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Octreotide for acute esophageal variceal bleeding
Poster Sessions
52
Category 2: Cirrhosis and its complications, pathophysiology and clinical aspects
I156
EFFECT
OF OBLITERATION
THE OUTCOME
OF FUNDAL
EXTENSIONS
OF PATIENTS WITH VARICEAL
ON
BLEEDING
A.M. Abdel Samie. Head Of GZT Unit, Egypt Air Hospital, Cairo, Egypt Oesophageal and gastric varices represent one of the most serious complications of portal hypertension. Linear fundal extensions are common sites of bleeding and rebleeding after endoscopic therapy. The objective of this study is to assess the effect of endoscopic obliteration of these extensions on the outcome of patients with acute variceal bleeding. We selected 806 patients (744 males & 62 females, mean age 38 years, range 27-61) with active variceal bleeding. In all cases there was fundal linear extension of one or more of the oesophageal varices, the extensions ranged from 1 to 5cm. The bleeding site was found on fundal extensions in 414 cases “51%“. Fundal extensions were obliterated with histoacryl-lipidol mixture while oesophageal varices were banded or injected with ethanolamine oleate 5% according to site of bleeding. Follow up endoscopy was performed for all patients after 2 weeks, 4 weeks, 8 weeks and 6 months, with follow up band ligation of oesophageal varices as needed. Control of acute bleeding was achieved in 804/806 patients. Rebleeding occurred in 6 cases during the first week, and in 8 cases during 6 months. Rebleeding site was from fundal extensions in 11114 patients, bleeding was controlled in 13/14 cases while one case died while TIPSS was being arranged. Eradication of varices was achieved after 2 sessions of band ligation in 499 patients, while 3 sessions were needed for 296 patients, and only 6 patients needed 4th session. 9 patients died with hepatocellular failure without bleeding. We concluded that fundal extensions of oesophageal varices are common sites of bleeding and must be looked for thoroughly in acute variceal bleeding. Injection of these extensions with tissue adhesive agent improves the rate of successful control of acute bleeding and minimizes the number of sessions needed for complete eradication of varices. Comparable studies with other therapeutic modalities like band ligation for fundal extensions are needed.
I
157
ESSENTIAL CHRONIC
SYSTEMIC
HYPERTENSION
AND VIRAL
LIVER DISEASE
A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. El Hendawy4, M.E. El Desouky4, S.M. ElHadad5, M.M. Kame16. ‘Mansoura International Hospital, Mansoura, Egypt; 2Kings Collague Hospital, London, UK; ‘Asuit University, Egypt; 4Mansoura University, Mansoura, Egypt; ‘Ein Shams University, Egypt; 6Cairo University,
that hypertensive patients with cirrhosis had better hepatic synthesis, fewer biochemical and ultrasound -Doppler signs of portal hypertension, but no difference in caliber of esophageal varices at endoscopy. Both phases of the study showed that chronic hepatitis patients with hypertension had a significantly higher onset age. Histological findings in chronic hepatitis revealed more fibrosis and less spotty necrosis, biochemical data, in these patients, disclosed lower transaminases levels. Conclusion: our results suggest that essential systemic hypertension seems to play a protective role in viral chronic liver disease, and that hemodynamic factors may be involved in the progression of chronic viral hepatitis.
