Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices.
Balloon-occluded retrograde transvenous obliteration (BRTO)
Esophageal varices
Gastric varices
Hepatic venous pressure gradient (HVPG)
Liver stiffness measurement
Journal
BMC gastroenterology
ISSN: 1471-230X
Titre abrégé: BMC Gastroenterol
Pays: England
ID NLM: 100968547
Informations de publication
Date de publication:
22 Dec 2022
22 Dec 2022
Historique:
received:
08
09
2022
accepted:
12
12
2022
entrez:
22
12
2022
pubmed:
23
12
2022
medline:
27
12
2022
Statut:
epublish
Résumé
Balloon-occluded retrograde transvenous obliteration (BRTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbation of esophageal varices (EVs), and prognosis of patients who underwent BRTO for GVs. Thirty-six patients with GVs treated with BRTO were enrolled in this study, and their HVPG was measured before (pre-HVPG) and on the day after BRTO (post-HVPG). After BRTO, patients were followed-up for a median interval of 24.5 (3-140) months. Clinical factors related to EVs exacerbation and prognosis after BRTO were retrospectively analyzed. Post-HVPG increased compared to pre-HVPG in 21 out of 36 patients (58%), and post-HVPG was overall significantly higher compared to pre-HVPG (P = 0.009). During the observation period, 19 patients (53%) developed EVs exacerbation, and the cumulative EVs exacerbation rates at 1, 3 and 5 years after BRTO were 27%, 67%, and 73%, respectively. Pre-HVPG was not related to EVs exacerbation, although elevation of post-HVPG to ≥ 13 mmHg (P < 0.01) and high level of serum aspartate aminotransferase (P < 0.05) were significant independent risk factors for EVs exacerbation after BRTO. Fourteen patients (38.9%) died during the observation period. An elevated value of liver stiffness measurement (LSM) of ≥ 21 kPa was a significant independent risk factor for poor prognosis after BRTO (P < 0.05). HVPG increases after BRTO. HVPG after BRTO has greater predictive ability for subsequent EVs exacerbation than HVPG before BRTO. LSM is a potential prognostic parameter in patients who undergo BRTO.
Sections du résumé
BACKGROUND
BACKGROUND
Balloon-occluded retrograde transvenous obliteration (BRTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbation of esophageal varices (EVs), and prognosis of patients who underwent BRTO for GVs.
METHODS
METHODS
Thirty-six patients with GVs treated with BRTO were enrolled in this study, and their HVPG was measured before (pre-HVPG) and on the day after BRTO (post-HVPG). After BRTO, patients were followed-up for a median interval of 24.5 (3-140) months. Clinical factors related to EVs exacerbation and prognosis after BRTO were retrospectively analyzed.
RESULTS
RESULTS
Post-HVPG increased compared to pre-HVPG in 21 out of 36 patients (58%), and post-HVPG was overall significantly higher compared to pre-HVPG (P = 0.009). During the observation period, 19 patients (53%) developed EVs exacerbation, and the cumulative EVs exacerbation rates at 1, 3 and 5 years after BRTO were 27%, 67%, and 73%, respectively. Pre-HVPG was not related to EVs exacerbation, although elevation of post-HVPG to ≥ 13 mmHg (P < 0.01) and high level of serum aspartate aminotransferase (P < 0.05) were significant independent risk factors for EVs exacerbation after BRTO. Fourteen patients (38.9%) died during the observation period. An elevated value of liver stiffness measurement (LSM) of ≥ 21 kPa was a significant independent risk factor for poor prognosis after BRTO (P < 0.05).
CONCLUSIONS
CONCLUSIONS
HVPG increases after BRTO. HVPG after BRTO has greater predictive ability for subsequent EVs exacerbation than HVPG before BRTO. LSM is a potential prognostic parameter in patients who undergo BRTO.
Identifiants
pubmed: 36550416
doi: 10.1186/s12876-022-02616-z
pii: 10.1186/s12876-022-02616-z
pmc: PMC9773455
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
535Informations de copyright
© 2022. The Author(s).
Références
United European Gastroenterol J. 2016 Feb;4(1):62-9
pubmed: 26966524
Hepatol Int. 2018 Feb;12(Suppl 1):102-111
pubmed: 28875380
Tech Vasc Interv Radiol. 2013 Jun;16(2):101-51
pubmed: 23830671
Hepatology. 2007 May;45(5):1290-7
pubmed: 17464971
Gastroenterology. 2004 Apr;126(4):1175-89
pubmed: 15057756
J Vasc Interv Radiol. 2016 Aug;27(8):1160-7
pubmed: 27234486
Hepatol Res. 2008 Apr;38(4):340-7
pubmed: 18021226
Hepatology. 1985 May-Jun;5(3):419-24
pubmed: 3873388
Hepatology. 2017 Jan;65(1):310-335
pubmed: 27786365
J Gastroenterol Hepatol. 2016 Nov;31(11):1844-1850
pubmed: 27003222
Radiology. 1999 May;211(2):349-56
pubmed: 10228513
J Vasc Interv Radiol. 2001 Mar;12(3):327-36
pubmed: 11287510
JAMA Surg. 2019 Jun 01;154(6):540-548
pubmed: 30942880
Medicina (Kaunas). 2022 Jan 28;58(2):
pubmed: 35208529
Hepatology. 2007 Sep;46(3):922-38
pubmed: 17879356
AJR Am J Roentgenol. 2005 Apr;184(4):1340-6
pubmed: 15788621
J Gastroenterol Hepatol. 2014 May;29(5):1035-42
pubmed: 24372807
Tech Vasc Interv Radiol. 2012 Sep;15(3):165-202
pubmed: 23021831
Hepatology. 2004 Feb;39(2):280-2
pubmed: 14767976
Ultraschall Med. 2020 Apr;41(2):157-166
pubmed: 30909311
Gastroenterology. 2006 Nov;131(5):1611-24
pubmed: 17101332
J Gastroenterol Hepatol. 2019 Jan;34(1):215-223
pubmed: 30070412
Hepatology. 1992 Dec;16(6):1343-9
pubmed: 1446890
Dig Endosc. 2010 Jan;22(1):1-9
pubmed: 20078657
J Gastroenterol Hepatol. 2012 Jan;27(1):137-41
pubmed: 21722180
Cardiovasc Intervent Radiol. 2014 Oct;37(5):1243-50
pubmed: 24322305
BMC Med Imaging. 2010 Jan 14;10:2
pubmed: 20074342
J Gastroenterol Hepatol. 1996 Jan;11(1):51-8
pubmed: 8672742
N Engl J Med. 2005 Nov 24;353(21):2254-61
pubmed: 16306522
Cardiovasc Intervent Radiol. 2009 Nov;32(6):1209-16
pubmed: 19688368
J Gastroenterol Hepatol. 2008 Nov;23(11):1702-9
pubmed: 18713295
World J Gastroenterol. 2006 Oct 7;12(37):5926-31
pubmed: 17009389
J Hepatol. 2017 Aug;67(2):399-411
pubmed: 28223101
Hepatol Res. 2020 Apr;50(4):426-438
pubmed: 31785120
J Clin Ultrasound. 2018 Sep;46(7):442-449
pubmed: 30132919
Hepatology. 1997 Feb;25(2):307-12
pubmed: 9021939
J Gastroenterol. 2007 Aug;42(8):663-72
pubmed: 17701130