Scandinavian Journal of Gastroenterology. 2015; 50: 593–600
ORIGINAL ARTICLE
Influence of splenorenal shunt on long-term outcomes in cirrhosis
Scand J Gastroenterol Downloaded from informahealthcare.com by University of Connecticut on 04/01/15 For personal use only.
HITOSHI MARUYAMA, TAKAYUKI KONDO, SOICHIRO KIYONO, TADASHI SEKIMOTO, MASANORI TAKAHASHI & OSAMU YOKOSUKA Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan
Abstract Objective. To examine the clinical effect of splenorenal shunt (SRS) on the long-term outcomes in patients with cirrhosis. Methods. The study consisted of 162 cirrhosis patients (male 85, female 77; 62.6 ± 11.7 years). The clinical findings and prognosis were examined with respect to portal hemodynamics including collateral vessel patterns, with or without the presence of SRS or short gastric vein (SGV). Median observation period was 30 months. Results. The incidence was 18.5% for SRS and 10.5% for SGV. Decompensated cirrhosis was significantly more frequent in patients with SRS (22/30) than those with SGV (5/17, p = 0.0034), and in patients with SRS >5.5 mm (14/15) or >95 ml/min (14/15) (both, median values) than those with SRS 3.0 mg/dl), according to the literatures [18,19]. The observation period was defined as the time between the initial US examination and the date of the last hospital visit, the time of treatment of the collateral vessels, death, or liver transplantation.
US examination US was performed with the patients in the supine position after fasting for 4 h or more, using an SSA-770A or 790A (Toshiba, Tokyo, Japan) with a 3.75-MHz convex probe. Spleen size (mm2) was calculated by multiplying the distance from the splenic hilum to the caudal polar angle, measured with two intersecting lines. The upper limit of normal used in the study was 2000 mm2 [20]. Shunt vessels were identified according to a previous report [20,21]. The pattern of shunt at the splenic hilum was classified as follows: SRS group for patients negative for gastric varices by endoscopy and SGV group for those positive for gastric varices. The shunt vessel was detected by B-mode US followed by color Doppler to confirm the presence of blood flow. Then, the blood flow was measured from the left lateral oblique scan using the pulsed Doppler method with the sampling point at the width corresponding to the diameter of the vessel and at an angle below 60 degrees between the US beam and the vessel. The data used for analysis were the average values, calculated using measurements taken 2–4 times. All of the US examinations were performed by HM or MT, who each had more than 8 years of experience.
Splenorenal shunt in cirrhosis
Scand J Gastroenterol Downloaded from informahealthcare.com by University of Connecticut on 04/01/15 For personal use only.
Statistical analysis Continuous variables were compared using Student’s t-test, Mann-Whitney’s U-test, or Fisher’s protected least-significant-difference test. Categorical variables were compared using the chi-squared test. The cumulative incidence of decompensation and survival rate were calculated using the Kaplan–Meier method and the difference was compared with the log-rank test. Statistical significance was defined as a p 95 ml/min (14/15) (both, median values) than those with SRS
ORIGINAL ARTICLE
Influence of splenorenal shunt on long-term outcomes in cirrhosis
Scand J Gastroenterol Downloaded from informahealthcare.com by University of Connecticut on 04/01/15 For personal use only.
HITOSHI MARUYAMA, TAKAYUKI KONDO, SOICHIRO KIYONO, TADASHI SEKIMOTO, MASANORI TAKAHASHI & OSAMU YOKOSUKA Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan
Abstract Objective. To examine the clinical effect of splenorenal shunt (SRS) on the long-term outcomes in patients with cirrhosis. Methods. The study consisted of 162 cirrhosis patients (male 85, female 77; 62.6 ± 11.7 years). The clinical findings and prognosis were examined with respect to portal hemodynamics including collateral vessel patterns, with or without the presence of SRS or short gastric vein (SGV). Median observation period was 30 months. Results. The incidence was 18.5% for SRS and 10.5% for SGV. Decompensated cirrhosis was significantly more frequent in patients with SRS (22/30) than those with SGV (5/17, p = 0.0034), and in patients with SRS >5.5 mm (14/15) or >95 ml/min (14/15) (both, median values) than those with SRS 3.0 mg/dl), according to the literatures [18,19]. The observation period was defined as the time between the initial US examination and the date of the last hospital visit, the time of treatment of the collateral vessels, death, or liver transplantation.
US examination US was performed with the patients in the supine position after fasting for 4 h or more, using an SSA-770A or 790A (Toshiba, Tokyo, Japan) with a 3.75-MHz convex probe. Spleen size (mm2) was calculated by multiplying the distance from the splenic hilum to the caudal polar angle, measured with two intersecting lines. The upper limit of normal used in the study was 2000 mm2 [20]. Shunt vessels were identified according to a previous report [20,21]. The pattern of shunt at the splenic hilum was classified as follows: SRS group for patients negative for gastric varices by endoscopy and SGV group for those positive for gastric varices. The shunt vessel was detected by B-mode US followed by color Doppler to confirm the presence of blood flow. Then, the blood flow was measured from the left lateral oblique scan using the pulsed Doppler method with the sampling point at the width corresponding to the diameter of the vessel and at an angle below 60 degrees between the US beam and the vessel. The data used for analysis were the average values, calculated using measurements taken 2–4 times. All of the US examinations were performed by HM or MT, who each had more than 8 years of experience.
Splenorenal shunt in cirrhosis
Scand J Gastroenterol Downloaded from informahealthcare.com by University of Connecticut on 04/01/15 For personal use only.
Statistical analysis Continuous variables were compared using Student’s t-test, Mann-Whitney’s U-test, or Fisher’s protected least-significant-difference test. Categorical variables were compared using the chi-squared test. The cumulative incidence of decompensation and survival rate were calculated using the Kaplan–Meier method and the difference was compared with the log-rank test. Statistical significance was defined as a p 95 ml/min (14/15) (both, median values) than those with SRS
