Search

Background: Esophageal-gastric variceal bleeding (EGVB) is a serious complication in patients with liver cirrhosis, characterized by high mortality and rebleeding rates. The effect of sequential endoscopic therapy on patient mortality and rebleeding rates remains unclear. Objectives: This study aimed to evaluate the effects of sequential endoscopic therapy on mortality and rebleeding rates in patients with EGVB. Design: In this single-center retrospective study, 373 hospitalized cases of EGVB caused by liver cirrhosis, collected between November 2019 and November 2023, were divided into four groups according to different treatment methods: a sequential endoscopy group, emergency endoscopy group, emergency endoscopy plus transjugular intrahepatic portosystemic shunt (TIPS) group and control group. Methods: Mortality and rebleeding rates were compared among the four groups using statistical analyses. Results: The mortality and rebleeding rates of the sequential endoscopy group (3.7% and 19%, respectively) were significantly lower than those of the emergency endoscopy (22% and 36%, respectively), emergency endoscopy plus TIPS (33% and 28%, respectively), and control groups (33% and 51%, respectively) (p = 0.013 and p = 0.013, respectively). Conclusion: Sequential endoscopic therapy may significantly reduce the mortality and rebleeding rates of patients with EGVB compared to other conventional treatment strategies. The findings of the study could help develop approaches benefiting EGVB treatment. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in preventing rebleeding in patients with hepatocellular carcinoma (HCC) comorbid with esophagogastric variceal bleeding and the influencing factors for prognosis. Methods A retrospective analysis was performed for the clinical data of 35 HCC patients comorbid with esophagogastric variceal bleeding who were admitted to Zengcheng Branch of Nanfang Hospital, Southern Medical University, and were treated with TIPS from July 2019 to April 2023. The Kaplan-Meier curve was used to assess rebleeding rate and survival rate after TIPS, and the Cox regression model was used to investigate the influencing factors for postoperative rebleeding and survival. Results The TIPS procedure was technically successful in all patients, with a median follow-up time of 16.4 months. During follow-up, 11 patients (31.4%) experienced esophagogastric variceal rebleeding, with the 1-month, 3-month, and 1-year rebleeding rates of 5.7%, 17.1%, and 28.6%, respectively. White blood cell count (WBC) (risk ratio [HR]=1.31, 95% confidence interval [CI]: 1.04 — 1.64, P=0.021), number of tumors ≥3 (HR=35.68, 95%CI: 1.74—733.79, P=0.021), and portal pressure gradient before TIPS (HR=0.85, 95%CI: 0.73 — 0.99, P=0.032) were independent predictive factors for rebleeding after TIPS. Shunt dysfunction was observed in 5 patients after surgery. A total of 19 patients died during follow-up, with a median survival time of 9.6 months. Portal vein tumor thrombosis (PVTT) (HR=7.04, 95%CI: 1.31—37.78, P=0.023), total bilirubin (TBil) (HR=1.02, 95%CI: 1.00—1.03, P=0.042), and serum albumin (HR=0.82, 95%CI: 0.72 — 0.94, P=0.004) were independent predictive factors for survival after TIPS. Conclusion TIPS procedure can be used as a therapeutic option to prevent esophagogastric variceal rebleeding in patients with HCC. Patients with a relatively high level of WBC or TBil or those with PVTT tend to have a poorer prognosis, and the application of TIPS treatment in such patients should be determined with caution. [ABSTRACT FROM AUTHOR]

Background: Previous studies have investigated the influence of diabetes on alcoholic liver cirrhosis patients, leaving its impact unclear. Thus, we conducted a study to reveal the association of diabetes and clinical outcomes of such patients. Materials and methods: We prospectively collected data from multicenter pertaining to 965 patients diagnosed with alcoholic liver cirrhosis, all of whom were admitted due to acute decompensation between 2015 and 2019. Risk of major precipitating factors and incidences of death or liver transplantation in patients with and without diabetes was comparatively assessed. Propensity score (PS) matching was performed at a 1:2 ratio for accurate comparisons. Results: The mean age was 53.4 years, and 81.0% of the patients were male. Diabetes was prevalent in 23.6% of the cohort and was positively correlated with hepatic encephalopathy and upper gastrointestinal bleeding, although not statistically significant. During a median follow-up of 903.5 person-years (PYs), 64 patients with and 171 without diabetes died or underwent liver transplantation, with annual incidence of 33.6/100 PYs and 24.0/100 PYs, respectively. In the PS-matched cohort, the incidence of death or liver transplantation was 36.8/100 PYs and 18.6/100 PYs in the diabetes and matched control group, respectively. After adjusting for various factors, coexisting diabetes significantly heightened the risk of death or liver transplantation in the short and long term, in addition to prolonged prothrombin time, low serum albumin, elevated total bilirubin and creatinine, and decreased serum sodium levels. Conclusions: Diabetes increases the risk of death or liver transplantation in patients with alcoholic liver cirrhosis. