Oct 2016 DOI 10.14302/issn.2574-4526.jddd-16-1153
Umair MasoodCorresponding author
A 69 year old female with a history of pancreatic mucinous cystadenoma (treated with Whipple procedure) and recently presumed liver cirrhosis presented to the hospital with melanotic stools. The source of the bleeding was initially thought to be secondary to upper gastrointestinal (GI) varices due to portal hypertension from the liver disease. Upper endoscopy found no active bleeding and confirmed grade 2 gastric varices with gastric wall edema. Due to persistent symptoms and inability to locate the exact source, she went to the operating room for possible transjugular intrahepatic portosystemic shunt (TIPS) but was not found to have any porto-systemic gradient. Instead, she was found to have an isolated stenosis of the left gastric vein, which was treated with balloon angioplasty and eventual splenectomy. Upper GI varices usually occur due to portal hypertension from liver disease. Extra hepatic causes are much rarer. We report a case of upper GI bleed from gastric varices secondary to left gastric vein stenosis rather than portal hypertension. The stenosis was due to a rare complication of a Whipple procedure. The case is unique as there are no reported cases of gastric varices secondary to left gastric vein stenosis.
Jun 2017 DOI 10.14302/issn.2574-4526.jddd-17-1557
Kidd Leong HoieCorresponding author
Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
Background and Aims: Establishing the degree of fibrosis is important in determining the prognosis of patients with chronic liver disease. Acoustic Radiation Force Impulse Imaging (ARFI) has been validated as a reliable method to estimate liver fibrosis. It remains unclear if ARFI readings may be a useful way to stage patients with established cirrhosis and predict the development of complications. The aim of this study was to determine if ARFI liver stiffness measurements correlate with the severity of liver disease in patients with cirrhosis, and predict the development of complications and decompensation. Methods: All patients attending our institution who had a prior clinical diagnosis of cirrhosis and an ARFI liver stiffness measurement (LSM) over 26 months were included. Area under the receiver operating characteristic (AUROC) curves were calculated for ARFI detection of any complication, any varices, medium or large varices, moderate or severe ascites, encephalopathy, Child Pugh Grade B or C and MELD ≥15. Results: ARFI LSM did not correlate with complications: any complication (AUROC 0.672), any varices (0.631), medium or large varices (0.610), moderate or severe ascites (0.681), Child Pugh B/C (0.691) or MELD ≥15 (0.711). Hepatic encephalopathy did correlate with higher LSM (0.854), but only in a small number of cases. Conclusion: ARFI in patients with cirrhosis does not correlate with the presence of portal hypertension or decompensated liver disease.