SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/05  
 
  2016 May;63(5):1640-50  
  doi: 10.1002/hep.28466  
 
  Natural history and management of esophagogastric varices in chronic noncirrhotic, nontumoral portal vein thrombosis.  
 
  Noronha Ferreira C, Seijo S, Plessier A, Silva-Junior G, Turon F, Rautou PE, Baiges A, Bureau C, Bosch J, Hernández-Gea V, Valla D, García-Pagan JC  
  http://www.ncbi.nlm.nih.gov/pubmed/26799606  
 
 

In patients with chronic noncirrhotic, nontumoral portal vein thrombosis (PVT), the usually recommended strategy for endoscopic screening and management of varices is the same as in cirrhosis. However, the efficacy of this policy in patients with PVT is unknown. We assessed the course of gastroesophageal varices in a large cohort of patients with chronic PVT. Patients prospectively registered in two referral centers for vascular liver disorders were eligible for the study. Endpoints were development and growth of varices and the incidence and outcome of portal hypertension-related bleeding. Included were 178 patients with chronic PVT. Median follow-up was 49 (1-598) months. Variceal bleeding was the initial manifestation in 27 (15%) patients. Initial endoscopy in the remaining 151 patients showed no varices in 52 (34%), small esophageal varices in 28 (19%), large esophageal varices (LEVs) in 60 (40%), and gastric varices without LEVs in 11 (7%). Ascites and splenomegaly were independent predictors for the presence of varices. In patients without varices, the probability of developing them was 2%, 22%, and 22% at 1, 3, and 5 years, respectively. In those with small esophageal varices, growth to LEVs was observed in 13%, 40%, and 54% at 1, 3, and 5 years, respectively. In patients with LEVs on primary prophylaxis, probability of bleeding was 9%, 20%, and 32% at 1, 3, and 5 years, respectively. Nine (5%) patients died after a median 51 (8-280) months, only one due to variceal bleeding.

CONCLUSIONS:

The course of varices in chronic noncirrhotic, nontumoral PVT appears to be similar to that in cirrhosis; using the same therapeutic approach as for cirrhosis is associated with a low risk of bleeding and death. (Hepatology 2016;63:1640-1650).

 
Question posée
 
Histoire naturelle des varices oesogastriques dans une cohorte de patients suivis pour une thrombose porte chronique : incidence et survenue d’hémorragie.
 
Question posée
 
Hémorragie digestive par rupture : manifestation initiale chez 15% des patients. Ascite et splénomegalie sont des facteurs indépendants pour prédire la présence de varices de grande taille (LEVs) (40%). Avec une prophylaxie primaire des ces LEVs, le risque d’hémorragie est de 9%, 20%, and 32% à 1, 3, et 5 ans, respectivement.
 
Commentaires

L'histoire naturelle des varices oesocardiales n’est pas très différente de la cirrhose : adopter la même attitude : recherche systématique et prophylaxie.

 
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