Skip to main content

Advertisement

SpringerLink
Log in

Novel noninvasive liver fibrotic markers to predict postoperative re-bleeding after laparoscopic splenectomy and azygoportal disconnection: a 1-year prospective study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Esophagogastric variceal re-bleeding (EGVR) is a common and potentially lethal complication after open or laparoscopic splenectomy and azygoportal disconnection (LSD) in patients with cirrhosis and portal hypertension. Currently, noninvasive biomarkers for predicting EGVR are lacking. This prospective study focused on developing a noninvasive and convenient clinical model for predicting postoperative EGVR.

Methods

Between September 2014 and March 2017, we enrolled 164 patients with cirrhosis who successfully underwent LSD. Based on the absence or presence of EGVR, patients were divided into EGVR and non-EGVR groups. We used correlation analysis to determine significant candidate variables among the liver fibrotic markers procollagen type III (PC-III), hyaluronidase (HA), laminin (LN), and type IV collagen (C-IV).

Results

Postoperative EGVR occurred in 22 (13.41%) patients. Correlation analyses showed that LN (r = 0.375; p < 0.001) and C-IV (r = 0.349; p < 0.001) were significantly positively associated with EGVR. The area under the receiver operating characteristic curve (AUC) of LN was 0.817 (95% confidence interval [CI] 0.722–0.913); that of C-IV was 0.795 (95% CI 0.710–0.881). In logistic multivariate regression, cutoff values LN ≥ 64 µg/L and of C-IV ≥ 65 µg/L were independent risk factors for EGVR. LN ≥ 64 µg/L combined with C-IV ≥ 65 µg/L was the best performing model, with AUC 0.867 (95% CI 0.768–0.967).

Conclusion

LN and C-IV are potential markers to predict EGVR. Combining the two markers showed satisfactory ability to predict EGVR in patients with cirrhosis and portal hypertension after LSD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J (2017) Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology (Baltimore, MD) 65:310–335

    Article  Google Scholar 

  2. Wright AS, Rikkers LF (2005) Current management of portal hypertension. J Gastrointestinal Surg 9:992–1005

    Article  Google Scholar 

  3. Bari K, Garcia-Tsao G (2012) Treatment of portal hypertension. World J Gastroenterol 18:1166–1175

    Article  CAS  Google Scholar 

  4. Huang Y, Qiu F (1996) Problems on the surgery of portal hypertension. Chinese J Surg 34:131–132

    CAS  Google Scholar 

  5. Idezuki Y, Kokudo N, Sanjo K, Bandai Y (1994) Sugiura procedure for management of variceal bleeding in Japan. World J Surg 18:216–221

    Article  CAS  Google Scholar 

  6. Selzner M, Tuttle-Newhall JE, Dahm F, Suhocki P, Clavien PA (2001) Current indication of a modified Sugiura procedure in the management of variceal bleeding. J Am Coll Surg 193:166–173

    Article  CAS  Google Scholar 

  7. Bai DS, Qian JJ, Chen P, Yao J, Wang XD, Jin SJ, Jiang GQ (2014) Modified laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension. Surg Endosc 28:257–264

    Article  Google Scholar 

  8. Yu H, Guo S, Wang L, Dong Y, Tian G, Mu S, Zhang H, Li D, Zhao S (2016) Laparoscopic splenectomy and esophagogastric devascularization for liver cirrhosis and portal hypertension is a safe, effective, and minimally invasive operation. J Laparoendosc Adv Surg Tech Part A 26:524–530

    Article  Google Scholar 

  9. Jiang GQ, Chen P, Qian JJ, Yao J, Wang XD, Jin SJ, Bai DS (2014) Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection. World J Gastroenterol 20:9146–9153

    PubMed  PubMed Central  Google Scholar 

  10. Wang YD, Ye H, Ye ZY, Zhu YW, Xie ZJ, Zhu JH, Liu JM, Zhao T (2008) Laparoscopic splenectomy and azygoportal disconnection for bleeding varices with hypersplenism. J Laparoendosc Adv Surg Tech Part A 18:37–41

    Article  Google Scholar 

  11. Zhe C, Jian-wei L, Jian C, Yu-dong F, Ping B, Shu-guang W, Shu-guo Z (2013) Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism: a comparative study. J Gastrointestinal Surg 17:654–659

    Article  Google Scholar 

  12. Neuman MG, Cohen LB, Nanau RM (2016) Hyaluronic acid as a non-invasive biomarker of liver fibrosis. Clin Biochem 49:302–315

    Article  CAS  Google Scholar 

  13. McHutchison JG, Blatt LM, de Medina M, Craig JR, Conrad A, Schiff ER, Tong MJ (2000) Measurement of serum hyaluronic acid in patients with chronic hepatitis C and its relationship to liver histology. Consensus Interferon Study Group. J Gastroenterol Hepatol 15:945–951

    Article  CAS  Google Scholar 

  14. Plebani M, Burlina A (1991) Biochemical markers of hepatic fibrosis. Clin Biochem 24:219–239

    Article  CAS  Google Scholar 

  15. El-Mezayen HA, Habib S, Marzok HF, Saad MH (2015) Diagnostic performance of collagen IV and laminin for the prediction of fibrosis and cirrhosis in chronic hepatitis C patients: a multicenter study. Eur J Gastroenterol Hepatol 27:378–385

