Current endoscopic therapy of variceal bleeding

Endoscopic Management of Variceal Haemorrhage

“…Different sclerosant agents (e.g. sodium morrhuate, podidocanol, ethanolamine, alcohol, and sodium tetradecyl sulphate) have been used in controlled trials [45] and nowadays the most commonly used agents are ethanolamine oleate (5%) or polidocanol (1%-2%) in Europe, and sodium morrhuate (5%) in the United States [46,47] . The injection of the sclerosant agent may be performed into the variceal lumen (intravariceal) or adjacent to it (paravariceal) inducing thrombosis of the vessel and inflammation of the surrounding tissues [48,49] leading to fibrosis and resulting in variceal obliteration [50] .…”

“…EVL consists in placing rubber rings on esophageal varices after sucking them into a plastic cylinder attached to the tip of the endoscope [69,70] ( Figure 2). In the beginning single-shot ligators were used, requiring the use of an overtube with all the complications of its use; nowadays multiple-shot (4-10 bands) devices are commonly used and the procedure is simpler and faster [46] . During an emergency EGD the bleeding varix is identified; the endoscope is then removed from the patient and the banding device is loaded.…”

“…A recent trial has shown that proton pump inhibitor therapy is associated with smaller ulcers but the total number and the symptoms were not different [73] . Varices are considered eradicated when they have either disappeared or cannot be sucked and banded by the ligator [46] . Variceal eradication is obtained in about 90% of patients with up to 4 banding sessions [46] but recurrence is not uncommon [74] .…”

“…Varices are considered eradicated when they have either disappeared or cannot be sucked and banded by the ligator [46] . Variceal eradication is obtained in about 90% of patients with up to 4 banding sessions [46] but recurrence is not uncommon [74] . A meta-analysis of 7 randomized controlled trials (RCTs) showed that there is a tendency toward benefit of EVL compared to ES in terms of control of bleeding, recurrent bleeding, side effects, need for fewer endoscopic treatments, and survival [60] .…”

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

“…Even in the absence of active bleeding, endoscopic treatment of esophageal varices is recommended after exclusion of other possible bleeding lesions, since a third of these patients with variceal hemorrhage have no signs of active bleeding at the moment of endoscopy (91) . Combined endoscopic and pharmacologic treatment is superior to each treatment modality (7,9,72,94,156) , but the use of vasoactive drugs should precede endoscopic hemostasis. Esophageal band ligation is the endoscopic treatment of choice (132) .…”