[Show abstract][Hide abstract] ABSTRACT: To evaluate the role of multi-detector row computed tomography (MDCT) angiography for assessing the therapeutic effects of percutaneous transhepatic variceal embolization (PTVE) for esophageal varices (EVs).
The subjects of this prospective study were 156 patients who underwent PTVE with cyanoacrylate for EVs. Patients were divided into three groups according to the filling range of cyanoacrylate in EVs and their feeding vessels: (1) group A, complete obliteration, with at least 3 cm of the lower EVs and peri-/EVs, as well as the adventitial plexus of the gastric cardia and fundus filled with cyanoacrylate; (2) group B, partial obliteration of varices surrounding the gastric cardia and fundus, with their feeding vessels being obliterated with cyanoacrylate, but without reaching lower EVs; and (3) group C, trunk obliteration, with the main branch of the left gastric vein being filled with cyanoacrylate, but without reaching varices surrounding the gastric cardia or fundus. We performed chart reviews and a prospective follow-up using MDCT images, angiography, and gastrointestinal endoscopy.
The median follow-up period was 34 mo. The rate of eradication of varices for all patients was 56.4% (88/156) and the rate of relapse was 31.3% (41/131). The rates of variceal eradication at 1, 3, and 5 years after PTVE were 90.2%, 84.1% and 81.7%, respectively, for the complete group; 61.2%, 49% and 42.9%, respectively, for the partial group; with no varices disappearing in the trunk group. The relapse-free rates at 1, 3 and 5 years after PTVE were 91.5%, 86.6% and 81.7%, respectively, for the complete group; 71.1%, 55.6% and 51.1%, respectively, for the partial group; and all EVs recurred in the trunk group. Kaplan-Meier analysis showed P values of 0.000 and 0.000, and odds ratios of 3.824 and 3.603 for the rates of variceal eradication and relapse free rates, respectively. Cyanoacrylate in EVs disappeared with time, but those in the EVs and other feeding vessels remained permanently in the vessels without a decrease with time, which is important for the continued obliteration of the feeding vessels and prevention of EV relapse.
MDCT provides excellent visualization of cyanoacrylate obliteration in EV and their feeding veins after PTVE. It confirms that PTVE is effective for treating EVs.
World Journal of Gastroenterology 03/2013; 19(10):1563-71. · 2.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the efficacy of modified percutaneous transhepatic variceal embolization (PTVE) with 2-octyl-cyanoacrylate (2-OCA) and endoscopic variceal obturation (EVO) with an injection of 2-OCA for prophylaxis of gastric variceal rebleeding.
In this retrospective study, the medical records of liver cirrhosis patients with gastric variceal bleeding who underwent either endoscopic 2-OCA (EVO) or modified PTVE using 2-OCA at Shandong Provincial Hospital from January 2006 to December 2008 were reviewed. Patient demographics, rebleeding rate, survival rate, and complications were compared between the two groups (PTVE and EVO). All results were expressed as mean ± SD, or as a percentage. Quantitative variables were compared by two sample Student t tests, and qualitative variables were compared by the Fisher exact test or the χ(2) test (with Yates correction) where appropriate. A P value less than 0.05 was considered significant. Statistical computation was performed using SPSS 13.0 software.
