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Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration
BACKGROUND/AIMS: Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in porta...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Editorial Office of Gut and Liver
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667928/ https://www.ncbi.nlm.nih.gov/pubmed/32050751 http://dx.doi.org/10.5009/gnl19293 |
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author | Park, Jae Woo Yoo, Jeong-Ju Kim, Sang Gyune Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Lee, Jae Myung Shim, Jong Joon Kim, Young Don Cheon, Gab Jin Jun, Baek Gyu Kim, Young Seok |
author_facet | Park, Jae Woo Yoo, Jeong-Ju Kim, Sang Gyune Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Lee, Jae Myung Shim, Jong Joon Kim, Young Don Cheon, Gab Jin Jun, Baek Gyu Kim, Young Seok |
author_sort | Park, Jae Woo |
collection | PubMed |
description | BACKGROUND/AIMS: Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver function, ascites, hepatic encephalopathy, and especially esophageal varix (EV) after PARTO. METHODS: From March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. RESULTS: The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score change from 11.46±4.35 to 10.33±2.96, p=0.021). Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52±3.83 to 14.68±5.03 mm Hg; p<0.001). Twenty-five patients with portal pressure measured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. No factor associated with portal pressure was affected by liver function improvement. Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post odds ratio, 1.341; 95% confidence interval, 1.017 to 1.767; p=0.037). CONCLUSIONS: The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG. Liver function was improved over the 6-month follow-up period. Portal pressure after PARTO was a significant risk factor for EV deterioration. Portal pressure measurement is helpful for predicting the patient’s clinical outcome. |
format | Online Article Text |
id | pubmed-7667928 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Editorial Office of Gut and Liver |
record_format | MEDLINE/PubMed |
spelling | pubmed-76679282020-11-18 Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration Park, Jae Woo Yoo, Jeong-Ju Kim, Sang Gyune Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Lee, Jae Myung Shim, Jong Joon Kim, Young Don Cheon, Gab Jin Jun, Baek Gyu Kim, Young Seok Gut Liver Original Article BACKGROUND/AIMS: Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver function, ascites, hepatic encephalopathy, and especially esophageal varix (EV) after PARTO. METHODS: From March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. RESULTS: The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score change from 11.46±4.35 to 10.33±2.96, p=0.021). Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52±3.83 to 14.68±5.03 mm Hg; p<0.001). Twenty-five patients with portal pressure measured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. No factor associated with portal pressure was affected by liver function improvement. Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post odds ratio, 1.341; 95% confidence interval, 1.017 to 1.767; p=0.037). CONCLUSIONS: The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG. Liver function was improved over the 6-month follow-up period. Portal pressure after PARTO was a significant risk factor for EV deterioration. Portal pressure measurement is helpful for predicting the patient’s clinical outcome. Editorial Office of Gut and Liver 2020-11-15 2020-02-14 /pmc/articles/PMC7667928/ /pubmed/32050751 http://dx.doi.org/10.5009/gnl19293 Text en Copyright © 2020 by The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Park, Jae Woo Yoo, Jeong-Ju Kim, Sang Gyune Jeong, Soung Won Jang, Jae Young Lee, Sae Hwan Kim, Hong Soo Lee, Jae Myung Shim, Jong Joon Kim, Young Don Cheon, Gab Jin Jun, Baek Gyu Kim, Young Seok Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration |
title | Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration |
title_full | Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration |
title_fullStr | Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration |
title_full_unstemmed | Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration |
title_short | Change in Portal Pressure and Clinical Outcome in Cirrhotic Patients with Gastric Varices after Plug-Assisted Retrograde Transvenous Obliteration |
title_sort | change in portal pressure and clinical outcome in cirrhotic patients with gastric varices after plug-assisted retrograde transvenous obliteration |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667928/ https://www.ncbi.nlm.nih.gov/pubmed/32050751 http://dx.doi.org/10.5009/gnl19293 |
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