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Emergency upper gastrointestinal bleeding

Krish Ragunath, Rudolf Stauber, Bjorn Rembacken

Summary

AI Generated

This educational course addresses the multidisciplinary management of upper gastrointestinal bleeding, a common emergency with substantial mortality.

  • Upper gastrointestinal bleeding is a common emergency associated with substantial mortality and requires multidisciplinary management involving intensivists, gastroenterologists, haematologists and surgeons.
  • The course covers general management principles, endoscopic management of bleeding sites, and strategies for cases where endoscopic therapy fails.
  • The target audience includes gastroenterologists, physicians and surgeons in other disciplines, nursing staff, endoscopy associates and medical students who care for patients with potential upper GI bleeding.
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Overview

Upper gastrointestinal bleeding is a common emergency associated with a substantial mortality rate. The management bridges disciplines and involves intensivists, gastroenterologists, haematologists and surgeons. Anyone looking after inpatients needs to have a working understanding of how to manage the condition.

Learning objectives

  • To be aware of the prevalence, morbidity and mortality of emergency upper GI bleeding
  • To understand the general management of the condition
  • To become familiar with endoscopic management of the bleeding site
  • To know how to manage cases when endoscopic therapy fails

Target audience

This course is suitable for gastroenterologists, physicians and surgeons in other disciplines who are caring for patients who may develop an upper GI bleeding site, as well as nursing staff, endoscopy associates and medical students.

Event

Emergency upper gastrointestinal bleeding

Topics

Endoscopy Oesophagus Small Intestine & Nutrition Stomach & H. Pylori

Accreditation status

not accredited

Duration

1 hour

Published

2016

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ROUTINE CARE DATA ANALYZED USING EXPLAINABLE ARTIFICIAL INTELLIGENCE IDENTIFY BEST THERAPEUTIC SEQUENCE OF 2ND LINE BIOLOGIC TREATMENTS AFTER A 1ST LINE WITH ANTI-TNF OR VEDOLIZUMAB IN INFLAMMATORY BOWEL DISEASE

Yoram Bouhnik 1, Pablo Iriso 2, Bastien Malahieude 3, Carmen Stefanescu 1, Chaima Romdhane 2, Yassamin BENHAYOUN SADAFYINE 1, Jawad Boulahfa 2, Laurent Peyrin-Biroulet 1, Jeremie Neuberg 3, Xavier Treton 1, Frederic Parmentier 2, Mohammad Afshar 2

Affiliations

1 Institut des MICI, Neuilly Sur Seine, France

2 Ariana Pharma, Paris, France

3 Instamed, Paris, France

Summary

AI Generated

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis, two conditions characterised by chronic inflammation of the gastrointestinal tract, which can damage the bowel and cause serious disabilities in patients' quality of life. Treatments only have a suspensive effect and the therapeutic sequences are currently based on reimbursement criteria or the prescriber's expertise, in a “trial-and-error” approach rather than on validated scientific evidence.
Routine clinical care data from 1,190 IBD patients collected by a private tertiary care centre dedicated to IBD patients, using the customised Instamed® platform, includes comprehensive information on the patient's treatment history, clinical variables and disease activity scores, in particular the Harvey-Bradshaw Index (HBI), Mayo Partial Score (MPS) and Simple Clinical Colitis Activity Index (SCCAI).
KEM® (Knowledge Extraction and Management) is an explainable Artificial Intelligence (xAI) platform using Formal Concept Analysis (FCA) that systematically extracts and evaluates all relations between variables in a database, thus enabling the identification of patient subgroups with greater likelihood of response to treatment sequences.