    Article  CAS  Google Scholar 

  16. Bai DS, Xia BL, Zhang C, Ye J, Qian JJ, Jin SJ, Jiang GQ (2019) Warfarin versus aspirin prevents portal vein thrombosis after laparoscopic splenectomy and azygoportal disconnection: a randomized clinical trial. Inter J Surg (London, England) 64:16–23

    Article  Google Scholar 

  17. Greiner M, Pfeiffer D, Smith RD (2000) Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Preventive Veterinary Med 45:23–41

    Article  CAS  Google Scholar 

  18. Bosch J, Garcia-Pagán JC, Berzigotti A, Abraldes JG (2006) Measurement of portal pressure and its role in the management of chronic liver disease. Semin Liver Dis 26:348–362

    Article  Google Scholar 

  19. Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC (2009) The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol 6:573–582

    Article  CAS  Google Scholar 

  20. Moitinho E, Escorsell A, Bandi JC, Salmerón JM, García-Pagán JC, Rodés J, Bosch J (1999) Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology 117:626–631

    Article  CAS  Google Scholar 

  21. Ready JB, Robertson AD, Goff JS, Rector WG Jr (1991) Assessment of the risk of bleeding from esophageal varices by continuous monitoring of portal pressure. Gastroenterology 100:1403–1410

    Article  CAS  Google Scholar 

  22. Liu C, Liu Y, Shao R, Wang S, Wang G, Wang L, Zhang M, Hou J, Zhang C, Qi X (2020) The predictive value of baseline hepatic venous pressure gradient for variceal rebleeding in cirrhotic patients receiving secondary prevention. Annals Translat Med 8:91

    Article  Google Scholar 

  23. Gressner AM, Kropf J (1988) Concentration of laminin in serum related to the degree of esophageal varices in fibrotic liver diseases. Clin Chem 34:1005–1006

    Article  CAS  Google Scholar 

  24. Mamori S, Searashi Y, Matsushima M, Hashimoto K, Uetake S, Matsudaira H, Ito S, Nakajima H, Tajiri H (2008) Serum type IV collagen level is predictive for esophageal varices in patients with severe alcoholic disease. World J Gastroenterol 14:2044–2048

    Article  CAS  Google Scholar 

  25. Shao RY, Zeng X, Liu C, Zhang CQ, Wang Y, Qi RZ, Li XL, Zhang Y, Wang JT, Qi XL et al (2019) Type IV collagen as novel noninvasive biomarker to predict failure to control bleeding and early rebleeding in patients with cirrhosis: a prospective, multicenter study. Hepatology 70:106A

    Article  Google Scholar 

  26. Xu L, Ji F, Xu QW, Zhang MQ (2011) Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation. World J Gastroenterol 17:3347–3352

    Article  Google Scholar 

  27. Khuroo MS, Khuroo NS, Farahat KL, Khuroo YS, Sofi AA, Dahab ST (2005) Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther 21:347–361

    Article  CAS  Google Scholar 

  28. Ba DS, Zhang C, Jin SJ, Chen P, Jiang GQ (2018) Laparoscopic splenectomy and azygoportal disconnection combining with pre- and postoperative endoscopic intervention—a sandwich-style sequential therapy for portal hypertensive bleeding: a retrospective cohort study. Turkish J Gastroenterol 29:669–675

    Article  Google Scholar 

Download references

Acknowledgment

This work was supported by the Project of Invigorating Health Care through Science, Technology and Education: Jiangsu Provincial Medical Youth Talent (QNRC2016331).

Author information

Author notes

  1. Long-Fei Wu, Xiao-Xing Xiang, and Dou-Sheng Bai have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, 225000, Jiangsu, China

    Long-Fei Wu, Dou-Sheng Bai, Sheng-Jie Jin, Chi Zhang, Bao-Huan Zhou, Jian-Jun Qian & Guo-Qing Jiang

  2. Department of Hepatobiliary Surgery, The First Clinical College, Dalian Medical University, Dalian, China

    Long-Fei Wu

  3. Department of Digestive Diseases, Clinical Medical College, Yangzhou University, Yangzhou, China

    Xiao-Xing Xiang

Authors
  1. Long-Fei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao-Xing Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dou-Sheng Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sheng-Jie Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bao-Huan Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jian-Jun Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Guo-Qing Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guo-Qing Jiang.

Ethics declarations

Disclosures

Drs. L.-F. Wu, X.-X. Xiang, D.-S. Bai, S.-J. Jin, C. Zhang, B.-H. Zhou, J.-J. Qian, G.-Q. Jiang have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

We registered our research at https://www.clinicaltrials.gov/. The name of research registered is “Warfarin Prevents Portal Vein Thrombosis in Patients After Laparoscopic Splenectomy and Azygoportal Disconnection”. The trial registration identifier at clinicaltrials.gov is NCT02247414.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, LF., Xiang, XX., Bai, DS. et al. Novel noninvasive liver fibrotic markers to predict postoperative re-bleeding after laparoscopic splenectomy and azygoportal disconnection: a 1-year prospective study. Surg Endosc 35, 6158–6165 (2021). https://doi.org/10.1007/s00464-020-08111-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08111-4

Keywords

Search

Navigation