Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance
Background This study aimed to determine the detection rate and clinical relevance of portosystemic collaterals. Methods We studied 326 cirrhotics. Portosystemic collaterals, portal vein diameter, and splenic area were evaluated by color Doppler sonography; esophageal varices were detected by endosc...
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| Veröffentlicht in: | Journal of gastroenterology 2009, Vol.44 (1), p.76-83 |
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| description | Background This study aimed to determine the detection rate and clinical relevance of portosystemic collaterals. Methods We studied 326 cirrhotics. Portosystemic collaterals, portal vein diameter, and splenic area were evaluated by color Doppler sonography; esophageal varices were detected by endoscopy. Results Of the cirrhotics, 130 had portosystemic collaterals (39.9% total, left gastric vein 11%, paraumbilical vein 7.4%, splenorenal shunts 13.8%, and combined shunts 7.7%). Cirrhotics without portosystemic collaterals or with a paraumbilical vein had a significantly narrower portal vein diameter than cirrhotics with a left gastric vein (P < 0.001). Cirrhotics with a paraumbilical vein had a significantly smaller splenic area than cirrhotics with a left gastric vein (P < 0.001), splenorenal shunts (P < 0.001), combined shunts (P < 0.001), or without portosystemic collaterals (P < 0.05). A significant association between portosystemic collaterals and Child's classes or presence and type of esophageal varices was found (P < 0.0001 and P = 0.0004, respectively). The highest prevalence of Child's class C and large (F-3) esophageal varices was found in cirrhotics with a left gastric vein (41.7% and 36.1%, respectively), whereas esophageal varices were absent in 47.4% of cirrhotics without portosystemic collaterals and in 58.3% of cirrhotics with a paraumbilical vein. Conclusions The left gastric vein is associated with some sonographic and clinical markers of disease severity, whereas the absence of portosystemic collaterals or the presence of paraumbilical veins seems to identify cirrhotics with markers predictive of a more favorable clinical course. |
| doi_str_mv | 10.1007/s00535-008-2279-1 |
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Methods We studied 326 cirrhotics. Portosystemic collaterals, portal vein diameter, and splenic area were evaluated by color Doppler sonography; esophageal varices were detected by endoscopy. Results Of the cirrhotics, 130 had portosystemic collaterals (39.9% total, left gastric vein 11%, paraumbilical vein 7.4%, splenorenal shunts 13.8%, and combined shunts 7.7%). Cirrhotics without portosystemic collaterals or with a paraumbilical vein had a significantly narrower portal vein diameter than cirrhotics with a left gastric vein (P < 0.001). Cirrhotics with a paraumbilical vein had a significantly smaller splenic area than cirrhotics with a left gastric vein (P < 0.001), splenorenal shunts (P < 0.001), combined shunts (P < 0.001), or without portosystemic collaterals (P < 0.05). A significant association between portosystemic collaterals and Child's classes or presence and type of esophageal varices was found (P < 0.0001 and P = 0.0004, respectively). The highest prevalence of Child's class C and large (F-3) esophageal varices was found in cirrhotics with a left gastric vein (41.7% and 36.1%, respectively), whereas esophageal varices were absent in 47.4% of cirrhotics without portosystemic collaterals and in 58.3% of cirrhotics with a paraumbilical vein. Conclusions The left gastric vein is associated with some sonographic and clinical markers of disease severity, whereas the absence of portosystemic collaterals or the presence of paraumbilical veins seems to identify cirrhotics with markers predictive of a more favorable clinical course.]]