Aims & Methods

This study addresses the prevalent clinical challenge of uncertainty in treatment selectionfollowing the initial administration of anti-TNF or vedolizumab given as first-line therapy for IBD, aiming to identify the most effective second-line treatment options.
Data were aggregated into a consolidated database of 1,190 patients and 1,269 variables within the KEM® xAI Platform. Patients with at least 2 treatment lines were selected. To ensure a strong causality between treatment prescription and response, the maximal number of treatment lines was limited to 3. The outcome used was therapeutic response after three treatment lines, evaluated using HBI, PMS and SCCAI. Within 19,230,463 associations between sequence of the first two treatment lines and the response, 70 associations were retained by KEM® with successful treatment sequence with anti-TNFs, vedolizumab or thiopurine as first treatment line.

Results

285 patients fulfilled the analysis criteria. We identified hypotheses in favor of a second-line biological treatment (ustekinumab, JAKi, 2nd anti-TNF) after failure of a first-line treatment with anti-TNF or vedolizumab. Ustekinumab was 2 times more likely to be associated with a response to treatment. JAKi was 2 times less likely to be associated with a response to treatment. The 2nd anti-TNF was associated with a response to treatment in a specific subgroup. Moreover, successful treatment sequences with patient count above 10 and up to 30, involved thiopurine as first line of treatment, followed by anti-TNFs or thiopurine repeated as second line of treatment.

Conclusion

We show a powerful setup using routine clinical care data from an initial set of 1,190 IBD patients and the KEM® xAI platform to provide actionable hypotheses supporting therapeutic
decisions for disease management. These initial results will be further tested and validated as we accumulate real-life data on new patients and complete the follow-up of patients already included. The flexibility of our platform will enable us to include more therapeutic sequences and to add all the new treatments available in current clinical practice. This will allow us to offer continuous, up-to-date support for difficult medical decisions, enabling patient management to be guided by results observed in real life and leading de facto to precision medicine.

Disclosure

None

Conference

UEG Week Vienna 2024

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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INCIDENCE OF CHRONIC END-STAGE RENAL DISEASE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY FROM THE FRENCH NATIONAL HEALTH INSURANCE DATABASE

prothe carole 1, Anastasia Boitel 1, Berenger Martin 1, Valentine Clairet 2, Lea Juif 3, Stephane Koch 3, Stephane Lang 1, Didier Ducloux 4, Maxime Desmarets 1, Lucine Vuitton 5

Affiliations

1 CHU Minjoz, Besançon, France

2 CHU Minjoz, Besancon, France

3 Chru Minjoz Besançon, Besancon, France

4 Chru Minjoz, Besancon, France

5 Besançon university hospital gastroenterology, Besançon, France

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Renal disorders are among the extra-intestinal manifestations of inflammatory bowel disease (IBD), and treatments may also lead to renal failure. However, the incidence of end-stage renal disease (ESRD), defined as the need for renal replacement therapy (dialysis and/or renal transplantation (RT)), is poorly known. The primary objective of our study was to assess the incidence of ESRD in IBD patients, and to compare it with the general health insurance scheme population.

Aims & Methods

We conducted a prognostic cohort study based on data from the French National Health Insurance Database(SNDS). Prevalent cases of IBD affiliated to the general health insurance scheme during the period 2011-2020 were identified on the basis of declarations long-term diseases ALD 24 or the presence of 2 hospital stays for IBD with ICD-10 codes or a single stay with reimbursement of specific treatments. Incident cases of ESRD were identified on the basis of a stay with a RT or a period with dialysis sessions for at least 45 days. Crude incidence rates of ESRD were calculated over the period for the IBD and the non-IBD population, with their 95% confidence intervals.