A total of 77 patients were included; 45 patients who underwent EVO and 32 patients who received PTVE. During the follow-up (19.78 ± 7.70 mo in the EVO group, vs 21.53 ± 8.56 mo in the PTVE group) rebleeding occurred in 17 patients in the EVO group and in 4 patients in the PTVE group (37.78% vs 12.5%, P = 0.028). The cumulative rebleeding-free rate was 75%, 59%, and 49% in 1, 2, and 3 years respectively for EVO, and 93%, 84%, and 84% for PTVE (P = 0.011). Cox analysis was used to identify independent factors that predicted rebleeding after treatment. Variables including age, gender, cause, Child-Pugh classification, size of gastric varices (GV), location of GV, and treatment methods were analyzed. It was revealed that Child-Pugh classification [risk ratio (RR) 2.10, 95%CI: 1.03-4.28, P = 0.040], choice of treatment (RR 0.25, 95%CI: 0.08-0.80, P = 0.019), and size of GV (RR 2.14, 95%CI: 1.07-4.28, P = 0.032) were the independent factors for predicting rebleeding. Follow-up computed tomography revealed that cyanoacrylate was retained in the varices and in the feeding veins of PTVE patients. During the follow-up, eight patients in the EVO group and four patients in the PTVE group died. The cumulative survival rates at 1, 2, and 3 years were 93%, 84%, and 67% respectively in the EVO group, and 97%, 88%, and 74% respectively in the PTVE group. The survival rates were not significantly different between the two groups (P = 0.432). Cox analysis showed that the Child-Pugh classification was the most significant prognostic factor of survival (RR 2.77, 95%CI: 1.12-6.80, P = 0.027). The incidence of complications was similar in both groups.
With extensive and permanent obliteration of gastric varices and its feeding veins, PTVE with 2-OCA is superior to endoscopic 2-OCA injection for preventing gastric variceal rebleeding.
World Journal of Gastroenterology 02/2013; 19(5):706-14. · 2.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus embolotherapy in the treatment of patients with gastroesophageal varices.
A total of 36 patients with gastroesophageal varices underwent the therapies of TIPS plus embolotherapy from July 2005 to March 2011 at Provincial Hospital Affiliated to Shandong University. The rechecked items included abdominal ultrasound examination, liver function test and blood routine examination at Day 7 post-operation. All received endoscopic examinations at Month 1.
The technical success rate of TIPS plus embolotherapy was 100%. The portal vein pressures declined from (28 ± 8) mm Hg (1 mm Hg = 0.133 kPa) to (14 ± 7) mm Hg at post-operation. Angiography showed gastroesophageal varices disappeared in all patients. Both liver function and gastroesophageal varices markedly improved. During the follow-up period of 3 - 6 months, 4 cases had hepatic encephalopathy and 1 case stent restenosis at post-operation. And most cases were resolved after treatment. No rebleeding occurred during the follow-up period.
The combined modality of TIPS plus embolotherapy can effectively lower portal vein pressure and cure esophageal and gastric varice bleeding. As a safe and excellent interventional procedure with fewer complications and a lower recurrence rate of portal hypertension, it has great clinical values in the treatment of portal hypertension and gastroesophageal varices.
[Show abstract][Hide abstract] ABSTRACT: To test the safety and validity of percutaneous transhepatic variceal embolization (PTVE) with tissue adhesive cyanoacrylate.
PTVE with cyanoacrylate was performed on 92 patients with gastroesophageal varices, 53 males and 39 females, aged 62.5 (7-84): cyanoacrylate was injected into the varices and the afferent veins. Endoscopy and CT were performed to evaluate the embolization.
PTVE was successfully completed in 89 of the 92 patients with a technical success rate of 96.7%, and 3 patients died within 1 month. Among the other 86 patients 3 types of cyanoacrylate embolization were achieved: embolization of coronary vein, vessels around gastric fundus, and variceal lower esophagus veins in 40 patients, embolization of coronary vein, gastric fundus and pericardial varices in 33 patients, and embolization of sole gastric coronary vein stem in 13 patients. Acute variceal bleeding in 18 patients was immediately arrested after the procedure, with an acute bleeding control rate of 100%. Eighty-six patients were followed up for 31.5 (6-52) months. The general variceal recurrence rate was 14.1% (10/71), and the variceal recurrence rate of the coronary vein embolization group was 100% (2/2), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 17.2% (5/29) respectively, P = 0.006]. The general rebleeding rate was 16.3% (14/86), and the rebleeding rates of the group of coronary vein embolization was 69.2% (9/13), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 15. 2% (5/33) respectively, P = 0.0092]. No obvious ectopic embolization was found. The mortality was 24.7% (22/89). The cause of rebleeding in coronary vein embolization was mainly recurrent variceal bleeding, whereas that in the group of fundus and esophagus variceal embolization was mainly hypertensive gastropathy.
