Effectiveness of Combination of Pharmacological Treatment and Endoscopic Band Ligation in Active Esophageale Varicos Bleeding

Yıl 2023, Cilt: 5 Sayı: 1, 6 - 8, 30.04.2023

Mehmet Önder Ekmen

https://doi.org/10.55994/ejcc.1266733

Öz

Acute gastrointestinal system bleeding in cirrhotic patients is one of the emergencies of gastroenterology that requires rapid and careful intervention. For this reason, patients who are thought to have esophageal variceal bleeding should be referred to a center that is adequately equipped for follow-up and treatment. There are studies supporting that current approaches to the treatment of esophageal variceal bleeding have a positive effect on life expectancy. Volume replacement is an important condition in the general approach to esophageal variceal bleeding. It is recommended to maintain hemodynamic stability and keep the hemoglobin level at approximately 8 g/dL. Additionally, it is thought that prophylactic antibiotic usage in gastrointestinal system bleeding of cirrhotic patients reduces the risk of bacterial infection and has a positive effect on life expectancy. In addition to these approaches, there are also specific measures for the control of esophageal variceal bleeding and the prevention of early recurrence of these bleedings. Pharmacological treatment for esophageal variceal bleeding can be started as soon as variceal bleeding is considered, even before upper gastrointestinal system endoscopy. Similar efficacy was demonstrated in a meta-analysis of 15 studies comparing emergency sclerotherapy and pharmacological therapy (vasopressin±nitroglycerin, terlipressin, somatostatin, octreotide). In the treatment of esophageal variceal bleeding, the combination of pharmacological and endoscopic treatment seems to be the most appropriate option. A meta-analysis of 8 studies compared the combination of endoscopic treatment [(sclerotherapy or endoscopic band ligation (EBL)] with endoscopic, pharmacological treatment) for acute variceal bleeding. Combination of endoscopic and pharmacological treatment was found superior in terms of bleeding control and risk of recurrence. In this study, we evaluated the efficacy of combination of pharmacological and endoscopic band ligation in patients who admitted to the hospital with esophageal variceal bleeding.

Anahtar Kelimeler

Schlerotherapy, Esophageale Varicose Bleding, Endoscopic Band Ligation

Kaynakça

• 1) Chalasani N, Kahi C, Francois F, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohortstudy. Am J Gastroenterol 2003; 98: 653-9
• 2) De Franchis R. Evolvingconsensus in portal hypertensionreport of theBaveno IV consensusworkshop on methodology of diagnosisandtherapy in portal hypertension. J Hepatol 2005; 43: 167-76.
• 3) Soares-WeiserK, BrezisM, Tur-KaspaR, LeiboviciL. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding (CochraneReview). Cochrane Database SystRev. 2002; (2): CD002907.
• 4) D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus vasoactive drugs for varicealbleeding in cirrhosis: a Cochrane meta-analysis. Gastroenterology 2003; 124: 1277-91
• 5) Banares R, Albillos A, Rincon D, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis. Hepatology 2002; 35: 609-15.
• 6) Garcia-Pagan JC, Bosch J. Endoscopic band ligation in the treatment of portal hypertension. Nat Clin Pract Gastroenterol Hepatol 2005; 2: 526- 35.
• 7) Planas R, Quer JC, Boix J, et al. A prospective randomized trial comparing somatostatin and sclerotherapy in thetreatment of acute variceal bleeding. Hepatology 1994; 20: 370-5.
• 8) Besson I, Ingrand P, Person B, et al. Sclerotherapy with or without octreotide for acute variceal bleeding. N Engl J Med 1995; 333: 555-60.
• 9) Sung JJ, Chung SC, Yung MY, et al. Prospective randomised study of efect of octreotide on rebleeding from oesophageal varices after endoscopicligation. Lancet 1995; 346: 1666-9.
• 10) Stiegman GV, Goff JS, Michaletz-Onody PA, et al. Endoscopicsclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med 1992; 326: 1527-32.