Results

A total of 280,283 IBD patients were included in the study over the period 2011-2020, 134,567 with ulcerative colitis(UC) and 145,716 with Crohn’s disease(CD). The mean age at study inclusion was 39.8 (± 17.1) years. The M/F sex ratio was 0.9. The mean age at incidence of ESRD in the non-IBD population was 65.0 (±17.0) years, the M/F sex ratio cases was 1.7.
Among IBD patients, 534 patients began replacement therapy by dialysis or RT, they were younger than non-IBD patients (60.3(±16.7)years, P<0.001).The mean incidence rate of ESRD over the period was 26.4 per 100,000 person-years (IC95% 23.1-29.6), 480 (89.9%) patients entered ESRD by dialysis, and 54 (10.1%) by preemptive RT. In the non-IBD population the mean rate of ESRD was 15.9 per 100,000 person-years (IC95% 14.8- 17.1; P<0.0001 compared with IBD): 79,606 (94.5%) patients entered ESRD by dialysis, and 4,634 (5.5%) by RT (as compared with IBD,P<0.001). In subgroup analysis, the mean incidence rate of ESRD was 22.8 per 100,000 person-years (IC95% 18.9-26.7) in UC patients and 29.5 (IC95% 25.3-33.6) in CD patients (P<0,0001). The rates of preemptive RT were 12.4% in UC patients (87.6% dialysis) and 8.6% in CD patients (91.4% dialysis).
Over a median follow-up of 6.8 years, the survival rate after ESRD was 40.8% in ESRD-IBD patients VS 34.2% in ESRD non-IBD patients (P<0.001). This difference remained significant for patients under 65 (p<0.0073).
No significant difference for the risk of re-hospitalization after RT (p=0.84), of retransplantation during the follow-up period in RT patients (p=0.67), or for the risk of hospitalization for severe infection (p=0.97) after RT in patients from the general population compared with IBD patients. The same was true for the type of severe infections after RT (p= 0.068) and for the risk of solid and haematological cancer after RT (p=0.48). However, there was a significant difference in the type of first severe infection after RT(p=0.003), but we are waiting for the results to tell us which one.

Conclusion

The incidence of ESRD is significantly higher in IBD than in the general data base population, confirming the need for regular monitoring of renal function in our patients.
Survival after ESRD onset, is higher in IBD patients.
The high incidence of RT in the IBD population confirms that access to transplantation is not restricted in this
population.

References

Kirchgesner et al, Gastroenterology 2018
Meyer et al, Aliment Pharmacol Ther. 2020
Tuppin et al, Nephrol Ther 2016

Conference

UEG Week Vienna 2024

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Alberto Larghi Alberto Larghi, Antonio Gasbarrini, Cristiano Spada, Brigida Annicchiarico, Giulia Venturini, Giulia Tripodi, Andrea Contegiacomo, Francesca Romana Ponziani, Francesco Santopaolo, Gianenrico Rizzatti, Lucia Giuli

UEG Poster
Standard Poster
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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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1000 PER-ORAL ENDOSCOPIC MYOTOMY AND COUNTING: AN 11-YEAR EXPERIENCE AT A SINGLE ENDOSCOPY CENTER

Rosario Landi 1, Francesca Mangiola 1, Tommaso Schepis 1, Federico Barbaro 1, Andrea Tringali 1, Vincenzo Perri 1, Guido Costamagna 1, Cristiano Spada 1, Pietro Familiari 1

Affiliations

1 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Per-Oral Endoscopic Myotomy (POEM) was introduced in clinical practice few years ago, and quickly become one of the first line treatments of esophageal motility disorders. We report on the outcomes of the first 1000 patients treated with POEM in a single tertiary referral center during 11 years.

Aims & Methods

The first 1000 patients treated with POEM between May 2011 and September 2022 were identified from a prospective database and included in this study.
Demographics, clinical and technical aspects and follow-up data were collected and analysed. After treatment, patients underwent a regular follow-up, after 6 month, 2 years, 5 years and 10 years. Additional follow-up visits were performed, if clinically indicated. Timed Barium Esophagram, EGD, and esophageal manometry were performed before endoscopic treatment and during post-operative follow-up; a 24-hour esophageal pH monitoring study was performed 6 months after POEM.
Clinical failure was defined by and Eckardt score > 3 and by the need for additional treatments.