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background This study aimed to assess the clinical use of the new FibroScan module for measurement of liver and spleen stiffness (LS and SS), comparing their usefulness in prediction of esophageal varices (EV) in patients with portal hypertension (PH) and their clinical value for monitoring response to non-selective beta blockers (NSBB) treatment in these cases. The study included 120 patients with compensated cirrhosis and PH, in addition to 30 healthy comparable controls. Based on gastrointestinal endoscopy, patients were classified into three groups: 48 without EV, 42 with small EV, and 30 with large varices needing treatment. Then, abdominal ultrasound and assessment of LS and SS using new FibroScan 630 Expert module were done for both patients and controls. Group 3 patients were then initiated on NSBB (propranolol), and follow-up of these parameters was done after 3 months. Results LS and SS were significantly increased in cirrhotic patients compared to controls and were positively correlated with ultrasonography parameters (spleen length and portal vein diameter). Moreover, they were significantly higher in patients with varices than in those without varices (compared to other noninvasive parameters), correlating with varices severity, and significantly decreased with NSBB treatment, especially SS. Conclusion Screening of cirrhotic patients for development of EV by elastography (LS and especially SS) using the new FibroScan machine seems to be an optimal method in clinical practice and superior to other noninvasive tests in the diagnosis, assessment of severity, and follow-up of response to treatment in these patients.

BackgroundThere are limited data regarding the longitudinal association between MEFIB-Index (MRE combined with FIB-4) versus MAST-Score (MRI-aspartate aminotransferase) and hepatic decompensation.AimTo examine the longitudinal association between MEFIB-Index versus MAST-Score in predicting hepatic decompensation in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).MethodsThis was a longitudinal, retrospective analysis of subjects from United States, Japan, and Turkey who underwent a baseline MRE and MRI-PDFF and were followed for hepatic decompensation. Cox-proportional hazard analyses were used to assess the association between MEFIB-Index versus MAST-Score with a composite primary outcome (hepatic decompensation) defined as ascites, hepatic encephalopathy, and varices needing treatment.ResultsThis meta-analysis of individual participants (IPDMA) included 454 patients (58% women) with a mean (±SD) age of 56.0 (±13.5) years. The MEFIB-Index (MRE ≥3.3 kPa + FIB 4 ≥1.6) and MAST-Score (>0.242) were positive for 34% and 9% of the sample, respectively. At baseline, 23 patients met criteria for hepatic decompensation. Among 297 patients with available longitudinal data with a median (IQR) of 4.2 (5.0) years of follow-up, 25 incident cases met criteria for hepatic decompensation. A positive MEFIB-Index [HR = 49.22 (95% CI: 6.23-388.64, p

BackgroundData are scarce regarding the development of hepatic decompensation in patients with non-alcoholic fatty liver disease (NAFLD) with and without type 2 diabetes. We aimed to assess the risk of hepatic decompensation in people with NAFLD with and without type 2 diabetes.MethodsWe did a meta-analysis of individual participant-level data from six cohorts in the USA, Japan, and Turkey. Included participants had magnetic resonance elastography between Feb 27, 2007, and June 4, 2021. Eligible studies included those with liver fibrosis characterisation by magnetic resonance elastography, longitudinal assessment for hepatic decompensation and death, and included adult patients (aged ≥18 years) with NAFLD, for whom data were available regarding the presence of type 2 diabetes at baseline. The primary outcome was hepatic decompensation, defined as ascites, hepatic encephalopathy, or variceal bleeding. The secondary outcome was the development of hepatocellular carcinoma. We used competing risk regression using the Fine and Gray subdistribution hazard ratio (sHR) to compare the likelihood of hepatic decompensation in participants with and without type 2 diabetes. Death without hepatic decompensation was a competing event.FindingsData for 2016 participants (736 with type 2 diabetes; 1280 without type 2 diabetes) from six cohorts were included in this analysis. 