></description><identifier>ISSN: 0944-1174</identifier><identifier>EISSN: 1435-5922</identifier><identifier>DOI: 10.1007/s00535-008-2279-1</identifier><identifier>PMID: 19159076</identifier><language>eng</language><publisher>Japan: Japan : Springer Japan</publisher><subject>Abdominal Surgery ; Aged ; Biliary Tract ; Cohort Studies ; Collateral Circulation ; color Doppler sonography ; Colorectal Surgery ; Endoscopy, Digestive System - methods ; Esophageal and Gastric Varices - diagnosis ; Esophageal and Gastric Varices - pathology ; Female ; Gastroenterology ; Hepatology ; Humans ; Hypertension, Portal - diagnostic imaging ; Hypertension, Portal - etiology ; Liver ; Liver - blood supply ; Liver - physiopathology ; liver cirrhosis ; Liver Cirrhosis - complications ; Liver Cirrhosis - physiopathology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Pancreas ; Portal Vein - diagnostic imaging ; Portal Vein - pathology ; portal vein diameter ; portosystemic shunts ; Predictive Value of Tests ; Severity of Illness Index ; Spleen - diagnostic imaging ; Spleen - pathology ; splenic area ; Surgical Oncology ; Ultrasonography, Doppler, Color ; Umbilical Veins - diagnostic imaging ; Umbilical Veins - pathology</subject><ispartof>Journal of gastroenterology, 2009, Vol.44 (1), p.76-83</ispartof><rights>Springer Japan 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-2ba73fe49e504f565c234a1cbb97a118d7574791d89a7ee689f25d6d78f657033</citedby><cites>FETCH-LOGICAL-c446t-2ba73fe49e504f565c234a1cbb97a118d7574791d89a7ee689f25d6d78f657033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00535-008-2279-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00535-008-2279-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,4024,27923,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19159076$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zardi, Enrico Maria</creatorcontrib><creatorcontrib>Uwechie, Valentina</creatorcontrib><creatorcontrib>Caccavo, Domenico</creatorcontrib><creatorcontrib>Pellegrino, Nelly Maria</creatorcontrib><creatorcontrib>Cacciapaglia, Fabio</creatorcontrib><creatorcontrib>Di Matteo, Francesco</creatorcontrib><creatorcontrib>Dobrina, Aldo</creatorcontrib><creatorcontrib>Laghi, Vittorio</creatorcontrib><creatorcontrib>Afeltra, Antonella</creatorcontrib><title>Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance</title><title>Journal of gastroenterology</title><addtitle>J Gastroenterol</addtitle><addtitle>J Gastroenterol</addtitle><description><![CDATA[Background This study aimed to determine the detection rate and clinical relevance of portosystemic collaterals. Methods We studied 326 cirrhotics. Portosystemic collaterals, portal vein diameter, and splenic area were evaluated by color Doppler sonography; esophageal varices were detected by endoscopy. Results Of the cirrhotics, 130 had portosystemic collaterals (39.9% total, left gastric vein 11%, paraumbilical vein 7.4%, splenorenal shunts 13.8%, and combined shunts 7.7%). Cirrhotics without portosystemic collaterals or with a paraumbilical vein had a significantly narrower portal vein diameter than cirrhotics with a left gastric vein (P < 0.001). Cirrhotics with a paraumbilical vein had a significantly smaller splenic area than cirrhotics with a left gastric vein (P < 0.001), splenorenal shunts (P < 0.001), combined shunts (P < 0.001), or without portosystemic collaterals (P < 0.05). A significant association between portosystemic collaterals and Child's classes or presence and type of esophageal varices was found (P < 0.0001 and P = 0.0004, respectively). The highest prevalence of Child's class C and large (F-3) esophageal varices was found in cirrhotics with a left gastric vein (41.7% and 36.1%, respectively), whereas esophageal varices were absent in 47.4% of cirrhotics without portosystemic collaterals and in 58.3% of cirrhotics with a paraumbilical vein. Conclusions The left gastric vein is associated with some sonographic and clinical markers of disease severity, whereas the absence of portosystemic collaterals or the presence of paraumbilical veins seems to identify cirrhotics with markers predictive of a more favorable clinical course.]]