Results

Mean age of patients was 51.5 years; 36 patients were younger than 18 years and 157 older than 70 years. Four-hundred ninety-eight patients were male. One hundred seventy-seven patients had received previous treatments for achalasia (110 pneumodilation, 46 surgical myotomy; 21 botulinum toxin injection).
A total of 141 patients had a type I achalasia, 626 a type II, 111% a type III, 30 non-achalasia spastic esophageal motility disorders; in 92 patients achalasia type were not adequately classified. A sigmoid-type esophagus was present in 45 patients.
Mean symptoms duration before POEM was 24±64.6 months.
POEM was technically successful in 979 patients.
The median length of myotomy was 8.0 cm (range 4-22 cm) in the esophagus and 3.1 cm (range 0-7 cm) in the stomach. An anterior myotomy was performed in the 83% of patients. Mean operative time was 50.4 minutes (11–180 minutes).
Length of hospital stay was a mean of 2.5 days (range 1 to 48 days) after POEM.
Mild or moderate complications occurred in 28 patients (2.8%) and were managed conservatively. Severe complications occurred in 2 patients and required prolongation of hospital stay and other interventional treatment. There were no perioperative deaths in our series.
A mean follow-up of 30.4 months (3–130 months) was available for 93.8% of patients. Overall clinical success rate (Eckardt score ≤ 3) was 95.1%. Clinical success was 97.3%, 95.2%, 90.8% and 82% after 6 months, 2 years, 5 years and 10 years, respectively.
Thirty-three patients (70.2 %) with clinical failure underwent pneumodilation (78.8% with persisting clinical benefits); 5 patients (10.6% underwent surgery), one (2.1%) underwent re-POEM.
Clinical success was 93.4% in achalasia-patients and 83.3% in those with spastic motility disorders (p=0.1742).
An altered esophageal pH-study was documented in 32.6% patients; esophagitis rate was 34% (88% grade A/B; 12% grade C/D). At the date of the last follow-up, 38% of patients was receiving daily proton-pump inhibitors for gastroesophageal reflux. Two patients underwent antireflux surgery. Non cases of post-operative Barrett esophagus were identified.

Conclusion

Our results confirm the efficacy of POEM in a large cohort of patients. Benefits of POEM seem durable; adverse events are rare and no specific mortality was reported. Prevalence of GERD is relatively high, but well controlled by medications in the vast majority of patients.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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1000 PER-ORAL ENDOSCOPIC MYOTOMY AND COUNTING: AN 11-YEAR EXPERIENCE AT A SINGLE ENDOSCOPY CENTER

Federico Barbaro Federico Barbaro, Pietro Familiari, Cristiano Spada, Guido Costamagna, Vincenzo Perri, Andrea Tringali, Tommaso Schepis, Francesca Mangiola, Rosario Landi

THE CONTRIBUTION OF THE MEDICAL EDUCATION OF THE PATIENT WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE ON THE THERAPEUTIC RESULTS

THE CONTRIBUTION OF THE MEDICAL EDUCATION OF THE PATIENT WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE ON THE THERAPEUTIC RESULTS

Georgiana- Emmanuela Gilca-Blanariu Georgiana- Emmanuela Gilca-Blanariu, Gheorghe Balan, Elena Gologan, Dimitrie Stefan Gologan, Mara-Krysta Grumeza, Andrei Nicolae Gologan

ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

Horia Stefanescu Horia Stefanescu, Cristina Pojoga, Bogdan Dumitru Procopet, Andrada Seicean, Irina Dragomir

ENDOSCOPIC ULTRASOUND DIRECT PORTAL PRESSURE MEASUREMENT IS MORE RELIABLE THAN HEPATIC VENOUS PRESSURE GRADIENT MEASUREMENT IN PATIENTS WITH PRE-SINUSOIDAL FORMS OF PORTAL HYPERTENSION