1074 (53%) of 2016 participants were female with a mean age of 57·8 years (SD 14·2) years and BMI of 31·3 kg/m2 (SD 7·4). Among 1737 participants (602 with type 2 diabetes and 1135 without type 2 diabetes) with available longitudinal data, 105 participants developed hepatic decompensation over a median follow-up time of 2·8 years (IQR 1·4-5·5). Participants with type 2 diabetes had a significantly higher risk of hepatic decompensation at 1 year (3·37% [95% CI 2·10-5·11] vs 1·07% [0·57-1·86]), 3 years (7·49% [5·36-10·08] vs 2·92% [1·92-4·25]), and 5 years (13·85% [10·43-17·75] vs 3·95% [2·67-5·60]) than participants without type 2 diabetes (p

Objectives: The application of rifaximin, a non‐absorbable antibiotic, in hepatic encephalopathy (HE) has been well established; however, its effect on other complications in cirrhotic patients with previous gastroesophageal variceal bleeding (GEVB) remains unclear. Therefore, we performed a pilot randomized controlled trial aiming to evaluate the impact of rifaximin on cirrhosis‐related complications and changes in gastric microbiota. Methods: Eighty cirrhotic patients who received prophylactic endoscopic treatment for variceal rebleeding were randomly assigned to the control or rifaximin treatment group (rifaximin 400 mg twice daily for 8 weeks). Primary outcome was the total liver‐related score, consisting of changes in cirrhosis‐related complications including rebleeding, ascites, HE and portal vein thrombosis (PVT). The 16S rDNA sequencing analysis was conducted with gastric lavage fluid samples for the analysis of gastric microbiota. Results: During the 8‐week follow‐up, the total liver‐related score decreased significantly upon rifaximin therapy (−0.35 ± 0.14 vs 0.05 ± 0.14, p = 0.0465) as well as serum C‐reactive protein (CRP) (p = 0.019) and interleukin‐8 (p = 0.025) compared with the control group. The rate of PVT recanalization was significantly higher in the rifaximin group (p = 0.012). Prominent difference in gastric microbiota between the two groups was observed, and the rifaximin group had a higher abundance of several taxa which were dysregulated in the progression of cirrhosis. CRP was correlated with several taxa including Alphaproteobacteria, Rhizobiales and Collinsella. Conclusions: Rifaximin may improve cirrhosis‐related complications, including PVT, in patients with previous GEVB through anti‐inflammatory and microbiota‐modulating functions. Trial registration number: NCT02991612. [ABSTRACT FROM AUTHOR]

Objective To establish a nomogram prediction model for the development of overt hepatic encephalopathy(OHE) in patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic shunt(TIPS) after esophagogastric variceal bleeding, and to evaluate the predictive ability of the model. Methods This study was conducted among 113 patients with esophagogastric variceal bleeding due to liver cirrhosis who were admitted to The First Affiliated Hospital of Soochow University from January 2020 to December 2022 and underwent TIPS after failed medical or endoscopic therapy. All patients were followed up for 6 months after surgery, and according to the presence or absence of OHE after TIPS, they were divided into OHE group with 32 patients and non-OHE group with 81 patients. Related data were collected from all patients, including clinical data, routine blood test results, serum biochemistry, and coagulation test results. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The multivariate Logistic regression analysis was used to investigate the independent risk factors for the onset of OHE after TIPS, and then a nomogram prediction model was established. The index of concordance(Cindex) was calculated and the calibration curve was plotted to evaluate the predictive ability of the model, and the clinical decision curve was plotted to analyze the net clinical benefit of the model. The receiver operating characteristic(ROC) curve was used to validate the predictive ability of the model. Results There were significant differences between the OHE group and the non-OHE group in age, diabetes, Child-Pugh class, ascites, main