الفهرس 
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Abstract
PHG is a vascular disorder characterized by ectasia of mucosal capillaries and submucosal venules without inflammation. It occurs as a complication of cirrhotic and non-cirrhotic portal hypertension. According to recent estimates the incidence of PHG varies greatly from 20 to 98% .Nonetheless, this common complication of cirrhosis is often underestimated in clinical practice. PHG most often lead to chronic GI bleeding manifested as transfusion dependant anaemia, however, it may also presents with acute and even massive GI bleeding. At present, there is no clear recommendations for emergency treatment of acute bleeding from PHG, and effective management of this condition remains a clinical challenge. Endoscopic therapy for acute bleeding from PHG has been little studied. Only one study has evaluated the use of endoscopic therapy with APC in chronic PHG bleeding with good results. Additionally, the use of hemospray to control acute bleeding from PHG has been reported in a single case report and few case series. Moreover, both techniques provide temporary control of bleeding. EBL was developed in the mid 1980s for the treatment of oesophageal variceal bleeding. Currently there is no studies or reports on the use of EBL for control of acute PHG related bleeding. Considering all these data, we conducted this study to evaluate the efficacy and safety of this old hemostatic modality to control acute bleeding from PHG which is a new and difficult situation. The incidence of acute bleeding from PHG in our cirrhotic patients is 3.75%.Our patients with acute bleeding PHG are predominantly males (66.7%), from rural areas (83.3%) and of relatively older age (mean =57.72 + 9.13 years). The main presentation in our study group was melena (73%), while massive bleeding (hematemesis & melena) was observed in 27% of our patients. This indicates that PHG may bleed massively unlike what is kept in our minds .Therefore, it must be considered an important cause of bleeding in cirrhotic patients. Interestingly, 73% of our patients with acute bleeding from PHG underwent previous endoscopic therapy for esophageal varices indicating that variceal obliteration by endoscopic therapy may aggravate PHG lesions and increase the risk of bleeding from these lesions. The results of laboratory and US studies of our patients with acute bleeding from PHG revealed that manifestations of portal hypertension were present in almost all patients (splenomegaly, dilated PV & thrombocytopenia),this confirm that portal hypertension is the main pathogenic factor for the development of PHG . Additionally, the vast majority of our patients (80%) have advanced liver disease (child’s class B or C ) ,also ascites was detected by US in 25(83.3%) patients indicating that the majority of our patients with acute bleeding from PHG have advanced or decompensated cirrhosis that may be considered a risk factor for acute bleeding from PHG lesions. A finding that was reported by other studies. During emergency endoscopy, 26 (86.7%) of our patients have actively bleeding PHG lesions (ooze) and 4 (13.3%) patients have densely adherent clots over these lesions. All our patients (100%) were treated by targeted EBL that was applied only for the bleeding PHG lesions. Initial hemostasis was achieved in all patients (100%), and recurrent bleeding was observed only in 3 (10%) patients. The only complication observed is a clean-base ulcer at the site of EBL in all patients (100%), while no serious complications were observed in any of the treated patients. Surprisingly, 3 (10%) of our cirrhotic patients with actively bleeding PHG have no varices, indicating that acute bleeding PHG may precede the development of varices in cirrhosis ,something that could be considered unique for this study that further raise the importance of acute bleeding PHG as an important cause of bleeding in cirrhotic patients which is often underestimated . Finally, based on the results of this study, one may say that targeted EBL is an effective, simple, cheap and safe hemostatic modality for the control of acute bleeding from PHG that should be among the first line options in the endoscopic treatment of this elusive and difficult to treat bleeding PHG.