Additional criterion for assessing the risk of gastric variceal bleeding according to multispiral computed tomography
https://doi.org/10.16931/1995-5464.2021159-65
Abstract
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. 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. 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. 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.
About the Authors
A. L. YudinRussian Federation
house 1, Ostrivityanova str., Moscow, 117997
E. A. Yumatova
Russian Federation
house 1, Ostrivityanova str., Moscow, 117997
K. V. Yagubova
Russian Federation
house 1, Ostrivityanova str., Moscow, 117997
References
1. Perri 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.22219
2. De 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.2005.05.009
3. Ripoll 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.2007.05.024
4. Sarin 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.1840160607
5. Willmann 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.52.6.886
6. Uflacker R. Atlas of Vascular Anatomy: An Angiographic Approach, 2nd Edition. Philadelphia, PA: Lippincott Williams& Wilkins, 2007. 905 p.
7. 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.
8. Blendis L., Wong F. Stopping the unstoppable? Gastroenterology.2000; 118 (6): 1270–1272. https://doi.org/10.1016/s0016-5085(00)70383-0
9. Garcia-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.21907
10. Zhao 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.i8.1003
11. Kiyosue 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.331125037
12. Kolsanov 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)
13. 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.iii1
14. Dawson 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.26.8.843
15. Garcia-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.1840050313
16. Polio 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-2008-1040614
17. Morrison 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.2017.10.014
18. Rajekar H. Complication of cirrhosis portal hypertension: a review. J. Liver. 2015; 4: 188. https://doi.org/10.4172/2167-0889.1000188
19. Hosking 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.1800750303
20. Pham 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.19.22460
21. Li 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/10.1155/2019/6704673
22. Horton 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.171.5.9798881
23. Semenova 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)
24. 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.x
25. Biecker 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.i31.5035
26. Zhigalova 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)
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For citations:
Yudin A.L., Yumatova E.A., Yagubova K.V. Additional criterion for assessing the risk of gastric variceal bleeding according to multispiral computed tomography. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021;26(1):59-65. (In Russ.) https://doi.org/10.16931/1995-5464.2021159-65