portal vein diameter before surgery, gamma-glutamyl transpeptidase(GGT) level, prothrombin time, and Freiburg index of post-TIPS survival(FIPS) score(all P<0.05). The multivariate Logistic regression analysis showed that Child-Pugh class(odds ratio ［OR］=17.498，95% confidence interval ［CI］：2.561—119.548，P=0.004)，main portal vein diameter before surgery(OR=1.361，95%CI：1.057—1.752，P=0.017), GGT(OR=1.032，95%CI：1.013—1.052，P= 0.001), and FIPS score(OR=2.838，95%CI：1.277—6.311，P=0.010) were independent influencing factors for the development of OHE after TIPS. The nomogram model established based on the above four indicators had a C-index of 0.875, good fitting of the calibration curve, and an area under the ROC curve of 0.875（95%CI：0.799—0.929，P<0.001), and the decision curve analysis showed that the 0.3 — 0.9 threshold probability model had a good net benefit. Conclusion Child-Pugh class, main portal vein diameter before surgery, GGT, and FIPS score have a certain value in predicting the development of OHE after TIPS in patients with esophagogastric variceal bleeding due to liver cirrhosis, and the nomogram model established based on these indicators can be used to individually predict the onset of OHE after TIPS in patients with esophagogastric variceal bleeding due to liver cirrhosis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the feasibility of non-contrast-enhanced MR angiography (NCE-MRA) in evaluating the morphology and blood supply of left gastric vein (LGV) in patients with gastroesophageal varices. Methods: Between March 2021 and October 2022, patients with gastroesophageal varices and who underwent NCE-MRA were retrospectively reviewed. In order to evaluate the blood supply of LGV, superior mesenteric vein (SMV) and splenic vein (SV) were visualized separately by using inflow-sensitive inversion recovery sequence. Two radiologists independently assessed the image quality, determined the origination and the blood supply of LGV, and measured the diameter of LGV. The origination and diameter of LGV were compared between NCE-MRA and contrast-enhanced CT. Differences in blood supply were compared between LGVs with different originations. Results: A total of 53 patients were enrolled in this study and the image quality was categorized as good or excellent in 52 patients. No significant differences were observed in visualizing the origination and the diameter of LGV between NCE-MRA and contrast-enhanced CT (p >.05). The blood supply of LGV was related to its origination (p <.001). Most LGVs with SV origination were supplied by SV. If LGV was originated from the portal vein (PV), about 70% of them were supplied by both SV and SMV. Compared with LGVs with SV origination, LGVs with PV origination showed more chance to receive blood from SMV (p <.001). Conclusion: Non-contrast-enhanced MR angiography appears to be a reliable technique in evaluating the morphology and blood supply of LGV in patients with gastroesophageal varices. Clinical relevance statement: Non-contrast-enhanced MR angiography provides valuable information for the management of gastroesophageal varices. Especially, it benefits patients with renal insufficiency. Key Points: • Non-contrast-enhanced MR angiography using inflow-sensitive inversion recovery technique can be used for evaluating not only morphology as CT but also blood supply of left gastric vein. • The blood supply of left gastric vein is related to its origination and left gastric vein with portal vein origination shows more chance to receive blood from superior mesenteric vein. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Educación e Investigación en Emergencias is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim. Portal vein thrombosis (PVT) in patients with liver cirrhosis (LC) has a prevalence of 0.6-26%. It is most commonly discovered incidentally as part of the evaluation of LC or in the context of acute decompensation of LC due to portal hypertension. The aim of the study was to determine the prevalence of PVT in patients with LC in relation to the severity of the disease and individual elements of portal hypertension. Methods. A total of 326 patients treated for LC decompensation were included in a retrospective study. Standard laboratory analyses, abdominal ultrasonography and/or computed tomography, and esophagogastroduodenoscopy were performed. Results. The diameter of the portal vein (PV) differed between patients without esophageal varices (12.2 mm) and those with large varices (13.6 mm), p = 0.026. PVT was identified in 6.1% of patients with LC. The patients were classified according to the Child-Pugh