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Current endoscopic therapy of variceal bleeding.
Best Pract Res Clin Gastroenterol. 2008; 22(2):261-78.BP

Abstract

Variceal ligation has proved more effective and safer than sclerotherapy and is currently the endoscopic treatment of choice for oesophageal varices. In acute bleeding, vasoactive drugs should be started before endoscopy and maintained for 2-5 days. The efficacy of drugs is improved when associated with emergency endoscopic therapy. Antibiotic prophylaxis should also be used. To prevent rebleeding, both endoscopic ligation and the combination of beta-blockers and nitrates may be used. Adding beta-blockers improves the efficacy of ligation. Haemodynamic responders to beta-blockers+/-nitrates (those with a decrease in portal pressure gradient HVPG to <12 mmHg or by >20% of baseline) have a marked reduction in the risk of haemorrhage and will not need further treatment. Beta-blockers significantly reduce the risk of a first haemorrhage in patients with large varices, and they improve survival. As compared to beta-blockers, endoscopic ligation reduces the risk of first bleeding without affecting mortality, and should be used in patients with contraindications or intolerance to beta-blockers.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Villanueva C
Servei de Patologia Digestiva, Hospital de la Santa Creu i Sant Pau, Avgda Sant Antoni M. Claret, 167, 08025 Barcelona, Spain. cvillanueva@santpau.es
Colomo A
No affiliation info available
Aracil C
No affiliation info available
Guarner C
No affiliation info available

MeSH

Adrenergic beta-AntagonistsEndoscopy, GastrointestinalEsophageal and Gastric VaricesHemostasis, EndoscopicHumansIsosorbideLigationLypressinPortasystemic Shunt, Transjugular IntrahepaticRecurrenceSomatostatinTerlipressinTissue Adhesives

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18346683

Clinical Trial Links

Predictive Factors and Outcome of Esophageal Ulcers After Endoscopic Treatment of Esophageal Varices

Citation

Villanueva, Càndid, et al. "Current Endoscopic Therapy of Variceal Bleeding." Best Practice & Research. Clinical Gastroenterology, vol. 22, no. 2, 2008, pp. 261-78.
Villanueva C, Colomo A, Aracil C, et al. Current endoscopic therapy of variceal bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):261-78.
Villanueva, C., Colomo, A., Aracil, C., & Guarner, C. (2008). Current endoscopic therapy of variceal bleeding. Best Practice & Research. Clinical Gastroenterology, 22(2), 261-78. https://doi.org/10.1016/j.bpg.2007.11.012
Villanueva C, et al. Current Endoscopic Therapy of Variceal Bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):261-78. PubMed PMID: 18346683.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current endoscopic therapy of variceal bleeding. AU - Villanueva,Càndid, AU - Colomo,Alan, AU - Aracil,Carlos, AU - Guarner,Carlos, PY - 2008/3/19/pubmed PY - 2008/8/15/medline PY - 2008/3/19/entrez SP - 261 EP - 78 JF - Best practice & research. Clinical gastroenterology JO - Best Pract Res Clin Gastroenterol VL - 22 IS - 2 N2 - Variceal ligation has proved more effective and safer than sclerotherapy and is currently the endoscopic treatment of choice for oesophageal varices. In acute bleeding, vasoactive drugs should be started before endoscopy and maintained for 2-5 days. The efficacy of drugs is improved when associated with emergency endoscopic therapy. Antibiotic prophylaxis should also be used. To prevent rebleeding, both endoscopic ligation and the combination of beta-blockers and nitrates may be used. Adding beta-blockers improves the efficacy of ligation. Haemodynamic responders to beta-blockers+/-nitrates (those with a decrease in portal pressure gradient HVPG to <12 mmHg or by >20% of baseline) have a marked reduction in the risk of haemorrhage and will not need further treatment. Beta-blockers significantly reduce the risk of a first haemorrhage in patients with large varices, and they improve survival. As compared to beta-blockers, endoscopic ligation reduces the risk of first bleeding without affecting mortality, and should be used in patients with contraindications or intolerance to beta-blockers. SN - 1521-6918 UR - https://www.unboundmedicine.com/medline/citation/18346683/Current_endoscopic_therapy_of_variceal_bleeding_ DB - PRIME DP - Unbound Medicine ER -