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Variceal bleeding and portal hypertension: still a therapeutic challenge?
Endoscopy. 2001 Feb; 33(2):126-39.E

Abstract

In the primary prevention of variceal hemorrhage, beta-blockers continue to be the first-line treatment. Newer nonselective beta-blockers with anti-alpha1-adrenergic activity, such as carvedilol, appear to have a better impact on reducing the hepatic venous pressure gradient than propranolol. The addition of isosorbide mononitrate appears to improve the effectiveness of beta-blockers in primary prophylaxis, but not that of somatostatin in the treatment of acute variceal hemorrhage. The use of vasoactive drugs alone in acute variceal bleeding has not proved to be more effective than endoscopic treatment. The advent of endoscopic variceal ligation (EVL) has strengthened the role of endoscopy in the management of bleeding esophageal varices. EVL has improved the results, particularly in terms of lowering the treatment-related morbidity, compared with endoscopic variceal sclerotherapy (EVS). However, the variceal recurrence rate after initial eradication with EVL is relatively high. In contrast to synchronous combined therapy with EVL plus EVS, metachronous combination of EVL and low-dose EVS may improve the results of EVL alone. For bleeding fundic varices, obliteration using cyanoacrylate is currently the treatment of choice. Endosonography (EUS) is coming into more widespread use in the assessment of variceal eradication and in further attempts to improve the results of endoscopic injection therapy. According to two meta-analysis studies, transjugular intrahepatic portosystemic shunt (TIPS) is not yet capable of replacing endoscopic treatment in the secondary prevention of variceal bleeding.

Authors+Show Affiliations

Dept. of Interdisciplinary Endoscopy, University Hospital, Eppendorf, Hamburg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11272215

Citation

Seewald, S, et al. "Variceal Bleeding and Portal Hypertension: Still a Therapeutic Challenge?" Endoscopy, vol. 33, no. 2, 2001, pp. 126-39.
Seewald S, Seitz U, Yang AM, et al. Variceal bleeding and portal hypertension: still a therapeutic challenge? Endoscopy. 2001;33(2):126-39.
Seewald, S., Seitz, U., Yang, A. M., & Soehendra, N. (2001). Variceal bleeding and portal hypertension: still a therapeutic challenge? Endoscopy, 33(2), 126-39.
Seewald S, et al. Variceal Bleeding and Portal Hypertension: Still a Therapeutic Challenge. Endoscopy. 2001;33(2):126-39. PubMed PMID: 11272215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variceal bleeding and portal hypertension: still a therapeutic challenge? AU - Seewald,S, AU - Seitz,U, AU - Yang,A M, AU - Soehendra,N, PY - 2001/3/29/pubmed PY - 2001/5/22/medline PY - 2001/3/29/entrez SP - 126 EP - 39 JF - Endoscopy JO - Endoscopy VL - 33 IS - 2 N2 - In the primary prevention of variceal hemorrhage, beta-blockers continue to be the first-line treatment. Newer nonselective beta-blockers with anti-alpha1-adrenergic activity, such as carvedilol, appear to have a better impact on reducing the hepatic venous pressure gradient than propranolol. The addition of isosorbide mononitrate appears to improve the effectiveness of beta-blockers in primary prophylaxis, but not that of somatostatin in the treatment of acute variceal hemorrhage. The use of vasoactive drugs alone in acute variceal bleeding has not proved to be more effective than endoscopic treatment. The advent of endoscopic variceal ligation (EVL) has strengthened the role of endoscopy in the management of bleeding esophageal varices. EVL has improved the results, particularly in terms of lowering the treatment-related morbidity, compared with endoscopic variceal sclerotherapy (EVS). However, the variceal recurrence rate after initial eradication with EVL is relatively high. In contrast to synchronous combined therapy with EVL plus EVS, metachronous combination of EVL and low-dose EVS may improve the results of EVL alone. For bleeding fundic varices, obliteration using cyanoacrylate is currently the treatment of choice. Endosonography (EUS) is coming into more widespread use in the assessment of variceal eradication and in further attempts to improve the results of endoscopic injection therapy. According to two meta-analysis studies, transjugular intrahepatic portosystemic shunt (TIPS) is not yet capable of replacing endoscopic treatment in the secondary prevention of variceal bleeding. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/11272215/Variceal_bleeding_and_portal_hypertension:_still_a_therapeutic_challenge L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2001-11666 DB - PRIME DP - Unbound Medicine ER -