The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization
Abstract Background Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is...
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2024-10-01
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| Online Access: | https://doi.org/10.1186/s12876-024-03464-9 |
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| author | Ming Zhang Dong Wang Xiao Chen Defeng Liang Tao Yang Yanlong Cao Bo Huang Jianguo Lu Jikai Yin |
| author_facet | Ming Zhang Dong Wang Xiao Chen Defeng Liang Tao Yang Yanlong Cao Bo Huang Jianguo Lu Jikai Yin |
| author_sort | Ming Zhang |
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| description | Abstract Background Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. Moreover, whether HVPG can provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. Methods From January 2016 to March 2023, 135 patients with PHT underwent LSED at our hospital were retrospectively evaluated. We analyzed the correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB). Among them, 57 patients remeasured postoperative HVPG. We further investigated the postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB. Results In this study, we found that 94 patients with preoperative UGIB (16.27 ± 5.73 mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90 mmHg) (p = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, p = 0.001) compared to the baseline, and 66% of patients (38/57) experienced a decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response (p<0.05). Additionally, patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, p = 0.013). Conclusion We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without. |
| format | Article |
| id | doaj-art-2959d6287d9c41c69972b7c8410ccbf7 |
| institution | DOAJ |
| issn | 1471-230X |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj-art-2959d6287d9c41c69972b7c8410ccbf72025-08-20T02:48:12ZengBMCBMC Gastroenterology1471-230X2024-10-0124111010.1186/s12876-024-03464-9The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularizationMing Zhang0Dong Wang1Xiao Chen2Defeng Liang3Tao Yang4Yanlong Cao5Bo Huang6Jianguo Lu7Jikai Yin8Department of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityDepartment of General Surgery, the Second Affiliated Hospital of Air Force Medical UniversityAbstract Background Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. Moreover, whether HVPG can provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. Methods From January 2016 to March 2023, 135 patients with PHT underwent LSED at our hospital were retrospectively evaluated. We analyzed the correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB). Among them, 57 patients remeasured postoperative HVPG. We further investigated the postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB. Results In this study, we found that 94 patients with preoperative UGIB (16.27 ± 5.73 mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90 mmHg) (p = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, p = 0.001) compared to the baseline, and 66% of patients (38/57) experienced a decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response (p<0.05). Additionally, patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, p = 0.013). Conclusion We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without.https://doi.org/10.1186/s12876-024-03464-9Liver cirrhosisPortal hypertensionSplenectomyEsophagogastric devascularizationHepatic venous pressure gradient |
| spellingShingle | Ming Zhang Dong Wang Xiao Chen Defeng Liang Tao Yang Yanlong Cao Bo Huang Jianguo Lu Jikai Yin The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization BMC Gastroenterology Liver cirrhosis Portal hypertension Splenectomy Esophagogastric devascularization Hepatic venous pressure gradient |
| title | The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization |
| title_full | The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization |
| title_fullStr | The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization |
| title_full_unstemmed | The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization |
| title_short | The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization |
| title_sort | independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization |
| topic | Liver cirrhosis Portal hypertension Splenectomy Esophagogastric devascularization Hepatic venous pressure gradient |
| url | https://doi.org/10.1186/s12876-024-03464-9 |
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