hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.2021159-65hepato-719Research ArticleПРЕДОПЕРАЦИОННОЕ ПЛАНИРОВАНИЕ - НЕИНВАЗИВНАЯ ЛУЧЕВАЯ ДИАГНОСТИКАPRE-OPERATIVE PLANNING – NON-INVASIVE RADIOLOGYДополнительный критерий оценки риска кровотечения из варикозно расширенных вен желудка по данным мультиспиральной компьютерной томографииAdditional criterion for assessing the risk of gastric variceal bleeding according to multispiral computed tomographyhttps://orcid.org/0000-0001-7284-4737ЮдинА. Л.YudinA. L.

Юдин Андрей Леонидович – доктор медицинских наук, профессор, заведующий кафедрой лучевой диагностики и терапии 

117997, г. Москва, ул. Островитянова, д. 1

house 1, Ostrivityanova str., Moscow, 117997

prof_yudin@mail.ruhttps://orcid.org/0000-0002-6020-9434ЮматоваЕ. А.YumatovaE. A.

Юматова Елена Анатольевна – кандидат медицинских наук, доцент кафедры лучевой диагностики и терапии 

117997, г. Москва, ул. Островитянова, д. 1

house 1, Ostrivityanova str., Moscow, 117997

yumatova_ea@mail.ruhttps://orcid.org/0000-0003-3218-8688ЯгубоваК. ВYagubovaK. V.

Ягубова Кира Владимировна – ассистент кафедры лучевой диагностики и терапии 

117997, г. Москва, ул. Островитянова, д. 1

house 1, Ostrivityanova str., Moscow, 117997

kira--95@mail.ruФГАОУ ВО Российский национальный исследовательский медицинский университет имени Н.И.Пирогова Минздрава РоссииРоссияPirogov Russian National Research Medical University of the Ministry of Health of RussiaRussian Federation2021040220212615965Copyright © Юдин А.Л., Юматова Е.А., Ягубова К.В., 20212021Юдин А.Л., Юматова Е.А., Ягубова К.В.Yudin A.L., Yumatova E.A., Yagubova K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/719Цель

Цель. По результатам мультиспиральной КТ установить параметры варикозно расширенных вен желудка, определяющие высокий риск развития желудочного кровотечения.

Материал и методы

Материал и методы. Ретроспективно изучены результаты обследования 39 пациентов с циррозом печени и варикозно расширенными венами желудка. У 9 из них были признаки состоявшегося кровотечения при эндоскопическом исследовании или соответствующие данные в истории болезни. У 3 пациентов желудочное кровотечение состоялось через 30–47 дней после проведения КТ.

Результаты

Результаты. По результатам мультиспиральной КТ с мультипланарной реконструкцией желудочное кровотечение определено у 12 пациентов с протрузией подслизистых варикозно расширенных вен в просвет желудка на ≥5 мм с диаметром вен >7 мм.

Заключение

Заключение. Результаты мультиспиральной КТ, дополненной методикой гидро-КТ, дают важную дополнительную информацию для прогнозирования развития желудочного кровотечения при отборе больных для превентивного проведения миниинвазивных вмешательств на венах желудка.

Aim

Aim. To establish the parameters of gastric varices which determine a high risk of gastric bleeding according to the results of multispiral computed tomography.

Material and methods

Material and methods. The results of studies of 39 patients with liver cirrhosis and gastric varices were retrospectively studied. Nine of them had signs of previous bleeding on endoscopic examination or the corresponding data in the medical history. In 3 patients gastric bleeding occurred 30-47 days after multispiral computed tomography.

Results

Results. According to the results of multispiral computed tomography with multiplanar reconstructions gastric bleeding was detected in 12 patients with protrusion of submucosal varicose veins into the gastric lumen by 5 mm or more with a vein diameter >7 mm.

Conclusion

Conclusion. The results of multispiral computed tomography, complemented by the hydro-computed tomography technique, provide important additional information on predicting the development of gastric bleeding in the selection of patients for preventive minimally invasive interventions on the veins of the stomach.

