Hepatic venous pressure gradient measurement in patients with liver cirrhosis: A correlation with disease severity and variceal bleeding

The aim of present study was to evaluate relationships between degree of portal hypertension, severity of the disease, and bleeding status in patients with liver cirrhosis. Patients and methods. All study patients with liver cirrhosis underwent hepatic venous pressure gradient measurements, endoscopy, clinical and biochemical evaluation. Liver function was evaluated according to Child-Turcotte-Pugh (Child’s) scoring system. Patients with decompensated cirrhosis (presence of severe ascites, acute variceal bleeding occurring within 14 days, hepatorenal syndrome, cardiopulmonary disorders, transaminase levels >10 times higher the upper normal limit), active alcohol intake, use of antiviral therapy and/or beta-blockers were excluded from the study. Results. One hundred twenty-eight patients with liver cirrhosis (male/female, 67/61; mean age, 53.8±12.7 years) were included into the study. Etiology of cirrhosis was viral hepatitis, alcoholic liver disease, cryptogenic and miscellaneous reasons in 57, 49, 14, and 8 patients, respectively. Child’s stages A, B, and C of liver cirrhosis were established in 28 (21.9%), 70 (54.9%), and 30 (23.4%) patients, respectively. The mean hepatic venous pressure gradient significantly differed among patients with different Child’s classes: 13.8±5.3 mm Hg, 17.3±4.6 mm Hg, and 17.7±5.05 mm Hg in Child’s A, B, and C classes, respectively (P=0.003). The mean hepatic venous pressure gradient in patients with grade I, II, and III varices was 14.8±4.5, 16.1±4.3, and 19.3±4.7 mm Hg, respectively (P=0.0001). Since nonbleeders had both small and large esophageal varices, patients with large varices were analyzed separately. The mean hepatic venous pressure gradient in patients with large (grade II and III) varices was significantly higher than that in patients with small (grade I) varices (17.8±4.8 mm Hg vs 14.6±4.8 mm Hg, P=0.007). Thirty-four (26.6%) patients had a history of previous variceal bleeding; all of them had large (20.6% – grade II, and 79.4% – grade III) varices. In patients with large varices, the mean hepatic venous pressure gradient was significantly higher in bleeders than in nonbleeders (18.7±4.7 mm Hg vs 15.9±4.7 mm Hg, P=0.006). Conclusions. Hepatic venous pressure gradient correlates with severity of liver disease, size of varices, and bleeding status. Among cirrhotics with large esophageal varices, bleeders have a significantly higher hepatic venous pressure gradient than nonbleeders. Hepatic venous pressure gradient measurement is useful in clinical practice selecting cirrhotic patients at the highest risk of variceal bleeding and guiding to specific therapy

HEPATOCELIULINĖS KARCINOMOS GYDYMO TRANSARTERINE CHEMOEMBOLIZACIJA DOKSORUBICINU IMPREGNUOTOMIS MIKROSFEROMIS (DEB TACE) LIETUVOS SVEIKATOS MOKSLŲ UNIVERSITETO LIGONINĖJE KAUNO KLINIKOSE ANALIZĖ

Tikslas. Išanalizuoti transarterinės chemoembolizacijos doksorubicinu impregnuotomis mikrosferomis (DEB TACE) būdu dėl hepatoceliulinės karcinomos gydytų pacientų gydymo išeitis Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose (LSMUL KK). Tyrimo medžiaga ir metodai. Atliktas retrospektyvinis tyrimas, įtraukta 20 HCC sergančių ir DEB TACE gydytų pacientų. Visiems pacientams nuo 2012 m. birželio mėn. iki 2015 m. kovo mėn. LSMUL KK atliktos superselektyvios DEB TACE procedūros naudojant doksorubicinu impregnuotas „Embozene TANDEM®“ („CeloNova“, „BioScience“, San Antonijus, JAV) mikrosferas. Gydymo išeitims vertinti analizuotas pacientų išgyvenamumas (mediana ir bendras išgyvenamumas), radiologinis atsakas į gydymą ir a-fetoproteino (AFP) koncentracijos pokytis lyginant reikšmes prieš pirmąjį DEB TACE ciklą ir po jo. Radiologiniam atsakui vertinti taikyti modifikuoti solidinių navikų atsako į gydymą vertinimo kriterijai (mRECIST). Išgyvenamumas vertintas taikant Kaplano ir Mejerio (Kaplan-Meier) metodą. Rezultatai. Išgyvenamumo mediana nuo diagnozės datos ir nuo pirmosios DEB TACE buvo atitinkamai 31,5 ± 9 mėn. ir 19,5 ± 3,9 mėn., bendras išgyvenamumas po 6 mėn. – 100 proc. ir 93,3 proc., po 1 m. – 80 proc. ir 79 proc., po 2 m. – 56,1 proc. ir 29,6 proc. Objektyvus radiologinis atsakas po 1 ir 3 mėn. pasiektas atitinkamai 78,6 proc. ir 77,8 proc. AFP koncentracija serume po pirmosios DEB TACE sumažėjo statistiškai reikšmingai (p &lt; 0,001). Bendras nepageidaujamų reiškinių dažnis – 23,5 proc. Išvados. Transarterinė chemoembolizacija doksorubicinu impregnuotomis mikrosferomis (DEB TACE) esant neoperabiliai hepotoceliulinei karcinomai yra gana saugi gydymo procedūra. DEB TACE galima pasiekti aukštą radiologinio atsako dažnį ir sąlyginai patenkinamą gyvenimo trukmę arba ši procedūra gali tapti tiltu į radikalesnį gydymą. Reikalingi tolesni tyrimai įvertinti šį daug žadantį gydymo metodą.</jats:p

Acute and 14-Day Hepatic Venous Pressure Gradient Response to Carvedilol and Nebivolol in Patients With Liver Cirrhosis

Background and Objective: Alternative drug therapies are needed for the treatment of portal hypertension.[...

