Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices
Abstract Background Balloon-occluded retrograde transvenous obliteration (BRTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbatio...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-12-01
|
| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-022-02616-z |
| _version_ | 1797977400995217408 |
|---|---|
| author | Yuki Shirane Eisuke Murakami Michio Imamura Masanari Kosaka Yusuke Johira Ryoichi Miura Serami Murakami Shigeki Yano Kei Amioka Kensuke Naruto Yuwa Ando Shinsuke Uchikawa Yuji Teraoka Takuro Uchida Hatsue Fujino Atsushi Ono Takashi Nakahara Tomokazu Kawaoka Daiki Miki Masami Yamauchi Wataru Okamoto Masataka Tsuge Keigo Chosa Kazuo Awai Hiroshi Aikata Shiro Oka |
| author_facet | Yuki Shirane Eisuke Murakami Michio Imamura Masanari Kosaka Yusuke Johira Ryoichi Miura Serami Murakami Shigeki Yano Kei Amioka Kensuke Naruto Yuwa Ando Shinsuke Uchikawa Yuji Teraoka Takuro Uchida Hatsue Fujino Atsushi Ono Takashi Nakahara Tomokazu Kawaoka Daiki Miki Masami Yamauchi Wataru Okamoto Masataka Tsuge Keigo Chosa Kazuo Awai Hiroshi Aikata Shiro Oka |
| author_sort | Yuki Shirane |
| collection | DOAJ |
| description | Abstract Background Balloon-occluded retrograde transvenous obliteration (BRTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbation of esophageal varices (EVs), and prognosis of patients who underwent BRTO for GVs. Methods Thirty-six patients with GVs treated with BRTO were enrolled in this study, and their HVPG was measured before (pre-HVPG) and on the day after BRTO (post-HVPG). After BRTO, patients were followed-up for a median interval of 24.5 (3–140) months. Clinical factors related to EVs exacerbation and prognosis after BRTO were retrospectively analyzed. Results Post-HVPG increased compared to pre-HVPG in 21 out of 36 patients (58%), and post-HVPG was overall significantly higher compared to pre-HVPG (P = 0.009). During the observation period, 19 patients (53%) developed EVs exacerbation, and the cumulative EVs exacerbation rates at 1, 3 and 5 years after BRTO were 27%, 67%, and 73%, respectively. Pre-HVPG was not related to EVs exacerbation, although elevation of post-HVPG to ≥ 13 mmHg (P < 0.01) and high level of serum aspartate aminotransferase (P < 0.05) were significant independent risk factors for EVs exacerbation after BRTO. Fourteen patients (38.9%) died during the observation period. An elevated value of liver stiffness measurement (LSM) of ≥ 21 kPa was a significant independent risk factor for poor prognosis after BRTO (P < 0.05). Conclusions HVPG increases after BRTO. HVPG after BRTO has greater predictive ability for subsequent EVs exacerbation than HVPG before BRTO. LSM is a potential prognostic parameter in patients who undergo BRTO. |
| first_indexed | 2024-04-11T05:06:20Z |
| format | Article |
| id | doaj.art-5a5eb080581442ad9a005702ca2d87f1 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-04-11T05:06:20Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-5a5eb080581442ad9a005702ca2d87f12022-12-25T12:18:22ZengBMCBMC Gastroenterology1471-230X2022-12-012211910.1186/s12876-022-02616-zHepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varicesYuki Shirane0Eisuke Murakami1Michio Imamura2Masanari Kosaka3Yusuke Johira4Ryoichi Miura5Serami Murakami6Shigeki Yano7Kei Amioka8Kensuke Naruto9Yuwa Ando10Shinsuke Uchikawa11Yuji Teraoka12Takuro Uchida13Hatsue Fujino14Atsushi Ono15Takashi Nakahara16Tomokazu Kawaoka17Daiki Miki18Masami Yamauchi19Wataru Okamoto20Masataka Tsuge21Keigo Chosa22Kazuo Awai23Hiroshi Aikata24Shiro Oka25Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityAbstract Background Balloon-occluded retrograde transvenous obliteration (BRTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbation of esophageal varices (EVs), and prognosis of patients who underwent BRTO for GVs. Methods Thirty-six patients with GVs treated with BRTO were enrolled in this study, and their HVPG was measured before (pre-HVPG) and on the day after BRTO (post-HVPG). After BRTO, patients were followed-up for a median interval of 24.5 (3–140) months. Clinical factors related to EVs exacerbation and prognosis after BRTO were retrospectively analyzed. Results Post-HVPG increased compared to pre-HVPG in 21 out of 36 patients (58%), and post-HVPG was overall significantly higher compared