I 158
OCTREOTIDE
FOR ACUTE ESOPHAGEAL
VARICEAL
BLEEDING
A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. E1Hendawy4, M.E. El Desouky4, S.M. El Hadad’, M.M. Kame16. ‘Mansoura International Hospital, Mansoura, Egypt; 2Kings Collague Hospital, London, UK; ‘Asuit University, Egypt; 4Mansoura University, Egypt; 5Ein Shams University, Egypt; 6Cairo University, Egypt Aim: The aim was to compare efficacy of endoscopic variceal sclerotherapy (EVS) alone and in combination with octreotide in the treatment of AVB,and preventing early rebleeding. Methods: 60 patients presenting with AVB (58 M, and 2 F, mean age 41.5). The patients divided into two groups: Group A-30 patients treated only with sclerotherapy, and group B-30 patients treated with sclerotherapy plus octreotide in continuous infusion of 50 micrograms/h 5 dayspatients were evaluated after 48 hours and after 6 days of treatment. Results: In group A, bleeding was controled in 22 patients from 30 (73%), and in group B in 27 patients from 30 (90%) -p>O.OOl. The number of patients who rebleeded during the first 6 days in group A was 8 (27%), and in group B was 3 (10%). The mean number of units of blood transfused within the first 48 hours after sclleroterapy was lower in group B, than in group A.Hospital mortality in group B was lo%, and in group A was 20%.Hospita1 stay was in group B 5,7 days, and in group A was 9,8 (p
I
159
ROLE OF THERLIPRESSINE
AND OCTREOTIDE
HEPATORENAL
(HRS)
SYNDROME
IN TYPE I
Egypt
A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. E1Hendawy4, M.E. El Desouky4, S.M. El Hadad’, M.M. Kame16. ‘Mansoura International Hospital, Mansoura, Egypt; 2Kings Collague Hospital, London, UK; ‘Asuit University, Egypt; 4Mansoura University, Mansoura, Egypt; ‘Ein Shams University, Egypt; 6Cairo University, Cairo, Egypt
Background: Systemic hypotension is a main feature of hyperdynamic circulation typical of evolved chronic liver disease, and is also a negative prognostic factor. Aim and Methods: This study aimed to discover whether essential hypertension modifies the natural progression of chronic liver disease. The study entailed two phases: a retrospective study (254 patients) to establish the natural history of viral chronic hepatitis in patients with and without essential hypertension, and a cross-sectional study to compare the ultrasound,endoscopic and biochemical signs in Child A cirrhosis (71 patients), and the histological and biohumoral alterations in chronic hepatitis (95 patients), with normal versus high blood pressure. Results: the retrospective study revealed a lower incidence of progression to cirrhosis and a significantly longer survival in the group of patients with chronic hepatitis and high blood pressure.The cross-sectional study showed
Aim of the Study: To report the results of treatment of HRS with therlipressine (glyopressine) and octreotide (Sandostatine). Methods: The study consisted of 15 patients (12male, 3 female), with ages 40-60 years, diagnosed with Child C stage liver cirhosis with type I HRS.Patients of group I (7 patients)were treated with octreotide (100 microgr x 3/day), while patients of group II were treated with therlipressine (2 mglday), over a mean period of 10 days (8.12).We determined systemic hemodynamics, renal hemodynamics, renal function, liver function tests and the portal flux (PF). Results: 5 patients of group I and 6 patients of group II responded to treatment (p=NS), as shown by a 38.50% decrease of creatinin on day 5 and up to 70% on day 10 of traetment.Mean values of diuresis increased from 680 ml/24h (150-1100) to 1200 ml/24 h after 7 days of treatment (p
52
Category 2: Cirrhosis and its complications, pathophysiology and clinical aspects
I156
EFFECT
OF OBLITERATION
THE OUTCOME
OF FUNDAL
EXTENSIONS
OF PATIENTS WITH VARICEAL
ON
BLEEDING
A.M. Abdel Samie. Head Of GZT Unit, Egypt Air Hospital, Cairo, Egypt Oesophageal and gastric varices represent one of the most serious complications of portal hypertension. Linear fundal extensions are common sites of bleeding and rebleeding after endoscopic therapy. The objective of this study is to assess the effect of endoscopic obliteration of these extensions on the outcome of patients with acute variceal bleeding. We selected 806 patients (744 males & 62 females, mean age 38 years, range 27-61) with active variceal bleeding. In all cases there was fundal linear extension of one or more of the oesophageal varices, the extensions ranged from 1 to 5cm. The bleeding site was found on fundal extensions in 414 cases “51%“. Fundal extensions were obliterated with histoacryl-lipidol mixture while oesophageal varices were banded or injected with ethanolamine oleate 5% according to site of bleeding. Follow up endoscopy was performed for all patients after 2 weeks, 4 weeks, 8 weeks and 6 months, with follow up band ligation of oesophageal varices as needed. Control of acute bleeding was achieved in 804/806 patients. Rebleeding occurred in 6 cases during the first week, and in 8 cases during 6 months. Rebleeding site was from fundal extensions in 11114 patients, bleeding was controlled in 13/14 cases while one case died while TIPSS was being arranged. Eradication of varices was achieved after 2 sessions of band ligation in 499 patients, while 3 sessions were needed for 296 patients, and only 6 patients needed 4th session. 9 patients died with hepatocellular failure without bleeding. We concluded that fundal extensions of oesophageal varices are common sites of bleeding and must be looked for thoroughly in acute variceal bleeding. Injection of these extensions with tissue adhesive agent improves the rate of successful control of acute bleeding and minimizes the number of sessions needed for complete eradication of varices. Comparable studies with other therapeutic modalities like band ligation for fundal extensions are needed.
