reduce the incidence of post-TIPS hepatic encephalopathy and improve treatment results.Optimize of TIPS technique has significantly expanded the indications for its use and made it one of the main methods for the treatment of portal hypertension complications.At the same time,there are a number of limitations and unresolved issues that require further randomized controlled trials involving a large cohort of patients.
文摘目的探讨食管胃静脉曲张出血后行内镜二级预防或TIPS二级预防的选择依据,评估肝静脉压力梯度(HVPG)协助临床决策的价值。方法回顾性分析了2016年1月-2018年2月解放军总医院第五医学中心食管胃静脉曲张出血后测得HVPG在12mm Hg以上并接受内镜或TIPS二级预防的患者148例,依据指南意见,HVPG>18 mm Hg是食管胃静脉曲张再出血的高危因素,将148例患者分为中压力组(HVPG 12~18 mm Hg)78例和高压力组(HVPG>18 mm Hg)70例,归纳两组的临床特点和内镜表现。再细化为12~16 mm Hg、>16~18 mm Hg、>18~20 mm Hg和>20 mm Hg 4组,对比各组行不同二级预防方式的安全性和有效性,重点关注再出血及预后情况。计量资料2组间比较采用独立样本t检验,计数资料2组间比较采用χ^2检验,等级资料多组间比较采用Kruskal-Wallis H检验。结果二级预防前中压力组和高压力组的血红蛋白、血小板、白蛋白、胆红素、肌酐、血氨和凝血酶原时间、Child-Pugh评分和MELD评分比较,差异均无统计学意义(P值均>0.05),中压力组有67.95%的患者存在侧支循环开放,显著多于高压力组的50.00%(χ^2=11.250,P=0.004)。中压力组和高压力组的食管胃静脉曲张LDRf分型差异无统计学意义(P>0.05)。高压力组选择TIPS的患者比例(28.57%)较中压力组患者(10.26%)显著增多(χ^2=8.067,P=0.005)。二级预防后,平均随访(28.66±11.20)个月,未发生严重并发症,各组各预防方式患者肝硬化病程没有明显进展,腹水情况好转。随着HVPG值的增高,内镜二级预防后的1年内再出血率呈现增高趋势,HVPG>20 mm Hg的患者中有41.03%在1年内追加预防治疗。HVPG 12~16 mm Hg的患者,内镜预防疗效好,一年内再出血率为14.63%。HVPG>20 mm Hg组内镜预防1年内再出血率为34.48%,TIPS预防1年内再出血率为10%。结论建议基于HVPG值指导静脉曲张出血二级预防方式的选择,制订不同HVPG值患者二级预防后的随访计划,开展个体化治疗。