></description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Biliary Tract</subject><subject>Cohort Studies</subject><subject>Collateral Circulation</subject><subject>color Doppler sonography</subject><subject>Colorectal Surgery</subject><subject>Endoscopy, Digestive System - methods</subject><subject>Esophageal and Gastric Varices - diagnosis</subject><subject>Esophageal and Gastric Varices - pathology</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Hypertension, Portal - diagnostic imaging</subject><subject>Hypertension, Portal - etiology</subject><subject>Liver</subject><subject>Liver - blood supply</subject><subject>Liver - physiopathology</subject><subject>liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - physiopathology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Pancreas</subject><subject>Portal Vein - diagnostic imaging</subject><subject>Portal Vein - pathology</subject><subject>portal vein diameter</subject><subject>portosystemic shunts</subject><subject>Predictive Value of Tests</subject><subject>Severity of Illness Index</subject><subject>Spleen - diagnostic imaging</subject><subject>Spleen - pathology</subject><subject>splenic area</subject><subject>Surgical Oncology</subject><subject>Ultrasonography, Doppler, Color</subject><subject>Umbilical Veins - diagnostic imaging</subject><subject>Umbilical Veins - pathology</subject><issn>0944-1174</issn><issn>1435-5922</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc2KFDEUhYMoTjv6AG40uHBXmpvKT8WdDP7BgILOOqRTt7ozVCdtkhqZtzdNNQy4cBXI_c7JJR8hL4G9A8b0-8KY7GXH2NBxrk0Hj8gGRLuRhvPHZMOMEB2AFhfkWSm3jEHP5PCUXIABaZhWGxJ_pFxTuS8VD8HTsl9iLTRE6ujs8g6pT_tG0DTRo6sBT9M_oe7pHO4wUx9y3qcSygc6YkVfQ4o0u4rUxZH6OcTg3Uwzznjnosfn5Mnk5oIvzuclufn86dfV1-76-5dvVx-vOy-Eqh3fOt1PKAxKJiappOe9cOC3W6MdwDBqqYU2MA7GaUQ1mInLUY16mJTUrO8vydu195jT7wVLtYdQPM6zi5iWYpUaBFPAG_jmH_A2LTm23SwHDYpzNjQIVsjnVErGyR5zOLh8b4HZkwm7mrDNhD2ZsNAyr87Fy_aA40Pi_PUN4CtQ2ijuMD-8_L_W12tocsm6XQ7F3vzkJ68gByl71f8FugydSQ</recordid><startdate>2009</startdate><enddate>2009</enddate><creator>Zardi, Enrico Maria</creator><creator>Uwechie, Valentina</creator><creator>Caccavo, Domenico</creator><creator>Pellegrino, Nelly Maria</creator><creator>Cacciapaglia, Fabio</creator><creator>Di Matteo, Francesco</creator><creator>Dobrina, Aldo</creator><creator>Laghi, Vittorio</creator><creator>Afeltra, Antonella</creator><general>Japan : Springer Japan</general><general>Springer Japan</general><general>Springer Nature B.V</general><scope>FBQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>2009</creationdate><title>Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance</title><author>Zardi, Enrico Maria ; Uwechie, Valentina ; Caccavo, Domenico ; Pellegrino, Nelly Maria ; Cacciapaglia, Fabio ; Di Matteo, Francesco ; Dobrina, Aldo ; Laghi, Vittorio ; Afeltra, Antonella</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-2ba73fe49e504f565c234a1cbb97a118d7574791d89a7ee689f25d6d78f657033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Biliary Tract</topic><topic>Cohort Studies</topic><topic>Collateral Circulation</topic><topic>color Doppler sonography</topic><topic>Colorectal Surgery</topic><topic>Endoscopy, Digestive System - methods</topic><topic>Esophageal and Gastric Varices - diagnosis</topic><topic>Esophageal and Gastric Varices - pathology</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Hypertension, Portal - diagnostic imaging</topic><topic>Hypertension, Portal - etiology</topic><topic>Liver</topic><topic>Liver - blood supply</topic><topic>Liver - physiopathology</topic><topic>liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - physiopathology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Pancreas</topic><topic>Portal Vein - diagnostic imaging</topic><topic>Portal Vein - pathology</topic><topic>portal vein diameter</topic><topic>portosystemic shunts</topic><topic>Predictive Value of Tests</topic><topic>Severity of Illness Index</topic><topic>Spleen - diagnostic imaging</topic><topic>Spleen - pathology</topic><topic>splenic area</topic><topic>Surgical Oncology</topic><topic>Ultrasonography, Doppler, Color</topic><topic>Umbilical Veins - diagnostic imaging</topic><topic>Umbilical Veins - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zardi, Enrico