Effect of Variceal Eradication on Portal Circulation

Study Overview
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Brief Summary
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Study the effect of variceal eradication on portal circulation, liver stiffness and Child-Pugh and MELD scores in patients with liver cirrhosis.

Detailed Description
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Portosystemic collateral circulation is a consequence of portal hypertension, which occurs in chronic liver disease and is responsible for numerous complications. Gastric and oesophageal varices are two of common portosystemic collaterals, patients usually presented with hematemesis, melena, or both, ultimately 20% is the mortality during the first attack. Although both band ligation and sclerotherapy are effective modalities of treatment in controlling acute variceal bleeding, in preventing future variceal bleeding as well as in eradicating varices with very few complications , their effects on portal circulation have raised concerns among hepatologist. Information about collateral pathways is especially relevant when interventional procedures or surgery is indicated because inadvertent distribution of these vessels can cause significant bleeding. Few studies pointed on development of new portosystemic collaterals post variceal eradication depending on abdominal computed tomography (CT ) compared to pre-variceal eradication as showed paraoesophageal varices, retro-gastric varices not visualized with endoscopy ,or large deep gastric collaterals that may increase risk for rebleeding. Also, liver stiffness measurement and indirect markers of portal hypertension have been correlated with the severity of portal hypertension and have been used to predict the presence of varices, and there is rising question what about effect of variceal eradication on liver stiffness. The Child-Pugh and MELD scores were significantly higher for patients with gastric variceal bleeding , and the question here is variceal eradication can improve Child-Pugh and MELD scores or there is no effect.

Official Title
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Assessment of Portal Circulation Before and After Variceal Eradication in Patients With Liver Cirrhosis.

Conditions
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Portosystemic Collateral Veins

Intervention / Treatment
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* Radiation: Abdominal computed tomography with angiography.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Age between 18 and 70 years old. Patient with documented liver cirrhosis undergoing either primary or secondary prophylactic variceal eradication. Liver cirrhosis with Child-Pugh score A and B. Exclusion Criteria: • Age less than 18 years. Have contraindications to computed abdominal CT-angiography (e.g. allergy to all suitable contrast agents, renal failure). Patients with history of recent significant bleeding varices. Previous history of variceal ligation, sclerotherapy, and TIPS operation. Patients with isolated gastric varices. Patients with HCC or other malignancies. End-stage liver disease (Child score more than 9). Patients with malignant portal vein thrombosis. Patients with non-cirrhotic portal hypertension. Patients refuse to participate in the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| canditates for variceal eradication<br>patients with documented liver cirrhosis (Based on clinical, laboratory and ultrasonographic findings) undergoing either primary or secondary prophylaxis variceal eradication at endoscopy unit of El-Rajhi hospital, Assuit University | Radiation: Abdominal computed tomography with angiography.<br>* technique of combing a Computed Tomography scan with the injection of dye to create pictures of the portal circulation and portosystemic collaterals veins.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Study the effect of variceal eradication on portal circulation, liver stiffness and Child-Pugh and MELD scores in patients with liver cirrhosis. | Study the effect of variceal eradication on portal circulation and development of new portosystemic collaterals had not be found before variceal eradication in patients with liver cirrhosis | 4 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Study the effect of variceal eradication on liver stiffness and Child-Pugh and MELD scores in patient with liver cirrhosis | study how can variceal eradication affect liver elasticity, liver function so can calculate Child-Pugh and MELD scores which can life expectancy of patients with liver cirrhosis | 4 years |