ENDOSCOPIC ULTRASOUND DIRECT PORTAL PRESSURE MEASUREMENT IS MORE RELIABLE THAN HEPATIC VENOUS PRESSURE GRADIENT MEASUREMENT IN PATIENTS WITH PRE-SINUSOIDAL FORMS OF PORTAL HYPERTENSION

Alberto Larghi Alberto Larghi, Antonio Gasbarrini, Cristiano Spada, Brigida Annicchiarico, Giulia Venturini, Giulia Tripodi, Andrea Contegiacomo, Francesca Romana Ponziani, Francesco Santopaolo, Gianenrico Rizzatti, Lucia Giuli

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THE CONTRIBUTION OF THE MEDICAL EDUCATION OF THE PATIENT WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE ON THE THERAPEUTIC RESULTS

Andrei Nicolae Gologan 1, Mara-Krysta Grumeza 1, Dimitrie Stefan Gologan 1, Elena Gologan 1, Gheorghe Balan 1, Georgiana- Emmanuela Gilca-Blanariu 1

Affiliations

1 University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania

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Abstract

Introduction

Metabolic-associated fatty liver disease (MAFLD) requires complex treatment based on diet and lifestyle. The understanding of the disease by patients through medical education is an element that could bring them a therapeutic benefit. Since the process is time-consuming and medical factors all over the world are under pressure to use maximum time for diagnostic and therapeutic purposes, an important role can be played by the voluntary activity carried out by medical students, under the guidance of teaching staff, devoted to this purpose.

Aims & Methods

A group of 250 patients with MAFLD, non-cirrhotic, diagnosed in a gastroenterology outpatient clinic, were proposed to participate in an educational program consisting of 3 sessions of 2 hours of interactive course about MAFLD (including notions of anatomy, physiology, diagnosis, evolution, prognosis, complications, risks, treatment, follow-up) in order to appreciate the contribution of medical education to the effectiveness of treatment. The patients did not receive medication but only recommendations regarding lifestyle changes and the Mediterranean diet. They were re-evaluated 6 months after the initial evaluation.

Results

Of the 250 patients, only 126 (50.4%) accepted participation in the educational plan after informed consent, a disappointing proportion; the subgroup of those who did not participate in the course was reported as a control group (the main reason of non-participation was the fact that most of these patients considered to have already enough knowledge about MAFLD), being also invited to be evaluate after 6 months. Educational presentations were given by medical students under the guidance of teaching staff (power-point presentations and informative flyers designed to fix the knowledges about disease) and patients were clinically, laboratory, ultrasound and fibroscan evaluated by attending physicians. Also a questionnaire about quality of life was completed by each patient. Finally, after 6 months, only 85 patients from the control group and 118 from the study group returned for the final evaluation. The final evaluation focused on 4 elements: 1- changes in body mass (decrease of more than 7%), 2- liver ultrasonography (reduction of the degree of steatosis), 3- laboratory analyzes (liver and metabolic tests) and 4- quality of life. In the study group, significantly better results were obtained for parameters 1, 3 and 4: (78%, 87.2%, 84.7%) compared to the reference group (38.8%, 54.1%, 62.3%) which confirms the fact that patient education is an important element in understanding the disease and its treatment. Only in parameter 2 (decrease of steatosis at ultrasonography) there were no significant differences between the two groups (50.8% vs 48.2%), probably due to the too short follow-up time of the patients.

Conclusion

Therapeutic education of patients with MAFLD can bring more efficiency to the treatment of the disease in non-cirrhotic patients, mainly on body mass control, liver laboratory tests and quality of life, if they accept to participate at educational program.