to pre-HVPG (P = 0.009). During the observation period, 19 patients (53%) developed EVs exacerbation, and the cumulative EVs exacerbation rates at 1, 3 and 5 years after BRTO were 27%, 67%, and 73%, respectively. Pre-HVPG was not related to EVs exacerbation, although elevation of post-HVPG to ≥ 13 mmHg (P < 0.01) and high level of serum aspartate aminotransferase (P < 0.05) were significant independent risk factors for EVs exacerbation after BRTO. Fourteen patients (38.9%) died during the observation period. An elevated value of liver stiffness measurement (LSM) of ≥ 21 kPa was a significant independent risk factor for poor prognosis after BRTO (P < 0.05). Conclusions HVPG increases after BRTO. HVPG after BRTO has greater predictive ability for subsequent EVs exacerbation than HVPG before BRTO. LSM is a potential prognostic parameter in patients who undergo BRTO.https://doi.org/10.1186/s12876-022-02616-zBalloon-occluded retrograde transvenous obliteration (BRTO)Esophageal varicesGastric varicesHepatic venous pressure gradient (HVPG)Liver stiffness measurement |
| spellingShingle | Yuki Shirane Eisuke Murakami Michio Imamura Masanari Kosaka Yusuke Johira Ryoichi Miura Serami Murakami Shigeki Yano Kei Amioka Kensuke Naruto Yuwa Ando Shinsuke Uchikawa Yuji Teraoka Takuro Uchida Hatsue Fujino Atsushi Ono Takashi Nakahara Tomokazu Kawaoka Daiki Miki Masami Yamauchi Wataru Okamoto Masataka Tsuge Keigo Chosa Kazuo Awai Hiroshi Aikata Shiro Oka Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices BMC Gastroenterology Balloon-occluded retrograde transvenous obliteration (BRTO) Esophageal varices Gastric varices Hepatic venous pressure gradient (HVPG) Liver stiffness measurement |
| title | Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices |
| title_full | Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices |
| title_fullStr | Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices |
| title_full_unstemmed | Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices |
| title_short | Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices |
| title_sort | hepatic venous pressure gradient after balloon occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices |
| topic | Balloon-occluded retrograde transvenous obliteration (BRTO) Esophageal varices Gastric varices Hepatic venous pressure gradient (HVPG) Liver stiffness measurement |
| url | https://doi.org/10.1186/s12876-022-02616-z |
| work_keys_str_mv | AT yukishirane hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT eisukemurakami hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT michioimamura hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT masanarikosaka hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT yusukejohira hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT ryoichimiura hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT seramimurakami hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT shigekiyano hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT keiamioka hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT kensukenaruto hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT yuwaando hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT shinsukeuchikawa hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT yujiteraoka hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT takurouchida hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT hatsuefujino hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT atsushiono hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT takashinakahara hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT tomokazukawaoka hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT daikimiki hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT masamiyamauchi hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT wataruokamoto hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT masatakatsuge hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT keigochosa hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT kazuoawai hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT hiroshiaikata hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices AT shirooka hepaticvenouspressuregradientafterballoonoccludedretrogradetransvenousobliterationandliverstiffnessmeasurementpredicttheprognosisofpatientswithgastricvarices |