2 research outputs found
Efficacy of long-acting somatostatin analogs in recurrent variceal bleeding in a patient with pre-hepatic portal vein thrombosis
Introduction. Bleeding from esophageal varices is a serious medical problem
because of the risk of recurrent bleeding and high mortality rate (17-54%).
Gastroesophageal varices develop in 50% of cirrhotic patients with portal
hypertension, but can also develop in other pre- or post-hepatic causes of
portal hypertension. Case report. We reported a 48-year-old female patient
with portal hypertension caused by mesenterial vein thrombosis due to
congenital thrombophilia. The patient was hospitalized several times because
of recurrent gastroesophageal bleeding. Thrombosis of portal, lienal and
mesenteric veins was diagnosed using multislice computed tomography (MSCT)
angiography. Sclerotherapy and/or variceal ligation could not be used due to
variceal size and distribution. Beta blockers were ineffective. Balloon
tamponade and octreotide were used in each massive bleeding episode.
Carvedilol therapy was introduced but rebleeding occured. Surgical treatment
was considered a high risk procedure due to massive thrombosis of mesenterial
veins, patient's general condition and high risk of postoperative thrombotic
events. Thus, long-acting somatostatin analogue - SandostatinĀ® LAR was
initiated at a dose of 30 mg im/month. The patient responded to the therapy
well and variceal bleeding did not occur for the following 3 months. After 3
months another episode of gastric variceal hemorrhage occurred and surgical
treatment was reconsidered. Total gastrectomy was performed in order to
prevent repeated bleeding from large gastric varices and the patient
recovered successfully, and after 1 year is symptom-free. Conclusion.
Long-lasting somatostatin analogue was used for the first time in treatment
of gastroesophageal variceal hemorrhage in the patient with prehepatic portal
hyperten-sion. It was effective as temporary therapeutic option allowing the
improvement of the patients general condition and adequate planning of
elective surgical procedure. Futher reports are needed in order to compare
efficacy in treatment of patients with variceal bleeding, where poor outcome
is expected. [Projekat Ministarstva nauke Republike Srbije, br. III41004
Noninvasive assessment of portal hypertension in patients with alcoholic cirrhosis
Background/aims: Portal hypertension and development of esophageal varices is one of the major complications of liver cirrhosis. The aim of our study was to evaluate the possibility of the presence of esophageal varices and their size using biochemical and ultrasonography parameters in patients with alcoholic liver cirrhosis. Material and Methods: We included in our study 86 patients (74 males, mean age 55 +/- 7) with alcoholic liver cirrhosis. The control group consisted of 102 patients with cirrhosis of other etiologies. All patients underwent a complete biochemical work up, upper digestive endoscopy and ultrasonography examination. The right liver lobe diameter/albumin and platelet count/spleen diameter ratios were calculated. The correlation of the calculated ratios with the presence and degree of esophageal varices in patients with liver cirrhosis was also determined. Results: The mean value of right liver lobe diameter-albumin ratio was 6.15 +/- 1.77, and statistically significantly differed from values determined in the control group (4.97 +/- 1.68). The mean platelet count-spleen diameter ratio was 972.5 +/- 599.0 in alcoholic liver cirrhosis and 1055.9 +/- 821.3 in controls (p>0.05). In patients with alcoholic liver cirrhosis, none of the analyzed noninvasive markers was shown to be a good predictor of the presence and size of esophageal varices. Conclusions: Despite the important role of noninvasive markers in providing information pertinent to determination of esophageal varices in patients with liver cirrhosis, these markers have limited relevance in patients with alcoholic cirrhosis