References

Koutny F, Aigner E, Datz C, Gensluckner S, Maieron A, Mega A, Iglseder B, Langthaler P, Frey V, Paulweber B, Trinka E, Wernly B. Relationships between education and non-alcoholic fatty liver disease. Eur J Intern Med. 2023 Dec;118:98-107. doi: 10.1016/j.ejim.2023.07.039. Epub 2023 Aug 3. PMID: 37541922.
Lee WM, Bae JH, Chang Y, Lee SH, Moon JE, Jeong SW, Jang JY, Kim SG, Kim HS, Yoo JJ, Kim YS. Effect of Nutrition Education in NAFLD Patients Undergoing Simultaneous Hyperlipidemia Pharmacotherapy: A Randomized Controlled Trial. Nutrients. 2021 Dec 13;13(12):4453. doi: 10.3390/nu13124453. PMID: 34960005; PMCID: PMC8709046.

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

Identification and mechanisms in SLD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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ROUTINE CARE DATA ANALYZED USING EXPLAINABLE ARTIFICIAL INTELLIGENCE IDENTIFY BEST THERAPEUTIC SEQUENCE OF 2ND LINE BIOLOGIC TREATMENTS AFTER A 1ST LINE WITH ANTI-TNF OR VEDOLIZUMAB IN INFLAMMATORY BOWEL DISEASE

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Federico Barbaro Federico Barbaro, Pietro Familiari, Cristiano Spada, Guido Costamagna, Vincenzo Perri, Andrea Tringali, Tommaso Schepis, Francesca Mangiola, Rosario Landi

THE CONTRIBUTION OF THE MEDICAL EDUCATION OF THE PATIENT WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE ON THE THERAPEUTIC RESULTS

THE CONTRIBUTION OF THE MEDICAL EDUCATION OF THE PATIENT WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE ON THE THERAPEUTIC RESULTS

Georgiana- Emmanuela Gilca-Blanariu Georgiana- Emmanuela Gilca-Blanariu, Gheorghe Balan, Elena Gologan, Dimitrie Stefan Gologan, Mara-Krysta Grumeza, Andrei Nicolae Gologan

ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

Horia Stefanescu Horia Stefanescu, Cristina Pojoga, Bogdan Dumitru Procopet, Andrada Seicean, Irina Dragomir

ENDOSCOPIC ULTRASOUND DIRECT PORTAL PRESSURE MEASUREMENT IS MORE RELIABLE THAN HEPATIC VENOUS PRESSURE GRADIENT MEASUREMENT IN PATIENTS WITH PRE-SINUSOIDAL FORMS OF PORTAL HYPERTENSION

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Alberto Larghi Alberto Larghi, Antonio Gasbarrini, Cristiano Spada, Brigida Annicchiarico, Giulia Venturini, Giulia Tripodi, Andrea Contegiacomo, Francesca Romana Ponziani, Francesco Santopaolo, Gianenrico Rizzatti, Lucia Giuli

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ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

Irina Dragomir 1, Andrada Seicean 2, Bogdan Dumitru Procopet 3, Cristina Pojoga 4, Horia Stefanescu 5

Affiliations

1 University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania

2 University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania

3 University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania

4 IRGH, Cluj Napoca, Romania

5 Cluj-Napoca University of Medicine and Pharmacy 3rd Medical Clinic, Hepatology and Medical Imaging D, Cluj-Napoca, Romania

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Abstract

Introduction

Endoscopic ultrasound (EUS) has emerged as a new tool in assessing portal hypertension (PH). EUS portal pressure measurement (EUS-PPG) was described in few studies using a compact manometer, but the use of a pressure transducer connected to a pressure measurement monitor was previously described in a very small number of patients. The comparative assessment of portal pressure measured by EUS and tranjugular route has not been done before. Our study aimed to compare the value of EUS-PPG and transjugular measurements (HVP, PPG) in patients with portal hypertension.

Aims & Methods

Patients with signs of PH on transabdominal imaging and need for haemodynamic and/or endoscopic assessment were included. Patients with platelet count <50000/µL and INR>2.5 were excluded. EUS was performed using a 22 G fine needle aspiration attached to a central venous pressure measurement monitor, and it evaluated the presence of gastrointestinal varices, portal vein (PV) diameter and pressure, median hepatic vein/inferior vena cava pressure. All patients had HVPG measurements through the transjugular approach under fluoroscopic guidance, and portal pressure was assessed in patients scheduled for postosystemic shunt (TIPS). The results obtained by the two methods were statistically analysed.