scoring system, which has the A, B, and C categories used to assess the severity of liver disease. PVT was present in 3.0% of patients in class C and 12.0% in class B, while none of the patients in class A had PVT (p = 0.005). PVT was present in 4.4% of patients with small varices and 16.7% with large varices (p < 0.001). There was no difference in the presence of PVT between the groups of patients with and without variceal bleeding nor between groups with different degrees of ascites. A fatal outcome occurred in 29.4% of patients, but there was no difference between patients with and without PVT. Conclusion. PVT is present in more advanced stages of LC and predominantly in patients with large esophageal varices. There was no higher prevalence of PVT observed with the occurrence of variceal bleeding or with the death outcome in patients with LC. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of large volume ligation device and tissue glue injection in the treatment of GOV gastric varicose veins, and to provide reference for the treatment of GOV gastric varicose veins. Methods A total of 150 patients with GOV type gastric varicose veins were prospectively included. Patients were divided into the endoscopic varicose vein ligation (EBL) group (78 cases) and the endoscopic varicose vein embolization (EVO) group (72 cases) according to their condition and willingness. In EBL group, GOV type gastric varices were treated by endoscopic ligation with a large volume ligation device. The EVO group was treated with tissue glue combined with cinnamyl alcohol injection. All patients were re-examined with gastroscopy 2-3 weeks after the first operation to observe whether varicose veins were residual and bleeding (if so, treatment should be repeated at this follow-up visit). Gastroscopy was performed at 1, 3 and 6 months after surgery to evaluate the main outcome measures after endoscopic treatment, including success rate of varicose vein hemostasis, technical success rate, eradication rate, recurrence rate and related complications (secondary indicators): endoscopy-related bleeding, fever, sepsis and distant embolization. Results There were no significant differences in technical success rate, hemostasis success rate, average treatment times and 6-month eradication rate of gastric varices between the EBL group and the EVO group. The recurrence rate was higher in the EVO group than that of EBL group (P＜0.05). The endoscopy-related bleeding rate and fever rate were lower in the EBL group than those in the EVO group (P＜0.05). In the EVO group, 1 patient developed pulmonary embolism after injection and 3 patients developed septicemia. Conclusion The short-term efficacy of high volume ligation device is similar to that of endoscopic injection of tissue glue in eradicating GOV gastric varices, but the former is safer than the latter. [ABSTRACT FROM AUTHOR]

Background & aimsAlcohol is one of the leading causes of hepatocellular carcinoma (HCC). However, pooled estimates of HCC incidence in alcohol-associated cirrhosis have not been evaluated systematically. We performed a pooled analysis of time-to-event data to provide robust estimates for the incidence of HCC in alcohol-associated cirrhosis.MethodsMedline, Embase, Cochrane Central Register, Scopus, and Web of Science were searched from inception to August 2021. Individual patient data were reconstructed from published Kaplan-Meier curves, and a pooled analysis of cumulative HCC incidence was performed using a random-effects model.ResultsWe screened 5022 articles and included 18 studies (148,333 patients). In the pooled analysis, the cumulative incidence of HCC in alcohol-associated cirrhosis at 1, 5, and 10 years among studies that accounted for the competing risk of death without HCC was 1%, 3%, and 9%, respectively. A secondary analysis by traditional meta-analysis determined that the HCC incidence rate was higher in cohorts enrolled in a HCC surveillance program (18.6 vs 4.8 per 1000 person-years; P = .001) vs those who were not enrolled in a surveillance program. Meta-regression showed that diabetes, smoking, variceal bleeding, and hepatic decompensation were associated with a higher risk of HCC.ConclusionsOur analysis determined that the 5- and 10- year cumulative risk of HCC in alcohol-associated cirrhosis was 3% and 9%, respectively, with a higher incidence in cohorts that were enrolled in a HCC surveillance program. These data should be validated further in large prospective studies, and may have important implications for HCC screening and surveillance among patients with alcohol-associated cirrhosis.

