Article Title
Abstract
Introduction. Liver cirrhosis (LC) is the end stage of chronic liver disease. One of the main complication caused by LC is esophageal varices (EV). Bleeding due to EV rupture is the main cause of mortality in patient with LC. EV band ligation can be used for primary or secondary prophylaxis to prevent bleeding. The purpose of this study was to know the clinical profile of LC patient with EV who underwent band ligation and who not underwent band ligation. Methods. A cross-sectional study was conducted in LC patients who underwent esophagogastroduodenoscopy (EGD) in Procedure Room Division of Hepatobiliary, Departement of Internal Medicine, Cipto Mangunkusumo Hospital from 2016 to 2017. Results. During January 2016-December 2017, a total of 313 patients underwent EGD. Most of them ( 73.2%) were male and predominantly > 60 years (34,2%). Most common LC etiology was hepatitis B (51.8%., There were 22% subjects with hepatocellular carcinoma (HCC). EV band ligations were done in 146 (46.7%) patients. In the ligation group, 56.2% patients were from outpatient clinic. The most common EGD indication (39%) was evaluation from previous ligation. Of 41.8% patients had Child-Turcotte-Pugh (CTP) class-A condition, 82.9% patients had MELD score < 15, 61.6% patients had large EV, 22.1% had red color sign (RCS) and 84,9% patients had portal hypertensive gastropathy. There were significant differences in CTP class, ascites, platelet, bilirubin, and albumin between ligation group compare to non-ligation group. Conclussion. Most of LC patients who underwent EV band ligation had CTP class-A, came from the outpatient clinic. The Jurnal Penyakit Dalam Indonesia | Vol. 6, No. 1 | Maret 2019 | 37 Profil Klinis Pasien Sirosis Hati dengan Varises Esofagus yang Menjalani Ligasi Varises Esofagus di Rumah Sakit Dr. Cipto Mangunkusumo main finding in EGD was large EV with portal hypertensive gastropathy. There were significant differences in liver functions between patient in ligation group compared to patient in non-ligation group.
References
1. Bhattacharyya M, Barman NN, Goswami B. Clinical profile of cirrhosis of liver in a tertiary care hospital of Assam, North East India. IOSR-JDMS. 2016;15(1):21-7. 2. Khan H, Zarif M. Risk Factors, Complications and prognosis of cirrhosis in a tertiary care hospital of Peshawar. Hepatitis Monthly. 2006;6(1):7-10 3. Maskey R, Karki P, Ahmed SV, Manandhar DN. Clinical profile of patients with cirrhosis of liver in a tertiary care hospital, Dharan, Nepal. Nepal Med Coll J. 2011;13(2):115-8. 4. Yalamanchi RP, Ganta V, Mohapatra PK, Sahu B, Raghvendar K, Anusha G, et al. A study of clinical profile of patients presenting with abnormalities detected by upper gastrointestinal endoscopy. Int J Adv Med. 2016;3(4):933-7. 5. Anand D, Gupta R, Dhar M, Ahuja V. Clinical and endoscopic profile of patients with upper gastrointestinal bleeding at tertiary care center of North India. J Dig Endosc. 2014;5(4):139-43. 6. D’Amico G, Pasta L, Morabito A, D’Amico M, Caltagirone M, Malizia G, et al. Competing risks and prognostic stages of cirrhosis: a 25- year inception cohort study of 494 patients. Aliment Pharmacol Ther. 2014;39(10):1180-93. 7. Kovalak M, Lake J, Mattek N, Eisen G, Lieberman D, Zaman A. Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database. Gastrointest Endosc. 2007;65:82-8. 8. Merli M, Nicolini G, Angeloni S, Rinaldi V, DeSantis A, Merkel C, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266-72. 9. Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Archive of Internal Medicine. 2001;160:2564-70. 10. Beppu K, Inokuchi K, Koyangi N, Nakayama S, Skata H, Kitano S, et al. Prediction of variceal hemorrhage by esophagealendoscopy. Gastrointest Endosc. 1981;27:213–8. 11. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis and management: 2016 practice guidance by the American Association for the study of liver disease. Hepatology. 2017; 65(1):310-35. 12. LaBrecque D, Khan AG, Sarin SK, Le Mair AW. World Gastroenterology Organisation Global Guidelines Esophageal Varices. Milwaukee, Wisconsin: World Gastroenterology Organisation; 2014. p.2-11. 13. Bhattarai S, Gyawali M, Dewan KR, Shrestha G. Demographic and clinical profile in patients with liver cirrhosis in a tertiary care hospital in Central Nepal. J Nepal Med Assoc. 2017;56(208):401-6. 14. Chang PE, Wong GW, Li JWQ, Lui HF, Chow WC, Tan CK. Epidemiology and clinical evolution of liver cirrhosis in Singapore. Ann Acad Med Singapore. 2015;44:218-25. 15. Qua CS, Goh KL. Liver cirrhosis in Malaysia: peculiar epidemiology in a multiracial Asian country. J Gastroenterol Hepatol. 2011;26(8):1333-7. 16. Setiawan VW, Stram DO, Porcel J, Lu SC, Marchand LL, Noureddin M. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology. 2016;64(6):1969–77. 17. D’Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis. 1999;19:475-505. 18. de Franchis R; Baveno V Faculty. Expanding consensus in portal hypertension. Report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743-52. 19. Everett BT, Lidofsky SD. Adherence to surveillance endoscopy following hospitalization for index esophageal variceal haemorrhage. World J Gastrointest Surg. 2018;10(4):40-8. 20. Bosch J, Abraldes JG, Berzigotti A, Garcia-Pagan JC. Portal hypertension and gastrointestinal bleeding. Semin Liver Dis. 2008;28(1):3-25.
Recommended Citation
Kalista, Kemal Fariz; Lesmana, Cosmas Rinaldi Adithya; Sulaiman, Andri Sanityoso; Gani, Rino Alvani; and Hasan, Irsan
(2019)
"Clinical Profile of Cirrhotic Patient with Esophageal Varices Who
Undergone Band Ligation in Cipto Mangunkusumo Hospital,"
Jurnal Penyakit Dalam Indonesia: Vol. 6:
No.
1, Article 16.
Available at:
https://scholarhub.ui.ac.id/jpdi/vol6/iss1/16