PTVE with cyanoacrylate is safe and effective for the obliteration of gastroesophageal varices in cirrhotic patients.
[Show abstract][Hide abstract] ABSTRACT: To study the clinical efficacy of TH glue (cyanoacrylate) obliteration of esophageal varices and partial spleen embolization (PSE) in the treatment of esophageal varices bleeding.
TH glue was injected into the gastroesophageal varices and their feeder veins in 84 patients. According to the size of the varices and their blood flow, the TH glue was injected alone or after a steel coil was placed at the ostium of the feeder vein. Sometimes absolute alcohol was also injected into the varices. PSE was performed after the TH glue obliteration in all patients.
(1) The TH glue obliteration was performed on 81 patients with a success rate of 96.4%. Three patients died from the procedure. (2) The left gastric vein coronary, gastric varices, pericardial varices, and lower esophageal veins were obliterated in 38 patients (group 1). Left gastric vein, gastric varices, and pericardial veins were obliterated in 31 patients (group 2). Only the main gastric coronary vein was obliterated in 9 patients (group 3). The disappearance rate of the esophageal varices was 71.1% (27/38), 35.5% (11/31) and 0% (0/9) in the three groups. (3) During a follow-up of 6-49 months, rebleeding occurred in 13 of all 78 (16.7%) patients, and it was 7.9% (3/38), 12.9% (4/31) and 66.7% (6/9) respectively in the three groups.
Our results suggest percutaneous transhepatic TH glue obliteration of esophageal varices and PSE are safe and effective in treating gastroesophageal varicose bleeding.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 11/2007; 15(10):742-5.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of Ginkgo biloba extract (EGb) on hepatic microcirculation and portal hypertension in CCl4 treated rats.
Twenty-five male Wistar rats were divided into a blank, a CCl4 treated and a CCl4 plus EGb treated group, and all were treated for 10 weeks. The free portal vein pressures were measured through catheterizations. Hepatic sinusoidal endothelial cells and other parameters of hepatic microcirculation were studied with transmission electron microscopy. The amounts of malondialdehyde (MDA), endothelin (ET-1), platelet-activating factor (PAF), nitric oxide (NO), cNOS and iNOS in the liver tissues were determined.
The portal vein pressure of the CCl4 plus EGb treated group was (7.4 +/- 0.6) mm Hg while the pressure of the CCl4 treated group was (8.7 +/- 0.8) mm Hg. Aggregation of blood cells or microthrombosis in hepatic sinusoids, deposition of collagen in hepatic sinusoids and spaces of Disse, injury of endothelial cells and capillarization of hepatic sinusoid were significantly milder in the EGb group. The amounts of MDA, ET-1, PAF, NO and iNOS were markedly lower in the CCl4 plus EGb treated group than in the CCl4 treated group.
The results demonstrated that EGb can decrease the portal vein pressure and improve hepatic microcirculation in CCl4 treated rats. The mechanisms of this effect may involve its inhibition on ET-1, PAF, lipid peroxidation, and down regulation of the hepatic iNOS and NO expressions.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 05/2007; 15(4):245-8.
[Show abstract][Hide abstract] ABSTRACT: AIM: To evaluate the effect of Ginko biloba extract (EGb761) on the microcirculatory dysfunction of hepatic sinusoid in patients with chronic hepatitis B. METHODS: Forty-seven chronic hepatitis B patients were randomly divided into EGb761 treatment group (n = 26) and control group (n = 21). All the cases underwent liver biopsy before and after treatment. The pathological changes of liver tissues were detected by HE staining. At the same time, 10 samples were selected from each group, and the changes of hepatic sinusoi- dal microcirculation were analyzed by electron microscopy before and after treatments. RESULTS: After treatment, liver cirrhosis and tissue damages were improved significantly ( P