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Conservative and semi-invasive modalities for treating bleeding esophageal varices.
Hepatogastroenterology. 1990 Dec; 37(6):561-4.H

Abstract

Although controversial, pharmacological therapy aimed at controlling acute variceal bleeding is widely used. A combination of intravenous vasopressin and nitroglycerin or glypressin alone with the aim of lowering portal pressure is currently recommended. Immediate endoscopy is mandatory to confirm that the patient is bleeding from varices. When variceal bleeding is detected, the patient should be immediately submitted to sclerotherapy, if expert treatment is available, or have the bleeding controlled by balloon tamponade or by pharmacological means, with subsequent performance of sclerotherapy with the use of a flexible endoscope within 6 to 24 hours, or transportation of the patient to a special center during this time. If bleeding has stopped, sclerotherapy can be performed immediately, or the patient can be observed while appropriate long-term management is planned. Patients who do not respond to immediate or delayed emergency sclerotherapy should be identified early and their suitability for a shunt or devascularisation procedure assessed. There is no question that at least after one or two early or even late recurrences of variceal hemorrhage, surgery should be planned and initiated. Although sclerotherapy is the favored form of emergency treatment, a nonshunting procedure or a portosystemic shunt operation should be recommended and thoroughly evaluated in order to determine whether this may be a preferable therapeutic option in a minority of patients, representing about 20% of all patients bleeding from esophageal varices referred to our institution.

Authors+Show Affiliations

Department of Surgery and Medicine, Heinz-Kalk-Hospital, Bad Kissingen, FRG.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

2289768

Citation

Paquet, K J., et al. "Conservative and Semi-invasive Modalities for Treating Bleeding Esophageal Varices." Hepato-gastroenterology, vol. 37, no. 6, 1990, pp. 561-4.
Paquet KJ, Mercado MA, Aichner W, et al. Conservative and semi-invasive modalities for treating bleeding esophageal varices. Hepatogastroenterology. 1990;37(6):561-4.
Paquet, K. J., Mercado, M. A., Aichner, W., Cuan-Orozco, F., Gad, H. A., & Müting, D. (1990). Conservative and semi-invasive modalities for treating bleeding esophageal varices. Hepato-gastroenterology, 37(6), 561-4.
Paquet KJ, et al. Conservative and Semi-invasive Modalities for Treating Bleeding Esophageal Varices. Hepatogastroenterology. 1990;37(6):561-4. PubMed PMID: 2289768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conservative and semi-invasive modalities for treating bleeding esophageal varices. AU - Paquet,K J, AU - Mercado,M A, AU - Aichner,W, AU - Cuan-Orozco,F, AU - Gad,H A, AU - Müting,D, PY - 1990/12/1/pubmed PY - 1990/12/1/medline PY - 1990/12/1/entrez SP - 561 EP - 4 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 37 IS - 6 N2 - Although controversial, pharmacological therapy aimed at controlling acute variceal bleeding is widely used. A combination of intravenous vasopressin and nitroglycerin or glypressin alone with the aim of lowering portal pressure is currently recommended. Immediate endoscopy is mandatory to confirm that the patient is bleeding from varices. When variceal bleeding is detected, the patient should be immediately submitted to sclerotherapy, if expert treatment is available, or have the bleeding controlled by balloon tamponade or by pharmacological means, with subsequent performance of sclerotherapy with the use of a flexible endoscope within 6 to 24 hours, or transportation of the patient to a special center during this time. If bleeding has stopped, sclerotherapy can be performed immediately, or the patient can be observed while appropriate long-term management is planned. Patients who do not respond to immediate or delayed emergency sclerotherapy should be identified early and their suitability for a shunt or devascularisation procedure assessed. There is no question that at least after one or two early or even late recurrences of variceal hemorrhage, surgery should be planned and initiated. Although sclerotherapy is the favored form of emergency treatment, a nonshunting procedure or a portosystemic shunt operation should be recommended and thoroughly evaluated in order to determine whether this may be a preferable therapeutic option in a minority of patients, representing about 20% of all patients bleeding from esophageal varices referred to our institution. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/2289768/Conservative_and_semi_invasive_modalities_for_treating_bleeding_esophageal_varices_ L2 - https://www.diseaseinfosearch.org/result/2658 DB - PRIME DP - Unbound Medicine ER -