Background: Prolonged QT intervals are extremely common in patients with cirrhosis and affect their treatment outcomes. Propranolol is often used to prevent gastroesophageal variceal hemorrhage in patients with cirrhosis; however, it is uncertain whether propranolol exerts a corrective effect on QT interval prolongation in patients with cirrhosis. Aim: The study aimed to investigate the therapeutic effects of propranolol on patients with cirrhosis and prolonged QT intervals. Methods: A retrospective cohort study approach was adopted. Patients with cirrhosis complicated by moderate-to-severe gastroesophageal varices, who were hospitalized at the Affiliated Hospital of Guangdong Medical University between 1 December 2020 and 31 November 2022, were included in the study. The patients were divided into the propranolol and control groups based on whether they had received propranolol. Upon admission, the patients underwent tests on liver and kidney functions, electrolytes, and coagulation function, as well as abdominal ultrasonography and electrocardiography. In addition to conventional treatment, the patients were followed up after the use or nonuse of propranolol for treatment and subsequently underwent reexamination of the aforementioned tests. Results: The propranolol group (26 patients) had an average baseline corrected QT (QTc) interval of 450.23 ± 37.18 ms, of which 14 patients (53.8%) exhibited QTc interval prolongation. Follow-up was continued for a median duration of 7.00 days after the administration of propranolol and conventional treatment. Electrocardiographic reexamination revealed a decrease in the QTc interval to 431.04 ± 34.64 ms (p = 0.014), and the number of patients with QTc interval prolongation decreased to five (19.2%; p < 0.001). After treatment with propranolol and multimodal therapy, QTc interval normalization occurred in nine patients with QTc interval prolongation, leading to a normalization rate of 64.3% (9/14). The control group (n = 58) had an average baseline QTc interval of 453.74 ± 30.03 ms, of which 33 patients (56.9%) exhibited QTc interval prolongation. After follow-up for a median duration of 7.50 days, the QTc interval was 451.79 ± 34.56 ms (p = 0.482), and the number of patients with QTc interval prolongation decreased to 30 (51.7%; p = 0.457). The QTc interval normalization rate of patients in the control group with QTc interval prolongation was merely 10.0% (3/33), which was significantly lower than that in the propranolol group (p < 0.001). Conclusion: In patients with cirrhosis complicated by QT interval prolongation, the short-term use of propranolol aids in correction of a long QT interval and provides positive therapeutic value for cirrhotic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Aims: Biliary atresia (BA) is a congestive biliary disease that develops in the neonatal period or early infancy. It may present with portal hypertension and varices needing treatment (VNT) even after successful Kasai portoenterostomy. This study aimed to stratify the risk of VNT in children and adolescents with BA. Methods: In this prospective cross‐sectional study, we measured liver stiffness (LS) and spleen stiffness (SS) by two‐dimensional shear wave elastography and checked for VNT endoscopically in 53 patients with BA who attended for follow‐up between July 2018 and September 2022. Varices needing treatment were defined as large esophageal varices, esophageal varices of any size with red color signs, and/or gastric varices along the cardia. Results: Twenty‐five patients (aged 0–18 years) had VNT. Eighteen patients met the Baveno VI criteria (LS <20 kPa; platelet count >150 000/L) and were deemed to be at low risk of VNT (spared endoscopies) while three had missed VNT (16.7%). Applying the Baveno VII criteria, which combines the SS cut‐off value of 40 kPa with the Baveno VI criteria, resulted in five missed VNTs among 22 spared endoscopies (22.7%). A modification of the Baveno VII criteria using the aspartate aminotransferase‐to‐platelet ratio index (APRI) instead of the platelet count with cut‐off values of 25 kPa, 30 kPa, and 1.04 for LS, SS, and APRI, respectively, missed only one VNT (5.0%) among 20 spared endoscopies. Conclusions: A novel diagnostic criterion that combines LS, SS, and APRI reduced the risk of missing VNT to 5% in children and adolescents with BA. [ABSTRACT FROM AUTHOR]

Objective　To investigate the efficacy, safety, and cost-effectiveness of endoscopic ultrasound （EUS）-guided coil placement combined with tissue adhesive injection in the treatment of gastric varices with spontaneous shunt. Methods　A retrospective analysis was performed for the patients with acute gastric variceal bleeding and spontaneous portosystemic shunt who were hospitalized and received balloon-occluded retrograde transvenous obliteration （BRTO） combined with endoscopic tissue adhesive injection or EUS-guided coil placement combined with tissue adhesive injection in Xiangyang Central Hospital from March 2019 to September 2022. The two surgical procedures were compared in terms of efficacy （technical success rate, 5-day rebleeding rate, 1-year rebleeding rate, and time to rebleeding）, safety （the incidence rate of ectopic embolism, the amount of tissue adhesive used, and the amount of lauromacrogol used）, and cost-effectiveness （hospital costs and length of hospital stay). The ttest was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier method was used to estimate the rebleeding. The chi-square test was used for comparison of categorical data between two groups. Results　A total of 25 patients received successful EUS-guided coil placement and tissue adhesive