печеньциррозпортальная гипертензиякровотечениеварикозное расширение венгастропатиямультиспиральная компьютерная томографияпрогнозlivercirrhosisportal hypertensionbleedingvaricose veinsgastropathymultispiral computed tomographyprognosisReferencesPerri R.E., Chiorean M.V., Fidler J.L., Fletcher J.G., Talwalkar J.A., Stadheim L., Shah N.D., Kamath P.S. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology. 2008; 47 (5): 1587–1594. https://doi.org/10.1002/hep.22219Perri R.E., Chiorean M.V., Fidler J.L., Fletcher J.G., Talwalkar J.A., Stadheim L., Shah N.D., Kamath P.S. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology. 2008; 47 (5): 1587–1594. https://doi.org/10.1002/hep.22219De Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J. Hepatol. 2005; 43 (1): 167–176. https://doi.org/10.1016/j.jhep.2005.05.009De Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J. Hepatol. 2005; 43 (1): 167–176. https://doi.org/10.1016/j.jhep.2005.05.009Ripoll C., Groszmann R., Garcia-Tsao G., Grace N., Burroughs A., Planas R., Escorsell A., Garcia-Pagan J.C., Makuch R., Patch D., Matloff D.S., Bosch J. Hepatic vein pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007; 133 (2): 481–488. https://doi.org/10.1053/j.gastro.2007.05.024Ripoll C., Groszmann R., Garcia-Tsao G., Grace N., Burroughs A., Planas R., Escorsell A., Garcia-Pagan J.C., Makuch R., Patch D., Matloff D.S., Bosch J. Hepatic vein pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007; 133 (2): 481–488. https://doi.org/10.1053/j.gastro.2007.05.024Sarin S.K., Lahoti D., Saxena S.P., Murthy N.S., Makwana U.K. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992; 16 (6): 1343–1349. https://doi.org/10.1002/hep.1840160607Sarin S.K., Lahoti D., Saxena S.P., Murthy N.S., Makwana U.K. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992; 16 (6): 1343–1349. https://doi.org/10.1002/hep.1840160607Willmann J.K., Weishaupt D., Böhm T., Pfammatter T., Seifert B., Marincek B., Bauerfeind P. Detection of submucosal gastric fundal varices with multidetector row CT angiography. Gut. 2003; 52 (6): 886–892. https://doi.org/10.1136/gut.52.6.886Willmann J.K., Weishaupt D., Böhm T., Pfammatter T., Seifert B., Marincek B., Bauerfeind P. Detection of submucosal gastric fundal varices with multidetector row CT angiography. Gut. 2003; 52 (6): 886–892. https://doi.org/10.1136/gut.52.6.886Uflacker R. Atlas of Vascular Anatomy: An Angiographic Approach, 2nd Edition. Philadelphia, PA: Lippincott Williams& Wilkins, 2007. 905 p.Uflacker R. Atlas of Vascular Anatomy: An Angiographic Approach, 2nd Edition. Philadelphia, PA: Lippincott Williams& Wilkins, 2007. 905 p.Garcia-Tsao G., Abraldes J.G., Berzigotti A., Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017; 65 (1): 310–335. https://doi.org/10.1002/hep.28906.Garcia-Tsao G., Abraldes J.G., Berzigotti A., Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017; 65 (1): 310–335. https://doi.org/10.1002/hep.28906.Blendis L., Wong F. Stopping the unstoppable? Gastroenterology.2000; 118 (6): 1270–1272. https://doi.org/10.1016/s0016-5085(00)70383-0Blendis L., Wong F. Stopping the unstoppable? Gastroenterology.2000; 118 (6): 1270–1272. https://doi.org/10.1016/s0016-5085(00)70383-0Garcia-Tsao G., Sanyal A.J., Grace N.D., Carey W. Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007; 46 (3): 922–938. https://doi.org/10.1002/hep.21907Garcia-Tsao G., Sanyal A.J., Grace N.D., Carey W. Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007; 46 (3): 922–938. https://doi.org/10.1002/hep.21907Zhao L.Q., He W., Ji M., Liu P., Li P. 64-row multidetector computed tomography portal venography of gastric variceal collateral circulation. World J. Gastroenterol. 