Results

We prospectively enrolled (January to December 2023) 19 patients of 50±14 years old, male to female ratio=2,1:1). The aetiology of PH was porto-sinusoidal vascular disease (n=3, 15%), alcohol cirrhosis (n=15,75%), viral cirrhosis (n=1,5%) and metabolic cirrhosis (n=1, 5%). The patients with cirrhosis had Child-Pugh class B or C in 50% of cases. The mean INR was 1.41and the mean platelet level was 122.000/mcL
EUS-PPG was technically successful in 18 patients (94%), with one failure attributed to obesity and important perihepatic ascites which limited the needle deep advancement. The mean EUS-PPG was 13.15 ± 5.48 mmHg. 73% of patients had oesophageal and/or gastric varices present. The mean PV diameter was 12.8 ± 2.7 mm.
HVPG measurements were technically performed in 18 cases (94%), the one exception was related to anatomical factors impeding hepatic vein catheterisation. Mean HVPG was 14.7 ± 5.26 mmHg and it was similar to EUS-PPG (p = 0.09), with strong Pearson correlation coefficient (r=0.88).
In patients scheduled for TIPS (n=10), mean PPG was 16±4,15 mmHg and it correlated with EUS-PPG (r=0,81).
No difference was observed between the patients performing measurements during TIPS under general anaesthesia and the group assessed under mild sedation with midazolam. No adverse effects were noted.

Conclusion

The measurements of PH by transjugular route or EUS are comparable. EUS-PPG measurement with 22G needle proved to be an accurate and safe technique. Further investigation is required to determine its indications in patients requiring endoscopic assessment of portal hypertension

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

LIVER (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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THE CONTRIBUTION OF THE MEDICAL EDUCATION OF THE PATIENT WITH METABOLIC-ASSOCIATED FATTY LIVER DISEASE ON THE THERAPEUTIC RESULTS

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ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

Horia Stefanescu Horia Stefanescu, Cristina Pojoga, Bogdan Dumitru Procopet, Andrada Seicean, Irina Dragomir

ENDOSCOPIC ULTRASOUND DIRECT PORTAL PRESSURE MEASUREMENT IS MORE RELIABLE THAN HEPATIC VENOUS PRESSURE GRADIENT MEASUREMENT IN PATIENTS WITH PRE-SINUSOIDAL FORMS OF PORTAL HYPERTENSION

ENDOSCOPIC ULTRASOUND DIRECT PORTAL PRESSURE MEASUREMENT IS MORE RELIABLE THAN HEPATIC VENOUS PRESSURE GRADIENT MEASUREMENT IN PATIENTS WITH PRE-SINUSOIDAL FORMS OF PORTAL HYPERTENSION

Alberto Larghi Alberto Larghi, Antonio Gasbarrini, Cristiano Spada, Brigida Annicchiarico, Giulia Venturini, Giulia Tripodi, Andrea Contegiacomo, Francesca Romana Ponziani, Francesco Santopaolo, Gianenrico Rizzatti, Lucia Giuli

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ENDOSCOPIC ULTRASOUND DIRECT PORTAL PRESSURE MEASUREMENT IS MORE RELIABLE THAN HEPATIC VENOUS PRESSURE GRADIENT MEASUREMENT IN PATIENTS WITH PRE-SINUSOIDAL FORMS OF PORTAL HYPERTENSION

Lucia Giuli 1, Gianenrico Rizzatti 1, Francesco Santopaolo 1, Francesca Romana Ponziani 1, Andrea Contegiacomo 1, Giulia Tripodi 1, Giulia Venturini 1, Brigida Annicchiarico 1, Cristiano Spada 1, Antonio Gasbarrini 1, Alberto Larghi 1