injection, with a technical success rate of 100%, a median amount of 2.5 mL tissue adhesive used, a median amount of 11.0 mL lauromacrogol used, a mean length of hospital stay of 14.88± 3.21 days, a mean hospital cost of 32 660.00±4 602.07 yuan, and a 5-day rebleeding rate of 0%； among these patients, 2 were lost to follow-up, and 23 patients with complete follow-up data had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 689 days. A total of 14 patients underwent modified BRTO combined with endoscopic tissue adhesive injection, with a technical success rate of 100%； a median amount of 5.0 mL tissue adhesive used during surgery, which was significantly higher than that used in EUS （U=39.000, P<0.001); a median amount of 10.5 mL lauromacrogol used during surgery； a mean length of hospital stay of 15.38±4.94 days； a mean hospital cost of 57 583.47±18 955.40 yuan, which was significantly higher than that used in EUS（ t=−6.310, P<0.001); a 5-day rebleeding rate of 0%. No patient was lost to follow-up, and all 14 patients had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 244.50 days, with no significant difference between the two groups（ χ²=1.448, P=0.229). Conclusion　EUS-guided coil placement combined with tissue adhesive injection is a relatively safe and effective technique for the treatment of gastric variceal bleeding and has a high technical success rate, a low incidence rate of serious adverse events, and similar efficacy to BRTO, with higher safety and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objective　To investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt （GRS）. Methods　The patients who attended Beijing Ditan Hospital, Capital Medical University, due to liver cirrhosis and gastric varices from February to June 2023 were enrolled, and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips. The primary evaluation index was alleviation or disappearance of varicose veins after surgery, and the secondary evaluation indices were surgical completion and complications. Results　A total of 11 patients were enrolled in this study, among whom there were 7 male patients and 4 female patients, with a median age of 55 years. Of all patients, 1 had Child class A liver function, 7 had Child class B liver function, and 3 had Child class C liver function. The maximum （median） diameter of the shunt was 8 mm, and the minimum （median） diameter of the shunt was 4 mm. The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips. The median amount of tissue adhesive injected was 2 mL, and the amount of lauromacrogol used was 1 mL. Disappearance of blood flow signals was observed in all patients after surgery （100%), and the success rate of surgery was 100%. No patient experienced rebleeding after follow-up for 6 weeks. Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients. Conclusion　Endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible, safe, and effective treatment method for cirrhotic patients with gastric varices and GRS. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index (APRI) and plateletalbumin-bilirubin (PALBI) score in predicting the risk of esophagogastric variceal bleeding in patients with liver cirrhosis. Methods A total of 119 patients with liver cirrhosis who were admitted to The First Affiliated Hospital of Soochow University from May 2021 and June 2022 were enrolled, and clinical data, routine blood test results, serum biochemistry, and coagulation test results were collected from all patients. According to the presence or absence of esophagogastric variceal bleeding, the patients were divided into non-bleeding group with 59 patients and bleeding group with 60 patients, and a comparative analysis was performed for the two groups. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-squared test or the Fisher’s exact test was used for comparison of categorical data between groups. The multivariate Logistic regression analysis was used to identify the independent risk factors for esophagogastric variceal bleeding in patients with liver cirrhosis and establish a nomogram predictive model. Results The male patients accounted for 75.00% in the bleeding group and 40.68% in the non-bleeding group, and there was a significant difference in sex composition between the two groups (χ2 =14.384, P<0.001). Chronic hepatitis B was the main etiology in both the bleeding group and the non-bleeding group (53.33% vs 38.98%), and there was no significant difference in composition ratio between the two groups (χ² =2.464, P=0.116). Compared with the non-bleeding group, the bleeding group had a significantly higher activity of AT-IIIA (t=3.329, P=0.001) and significantly lower levels of PLT, TBil, Ca, TC, and TT (all P<0.05). There were significant differences in APRI and PALBI between the two groups (χ² =6.175 and 19.532, both P<0.05). The binary logistic regression analysis showed that APRI (odds ratio ［OR］=0.309, 95% confidence interval ［CI］：0.109—0.881, P=0.028), PALBI (OR=7.667, 95%CI：2.005—29.327, P=0.003), Ca (OR=0.001, 95%CI：0.000—0.141, P=0.007), TC (OR=0.469, 95%CI：0.226—0.973, P=0.042), and TT (OR=0.599, 95%CI： 0.433—0.830, P=0.002) were independent influencing factors for esophagogastric variceal bleeding in liver cirrhosis. A nomogram model was established based on the above factors and had an index of concordance of 0.899 and a well-fitted calibration curve. Conclusion APRI and PALBI have a good value in predicting esophagogastric variceal bleeding in patients with liver cirrhosis, and the nomogram model established based on this study can predict the incidence rate of esophagogastric variceal bleeding in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]