2010; 16 (8): 1003–1007. https://doi.org/10.3748/wjg.v16.i8.1003Zhao L.Q., He W., Ji M., Liu P., Li P. 64-row multidetector computed tomography portal venography of gastric variceal collateral circulation. World J. Gastroenterol. 2010; 16 (8): 1003–1007. https://doi.org/10.3748/wjg.v16.i8.1003Kiyosue H., Ibukuro K., Maruno M., Tanoue Sh., Hongo N., Mori H. Multidetector CT anatomy of drainage routes of gastric varices: a pictorial review. RadioGraphics. 2013; 33 (1): 87–100. https://doi.org/10.1148/rg.331125037Kiyosue H., Ibukuro K., Maruno M., Tanoue Sh., Hongo N., Mori H. Multidetector CT anatomy of drainage routes of gastric varices: a pictorial review. RadioGraphics. 2013; 33 (1): 87–100. https://doi.org/10.1148/rg.331125037Колсанов А.В., Зельтер П.М., Колесник И.В., Капишников А.В., Чаплыгин С.С., Соловов Д.В. Компьютерная томография с 3d-моделированием при планировании операций у пациентов с синдромом портальной гипертензии. Russian Electronic Journal of Radiology (REJR). 2019; 9 (1): 67–74. https://doi.org/10.21569/2222-7415-2019-9-1-67-74Kolsanov A.V., Zelter P.M., Kolesnik I.V., Kapishnikov A.V., Chaplygin S.S., Solovov D.V. Computed tomography with 3d-modeling in portal hypertension surgery planning. Russian Electronic Journal of Radiology (REJR). 2019; 9 (1): 67–74. https://doi.org/10.21569/2222-7415-2019-9-1-67-74 (In Russian)Jalan R., Hayes P.C. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2000; 46 (Suppl III): iii1– iii15. https://doi.org/10.1136/gut.46.suppl_3.iii1Jalan R., Hayes P.C. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2000; 46 (Suppl III): iii1– iii15. https://doi.org/10.1136/gut.46.suppl_3.iii1Dawson J., Gertsch P., Mosimann F., West R., Elias E. Endoscopic variceal pressure measurements: response to isosorbide dinitrate. Gut. 1985; 26 (8): 843–847. https://doi.org/10.1136/gut.26.8.843Dawson J., Gertsch P., Mosimann F., West R., Elias E. Endoscopic variceal pressure measurements: response to isosorbide dinitrate. Gut. 1985; 26 (8): 843–847. https://doi.org/10.1136/gut.26.8.843Garcia-Tsao G., Groszmann R.J., Fisher R.L., Conn H.O., Atterbury C.E., Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985; 5 (3): 419–424. https://doi.org/10.1002/hep.1840050313Garcia-Tsao G., Groszmann R.J., Fisher R.L., Conn H.O., Atterbury C.E., Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985; 5 (3): 419–424. https://doi.org/10.1002/hep.1840050313Polio J., Groszmann R.J. Hemodynamic factors involved in the development and rupture of esophageal varices: a pathophysiologic approach to treatment. Semin. Liver Dis. 1986; 6 (4): 318–331. https://doi.org/10.1055/s-2008-1040614Polio J., Groszmann R.J. Hemodynamic factors involved in the development and rupture of esophageal varices: a pathophysiologic approach to treatment. Semin. Liver Dis. 1986; 6 (4): 318–331. https://doi.org/10.1055/s-2008-1040614Morrison J.D., Mendoza-Elias N., Lipnik A.J., Lokken R.P., Bui J.T., Ray Jr Ch.E., Gaba R.C. Gastric varices bleed at lower portosystemic pressure gradients than esophageal varices. J. Vasc. Interv. Radiol. 2018; 29 (5): 636–641. https://doi.org/10.1016/j.jvir.2017.10.014Morrison J.D., Mendoza-Elias N., Lipnik A.J., Lokken R.P., Bui J.T., Ray Jr Ch.E., Gaba R.C. Gastric varices bleed at lower portosystemic pressure gradients than esophageal varices. J. Vasc. Interv. Radiol. 2018; 29 (5): 636–641. https://doi.org/10.1016/j.jvir.2017.10.014Rajekar H. Complication of cirrhosis portal hypertension: a review. J. Liver. 2015; 4: 188. https://doi.org/10.4172/2167-0889.1000188Rajekar H. Complication of cirrhosis portal hypertension: a review. J. Liver. 