Endogenous motion of liver correlates to the severity of portal hypertension

Degree of portal hypertension (PH) is the most important prognostic factor for the decompensation of liver cirrhosis and death, therefore adequate care for patients with liver cirrhosis requires timely detection and evaluation of the presence of clinically significant PH (CSPH) and severe PH (SPH). As the most accurate method for the assessment of PH is an invasive direct measurement of hepatic venous pressure gradient (HVPG), the search for non-invasive methods to diagnose these conditions is actively ongoing. AIM To evaluate the feasibility of parameters of endogenously induced displacements and strain of liver to assess degree of PH. METHODS Of 36 patients with liver cirrhosis and measured HVPG were included in the casecontrol study. Endogenous motion of the liver was characterized by derived parameters of region average tissue displacement signal (dantero, dretro, dRMS) and results of endogenous tissue strain imaging using specific radiofrequency signal processing algorithm. Average endogenous strain μ and standard deviation σ of strain were assessed in the regions of interest (ROI) (1 cm × 1 cm and 2 cm × 2 cm in size) and different frequency subbands of endogenous motion (0-10 Hz and 10- 20 Hz). RESULTS Four parameters showed statistically significant (P < 0.05) correlation with HVPG measurement. The strongest correlation was obtained for the standard deviation of strain (estimated at 0-10 Hz and 2 cm × 2 cm ROI size).[...]

Kepenų venų spaudimo gradiento matavimas kepenų ciroze sergantiems pacientams: ryšys su kepenų ligos sunkumo laipsniu ir varikoziniu kraujavimu

The aim of present study was to evaluate relationships between degree of portal hypertension, severity of the disease, and bleeding status in patients with liver cirrhosis. Patients and methods. All study patients with liver cirrhosis underwent hepatic venous pressure gradient measurements, endoscopy, clinical and biochemical evaluation. Liver function was evaluated according to Child-Turcotte-Pugh (Child’s) scoring system. Patients with decompensated cirrhosis (presence of severe ascites, acute variceal bleeding occurring within 14 days, hepatorenal syndrome, cardiopulmonary disorders, transaminase levels >10 times higher the upper normal limit), active alcohol intake, use of antiviral therapy and/or beta-blockers were excluded from the study. Results. One hundred twenty-eight patients with liver cirrhosis (male/female, 67/61; mean age, 53.8±12.7 years) were included into the study. Etiology of cirrhosis was viral hepatitis, alcoholic liver disease, cryptogenic and miscellaneous reasons in 57, 49, 14, and 8 patients, respectively. Child’s stages A, B, and C of liver cirrhosis were established in 28 (21.9%), 70 (54.9%), and 30 (23.4%) patients, respectively. The mean hepatic venous pressure gradient significantly differed among patients with different Child’s classes: 13.8±5.3 mm Hg, 17.3±4.6 mm Hg, and 17.7±5.05 mm Hg in Child’s A, B, and C classes, respectively (P=0.003). The mean hepatic venous pressure gradient in patients with grade I, II, and III varices was 14.8±4.5, 16.1±4.3, and 19.3±4.7 mm Hg, respectively (P=0.0001). Since nonbleeders had both small and large esophageal varices, patients with large varices were analyzed separately. The mean hepatic venous pressure gradient in patients with large (grade II and III) varices was significantly higher than that in patients with small (grade I) varices (17.8±4.8 mm Hg vs 14.6±4.8 mm Hg, P=0.007). Thirty-four (26.6%) patients had a history of previous variceal bleeding; all of them [...

Percutaneous transhepatic biliary stenting with uncovered self-expandable metallic stents in patients with malignant biliary obstruction – efficacy and survival analysis

The aim of this study was to assess short- and long-term outcomes of malignant biliary obstruction (MBO) treatment by percutaneous transhepatic biliary stenting (PTBS) with uncovered selfexpandable metallic stents (SEMS), and to identify predictors of survival. Material/Methods: A nine-year, single-centre study from a prospectively collected database included 222 patients with inoperable MBO treated by PTBS with uncovered nitinol SEMS. Results: Technical and clinical success rates were 95.9% and 82.4%, respectively. The total rate of postprocedural complications was 14.4%. The mean durations of the primary and secondary stent patency were 114.7±15.1 and 146.4±21.2 days, respectively. The 30-day mortality rate was 15.3% with no procedure-related deaths. The mean estimated length of survival was 143.3±20.6 days. Independent predictors increasing the risk of death included higher than 115 μmol/L serum bilirubin 2–5 days after biliary stenting (HR 3.274, P=0.019), distal (non-hilar) obstruction of the bile ducts (HR 3.711, P=0.008), Bismuth-Corlette type IV stricture (HR 2.082, P=0.008), obstruction due to gallbladder cancer (HR 31.029, P=0.012) and only partial drainage of liver parenchyma (HR 4.158, P=0.040). Conclusions: PTBS with uncovered SEMS is an effective and safe method for palliative treatment of MBO. Serum bilirubin higher than 115 μmol/L 2–5 days after the procedure has a significant negative impact on patients’ survival. Lower survival is also determined by distal bile duct obstruction, Bismuth– Corlette type IV stricture, biliary obstruction caused by gallbladder cancer and when only partial liver drainage is applied. Background Malignant biliary obstruction (MBO) can be caused by primary tumours (most frequently cholangiocarcinomas, gallbladder cancer and pancreatic carcinomas), metastases or compression of metastatic lymph nodes [1]. At the time of diagnosis, for the majority of patient[...]