Maria</creatorcontrib><creatorcontrib>Uwechie, Valentina</creatorcontrib><creatorcontrib>Caccavo, Domenico</creatorcontrib><creatorcontrib>Pellegrino, Nelly Maria</creatorcontrib><creatorcontrib>Cacciapaglia, Fabio</creatorcontrib><creatorcontrib>Di Matteo, Francesco</creatorcontrib><creatorcontrib>Dobrina, Aldo</creatorcontrib><creatorcontrib>Laghi, Vittorio</creatorcontrib><creatorcontrib>Afeltra, Antonella</creatorcontrib><collection>AGRIS</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>ComDisDome</collection><jtitle>Journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zardi, Enrico Maria</au><au>Uwechie, Valentina</au><au>Caccavo, Domenico</au><au>Pellegrino, Nelly Maria</au><au>Cacciapaglia, Fabio</au><au>Di Matteo, Francesco</au><au>Dobrina, Aldo</au><au>Laghi, Vittorio</au><au>Afeltra, Antonella</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance</atitle><jtitle>Journal of gastroenterology</jtitle><stitle>J Gastroenterol</stitle><addtitle>J Gastroenterol</addtitle><date>2009</date><risdate>2009</risdate><volume>44</volume><issue>1</issue><spage>76</spage><epage>83</epage><pages>76-83</pages><issn>0944-1174</issn><eissn>1435-5922</eissn><abstract><![CDATA[Background This study aimed to determine the detection rate and clinical relevance of portosystemic collaterals. Methods We studied 326 cirrhotics. Portosystemic collaterals, portal vein diameter, and splenic area were evaluated by color Doppler sonography; esophageal varices were detected by endoscopy. Results Of the cirrhotics, 130 had portosystemic collaterals (39.9% total, left gastric vein 11%, paraumbilical vein 7.4%, splenorenal shunts 13.8%, and combined shunts 7.7%). Cirrhotics without portosystemic collaterals or with a paraumbilical vein had a significantly narrower portal vein diameter than cirrhotics with a left gastric vein (P < 0.001). Cirrhotics with a paraumbilical vein had a significantly smaller splenic area than cirrhotics with a left gastric vein (P < 0.001), splenorenal shunts (P < 0.001), combined shunts (P < 0.001), or without portosystemic collaterals (P < 0.05). A significant association between portosystemic collaterals and Child's classes or presence and type of esophageal varices was found (P < 0.0001 and P = 0.0004, respectively). The highest prevalence of Child's class C and large (F-3) esophageal varices was found in cirrhotics with a left gastric vein (41.7% and 36.1%, respectively), whereas esophageal varices were absent in 47.4% of cirrhotics without portosystemic collaterals and in 58.3% of cirrhotics with a paraumbilical vein. Conclusions The left gastric vein is associated with some sonographic and clinical markers of disease severity, whereas the absence of portosystemic collaterals or the presence of paraumbilical veins seems to identify cirrhotics with markers predictive of a more favorable clinical course.]]></abstract><cop>Japan</cop><pub>Japan : Springer Japan</pub><pmid>19159076</pmid><doi>10.1007/s00535-008-2279-1</doi><tpages>8</tpages></addata></record> |
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| subjects | Abdominal Surgery Aged Biliary Tract Cohort Studies Collateral Circulation color Doppler sonography Colorectal Surgery Endoscopy, Digestive System - methods Esophageal and Gastric Varices - diagnosis Esophageal and Gastric Varices - pathology Female Gastroenterology Hepatology Humans Hypertension, Portal - diagnostic imaging Hypertension, Portal - etiology Liver Liver - blood supply Liver - physiopathology liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - physiopathology Male Medicine Medicine & Public Health Middle Aged Pancreas Portal Vein - diagnostic imaging Portal Vein - pathology portal vein diameter portosystemic shunts Predictive Value of Tests Severity of Illness Index Spleen - diagnostic imaging Spleen - pathology splenic area Surgical Oncology Ultrasonography, Doppler, Color Umbilical Veins - diagnostic imaging Umbilical Veins - pathology |
| title | Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance |
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