Treatment Of Variceal Bleeding

Year 2021, Volume: 38 Issue: 2s, 17 - 22, 18.03.2021

Yusuf Serdar Sakin , Galip Büyükturan

Abstract

Cirrhosis is termed as the late stage of progressive hepatic fibrosis characterized by the disruption of the hepatic parenchymal structure and the formation of regenerative nodules. Many factors play a role in the etiology of cirrhosis. Currently, mortality is still high and causes significant work loss. The prognosis of patients with cirrhosis is largely due to its complications. Treatment of cirrhosis is limited except liver transplantation. An important cause of the morbidity and mortality associated with cirrhosis is the development of variceal bleeding secondary to portal hypertension. The prognosis of patients with variceal bleeding depends on the bleeding or other complications is associated with underlying chronic liver disease and its management. The mortality rate due to active variceal bleeding is around 20 percent during each bleeding and re-bleeding is observed in 70 percent of patients within one year. Upper gastrointestinal bleeding unrelated to portal hypertension is also common in patients with portal hypertension (eg, peptic ulcer disease). In this article, we will talk about variceal bleeding secondary to portal hypertension and its treatment based on current data.

Keywords

variceal bleeding, endoscopic band ligation, endoscopic sclerotherapy

References

• Avgerinos A, Nevens F, Raptis S, Fevery J. Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial. Lancet 1997; 350:1495.
• Beppu K, Inokuchi K, Koyanagi N, et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc 1981; 27:213.
• Besson I, Ingrand P, Person B, et al. Sclerotherapy with or without octreotide for acute variceal bleeding. N Engl J Med 1995; 333:555.
• Bosch J, Bordas JM, Rigau J, et al. Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge: comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy. Hepatology 1986; 6:667.
• Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, et al. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review. Aliment Pharmacol Ther 2011; 34:509.
• D’Amico G, Politi F, Morabito A, et al. Octreotide compared with placebo in a treatment strategy for early rebleeding in cirrhosis. A double blind, randomized pragmatic trial. Hepatology 1998; 28:1206.
• D’amico G, Criscuoli V, Fili D, et al. Meta-analysis of trials for variceal bleeding. Hepatology 2002; 36:1023.
• D’Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 2006; 131:1611.
• de Franchis R, Primignani M. Why do varices bleed? Gastroenterol Clin North Am 1992; 21:85.
• de Franchis R, Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53:762.
• Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65:310.
• Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353:2254.
• Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev 2003; :CD002147.
• Li L, Yu C, Li Y. Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: a meta-analysis. Can J Gastroenterol 2011; 25:147.
• Lux G, Retterspitz, M. Stabenow-Lohbauer, U, et al. Treatment of Bleeding Esophageal Varices with Cyanoacrylate and Polidocanol, or Polidocanol Alone: Results of a Prospective Study in an Unselected Group of Patients with Cirrhosis of the Liver. Endoscopy 1997; 29(4): 241-246.
• Lv Y, Yang Z, Liu L, et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial. Lancet Gastroenterol Hepatol 2019; 4:587.
• Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 2003; 38:266.
• North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 1988; 319:983.