I
157
ESSENTIAL CHRONIC
SYSTEMIC
HYPERTENSION
AND VIRAL
LIVER DISEASE
A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. El Hendawy4, M.E. El Desouky4, S.M. ElHadad5, M.M. Kame16. ‘Mansoura International Hospital, Mansoura, Egypt; 2Kings Collague Hospital, London, UK; ‘Asuit University, Egypt; 4Mansoura University, Mansoura, Egypt; ‘Ein Shams University, Egypt; 6Cairo University,
that hypertensive patients with cirrhosis had better hepatic synthesis, fewer biochemical and ultrasound -Doppler signs of portal hypertension, but no difference in caliber of esophageal varices at endoscopy. Both phases of the study showed that chronic hepatitis patients with hypertension had a significantly higher onset age. Histological findings in chronic hepatitis revealed more fibrosis and less spotty necrosis, biochemical data, in these patients, disclosed lower transaminases levels. Conclusion: our results suggest that essential systemic hypertension seems to play a protective role in viral chronic liver disease, and that hemodynamic factors may be involved in the progression of chronic viral hepatitis.
I 158
OCTREOTIDE
FOR ACUTE ESOPHAGEAL
VARICEAL
BLEEDING
A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. E1Hendawy4, M.E. El Desouky4, S.M. El Hadad’, M.M. Kame16. ‘Mansoura International Hospital, Mansoura, Egypt; 2Kings Collague Hospital, London, UK; ‘Asuit University, Egypt; 4Mansoura University, Egypt; 5Ein Shams University, Egypt; 6Cairo University, Egypt Aim: The aim was to compare efficacy of endoscopic variceal sclerotherapy (EVS) alone and in combination with octreotide in the treatment of AVB,and preventing early rebleeding. Methods: 60 patients presenting with AVB (58 M, and 2 F, mean age 41.5). The patients divided into two groups: Group A-30 patients treated only with sclerotherapy, and group B-30 patients treated with sclerotherapy plus octreotide in continuous infusion of 50 micrograms/h 5 dayspatients were evaluated after 48 hours and after 6 days of treatment. Results: In group A, bleeding was controled in 22 patients from 30 (73%), and in group B in 27 patients from 30 (90%) -p>O.OOl. The number of patients who rebleeded during the first 6 days in group A was 8 (27%), and in group B was 3 (10%). The mean number of units of blood transfused within the first 48 hours after sclleroterapy was lower in group B, than in group A.Hospital mortality in group B was lo%, and in group A was 20%.Hospita1 stay was in group B 5,7 days, and in group A was 9,8 (p
I
159
ROLE OF THERLIPRESSINE
AND OCTREOTIDE
HEPATORENAL
(HRS)
SYNDROME
IN TYPE I
Egypt
A.R. Abulfutuh’, M.A. Morsy2, A.M. Solyman3, S.M. E1Hendawy4, M.E. El Desouky4, S.M. El Hadad’, M.M. Kame16. ‘Mansoura International Hospital, Mansoura, Egypt; 2Kings Collague Hospital, London, UK; ‘Asuit University, Egypt; 4Mansoura University, Mansoura, Egypt; ‘Ein Shams University, Egypt; 6Cairo University, Cairo, Egypt
Background: Systemic hypotension is a main feature of hyperdynamic circulation typical of evolved chronic liver disease, and is also a negative prognostic factor. Aim and Methods: This study aimed to discover whether essential hypertension modifies the natural progression of chronic liver disease. The study entailed two phases: a retrospective study (254 patients) to establish the natural history of viral chronic hepatitis in patients with and without essential hypertension, and a cross-sectional study to compare the ultrasound,endoscopic and biochemical signs in Child A cirrhosis (71 patients), and the histological and biohumoral alterations in chronic hepatitis (95 patients), with normal versus high blood pressure. Results: the retrospective study revealed a lower incidence of progression to cirrhosis and a significantly longer survival in the group of patients with chronic hepatitis and high blood pressure.The cross-sectional study showed
Aim of the Study: To report the results of treatment of HRS with therlipressine (glyopressine) and octreotide (Sandostatine). Methods: The study consisted of 15 patients (12male, 3 female), with ages 40-60 years, diagnosed with Child C stage liver cirhosis with type I HRS.Patients of group I (7 patients)were treated with octreotide (100 microgr x 3/day), while patients of group II were treated with therlipressine (2 mglday), over a mean period of 10 days (8.12).We determined systemic hemodynamics, renal hemodynamics, renal function, liver function tests and the portal flux (PF). Results: 5 patients of group I and 6 patients of group II responded to treatment (p=NS), as shown by a 38.50% decrease of creatinin on day 5 and up to 70% on day 10 of traetment.Mean values of diuresis increased from 680 ml/24h (150-1100) to 1200 ml/24 h after 7 days of treatment (p