2015; 4: 188. https://doi.org/10.4172/2167-0889.1000188Hosking S.W., Johnson A.G. Gastric varices: a proposed classification leading to management. Br. J. Surg. 1988; 75 (3): 195–196. https://doi.org/10.1002/bjs.1800750303Hosking S.W., Johnson A.G. Gastric varices: a proposed classification leading to management. Br. J. Surg. 1988; 75 (3): 195–196. https://doi.org/10.1002/bjs.1800750303Pham J.T., Kalantari J., Ji Ch., Chang J.H., Kiang Sh.C., Jin D.H., Tomihama R.T. Quantitative CT predictors of portal venous intervention in uncontrolled variceal bleeding. AJR. 2020; 215 (5): 1247–1251. https://doi.org/10.2214/ajr.19.22460Pham J.T., Kalantari J., Ji Ch., Chang J.H., Kiang Sh.C., Jin D.H., Tomihama R.T. Quantitative CT predictors of portal venous intervention in uncontrolled variceal bleeding. AJR. 2020; 215 (5): 1247–1251. https://doi.org/10.2214/ajr.19.22460Li Q., Wang R., Guo X., Li H., Shao X., Zheng K., Qi X., Li Y., Qi X. Contrast-enhanced CT may be a diagnostic alternative for gastroesophageal varices in cirrhosis with and without previous endoscopic variceal therapy. Gastroenterol. Res. Pract. 2019; 2019: 1–15. https://doi.org/10.1155/2019/6704673Li Q., Wang R., Guo X., Li H., Shao X., Zheng K., Qi X., Li Y., Qi X. Contrast-enhanced CT may be a diagnostic alternative for gastroesophageal varices in cirrhosis with and without previous endoscopic variceal therapy. Gastroenterol. Res. Pract. 2019; 2019: 1–15. https://doi.org/10.1155/2019/6704673Horton K.M., Fishman E.K. Helical CT of the stomach: evaluation with water as an oral contrast agent. AJR. 1998; 171 (5): 1373–1376. https://doi.org/10.2214/ajr.171.5.9798881Horton K.M., Fishman E.K. Helical CT of the stomach: evaluation with water as an oral contrast agent. AJR. 1998; 171 (5): 1373–1376. https://doi.org/10.2214/ajr.171.5.9798881Семенова Т.С., Пальцева Е.М., Жигалова С.Б., Шерцингер А.Г. Портальная гипертензионная гастропатия. Архив патологии. 2014; 6: 64–68. https://doi.org/10.17116/patol201476664-68Semenova T.S., Paltseva E.M., Zhigalova S.B., Shertsinger A.G. Portal hypertensive gastropathy. Archive of pathology = Arhiv patologii. 2014; 6: 64–68 https://doi.org/10.17116/patol201476664-68. (In Russian)Cubillas R., Rockey D. Portal hypertensive gastropathy: a review. Liver Int. 2010; 30 (8): 1094–1102. https://doi.org/10.1111/j.1478-3231.2010.02286.xCubillas R., Rockey D. Portal hypertensive gastropathy: a review. Liver Int. 2010; 30 (8): 1094–1102. https://doi.org/10.1111/j.1478-3231.2010.02286.xBiecker E. Portal hypertension and gastrointestinal bleeding: diagnosis, prevention and management. World J. Gastroenterol. 2013; 19 (31): 5035–5050. https://doi.org/10.3748/wjg.v19.i31.5035Biecker E. Portal hypertension and gastrointestinal bleeding: diagnosis, prevention and management. World J. Gastroenterol. 2013; 19 (31): 5035–5050. https://doi.org/10.3748/wjg.v19.i31.5035Жигалова С.Б., Манукьян Г.В., Шерцингер А.Г., Фандеев Е.Е., Семенова Т.С., Коршунов И.Б., Мартиросян Р.А. Прогностические критерии кровотечений из варикозно расширенных вен пищевода и желудка у больных портальной гипертензией. Анналы хирургической гепатологии. 2018; 23 (4): 76–85. https://doi.org/10.16931/1995-5464.2018476-85Zhigalova S.B., Manukiyan G.V., Shertsinger A.G., Fandeyev E.E., Semenova T.S., Korshunov I.B., Martirosyan R.A. Prognostic criteria of variceal bleeding in patients with portal hypertension. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2018; 23 (4): 76–85. https://doi.org/10.16931/1995-5464.2018476-85 (In Russian)

The authors declare that there are no conflicts of interest present.