Affiliations

1 Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy

Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Hepatic venous pressure gradient (HVPG) represents the gold standard for the evaluation of portal hypertension (PH). HVPG > 10 mmHg defines clinically significant portal hypertension (CSPH), a condition that is independently associated with the occurrence of decompensation events. Portal pressure measurement is of fundamental importance for prognostic stratification and assessment of response to therapies. Indeed, a decrement of HVPG by 20% and/or < 10 mmHg reduces the decompensation risk. HVPG, however, indirectly measures PH and it may underestimate portal pressure gradient (PPG) in patients with pre-sinusoidal forms or with a pre-sinusoidal component of PH such in the case of initial stages of primary biliary cholangitis (PBC), non-alcoholic fatty liver disease (NAFLD), porto-sinusoidal vascular disorder (PSVD). Moreover, HVPG procedure is invasive, involves radiographic exposure, and requires use of intravenous contrast media. Endoscopic ultrasound (EUS)-guided PPG measurement has recently become available. This technique allows measurement of portal pressure directly in the portal vein system and theoretically overcomes HVPG limitations.

Aims & Methods

We investigated the safety and accuracy of EUS measurements as compared to HVPG in evaluating PPG in a cohort of patients with CSPH. In patients naïve to non-selective beta-blockers (NSBBs) hemodynamic response to therapy was also evaluated.
Consecutive outpatients with liver disease characterized by pre-sinusoidal forms of PH who presented specific sign(s) of CSPH (gastro-oesophageal varices and/or portosystemic collaterals) underwent HVPG and EUS-guided PPG measurements with Echotip Insight 25G device (Cook Ireland Ltd.). In patients naive to NSBBs, treatment was started and after its titration EUS-PPG measurement was repeated. Definition and severity of adverse events (AEs) were based on classification of Cotton et al.

Results

Between March 2022 and December 2022, fourteen patients (mean age 58 ± 15; 57% males; etiology NAFLD related-cirrhosis 21.4%, PBC 7.2%, PSVD 71.4%) were enrolled. Mean platelet count was 71.000 U/microliter with 21% of patients having platelet count < 50.000 U/microliter. A total of 18 EUS-guided PPG and 14 HVPG measurements were performed. EUS-PPG was technically successful in all cases, without any AEs and requirement for platelet transfusion. EUS-PPG mean value was 18.7 ± 3.4 mmHg versus 9 ± 4.4 mmHg of HVPG (p<0.0001). In four patients naive to NSBBs we repeated a new EUS-PPG measurement after drug titration. The average PPG value in these patients before and after NSBBs titration was respectively 19.7 (± 3.4) and 17 (± 2.7) mmHg, with one patient out of four who achieved a decrement of PPG > 20 %.

Conclusion

Direct EUS-guided PPG measurement is safe and significantly more reliable than HVPG in the evaluation of PH in patients with pre-sinusoidal forms of PH. This technique could be also used to assess hemodynamic response to therapy in these patients.

Disclosure

N/A

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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ROUTINE CARE DATA ANALYZED USING EXPLAINABLE ARTIFICIAL INTELLIGENCE IDENTIFY BEST THERAPEUTIC SEQUENCE OF 2ND LINE BIOLOGIC TREATMENTS AFTER A 1ST LINE WITH ANTI-TNF OR VEDOLIZUMAB IN INFLAMMATORY BOWEL DISEASE

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ENDOSCOPIC ULTRASOUND ASSESSMENT OF PORTAL HYPERTENSION VERSUS TRANSJUGULAR MEASUREMENTS

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Alberto Larghi Alberto Larghi, Antonio Gasbarrini, Cristiano Spada, Brigida Annicchiarico, Giulia Venturini, Giulia Tripodi, Andrea Contegiacomo, Francesca Romana Ponziani, Francesco Santopaolo, Gianenrico Rizzatti, Lucia Giuli

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