Emergency Transumbilical Embolization of Bleeding Esophageal Varices

Tauber, Jürg W.

doi:10.1001/archsurg.1982.01380290074013

Cited by 4 publications

(2 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Da in der Literatur Embolisationen blutender Ösophagusvarizen von transumbilikal sowie die perkutane Coilembolisation von Jejunalvarizenblutungen beschrieben sind, wurde im interdisziplinären Konsens zwischen Internisten, Chirurgen und interventionellen Radiologen die Entscheidung zum angiografischen Embolisationsversuch des für die Rektumvarizenblutungen verantwortlichen Pfortaderumgehungskreislaufes von paraumbilikal vereinbart [1][2][3][4].…”

Section: Diskussionunclassified

Erfolgreiche Behandlung von rezidivierenden Rektumvarizenblutungen mittels perkutaner paraumbilikaler Embolisation bei Pfortaderhochdruck

2016

View full text Add to dashboard Cite

Portal hypertension may lead to severe esophageal or rectal variceal bleeding. We present a case of a 67-year-old patient presenting with recurrent rectal variceal bleeding who was non-responsive to endoscopic treatment. We are reporting on an interventional therapeutic approach found in interdisciplinary consensus. Endoscopy, surgery or TIPS (transjugular intrahepatic portosystemic shunt) can be performed in patients with gastrointestinal bleeding due to portal hypertension in liver cirrhosis. In cases not suitable for these treatment options, or in cases where these failed to stop the bleeding, radiological percutaneous paraumbilical coil embolization of the portal vein collateral feeding the bleeding could be performed. In our case, as well as in published cases with embolization of jejunal or esophageal hemorrhage, complete stopping of the bleeding could be achieved without further treatment or re-bleeding.

show abstract

Section: Diskussionunclassified

Erfolgreiche Behandlung von rezidivierenden Rektumvarizenblutungen mittels perkutaner paraumbilikaler Embolisation bei Pfortaderhochdruck

2016

View full text Add to dashboard Cite

show abstract

“…21 Up to 36% of patients develop portal vein thromboses and postembolization ascites is a problem. Because 55% rebleed 22 this method is no longer recommended.…”

Section: Introductionmentioning

confidence: 99%

Sclerotheraphy for Esophageal Varices: A Retrospective Study of 61 Patients Treated at King Faisal Specialist Hospital

et al. 1984

View full text Add to dashboard Cite

Over a period of 36 months, 61 patients underwent sclerotherapy for esophageal varices, 49 after a variceal bleeding episode (Group I) and 12 selected patients prophylactically (Group II). Mean follow-up was 12.6 months in Group I and 15.5 months in Group II. In Group I 27% died; only 10% of those patients presenting with mild liver disease (Child's Group A) who were followed died of gastrointestinal hemorrhage; but all presenting with severe liver disease (Child's Group C) died after a mean of 6.3 months, 57% following rebleeding. No patients in Group II died from esophageal hemorrhage. The rebleeding risk per patient-month of follow-up was 0.04 in Group I, 0.005 in Group II and 0.01 in the 22% of patients in Group I who achieved complete ablation of their varices. There was no mortality attributable to the procedure, and complications occurred after only 4.5% of the procedures; all were reversible. Sclerotherapy seems at present the treatment of choice for bleeding esophageal varices, considering its efficacy, safety and simplicity. It is probably also of value prophylactically in selected patients.

show abstract

Non-operative management of variceal bleeding

Joffe

1984

Journal of British Surgery

View full text Add to dashboard Cite

The treatment of variceal haemorrhage remains controversial. Resurgence of old therapies (endoscopic sclerotherapy) and the introduction of new modalites (obliterative angiotherapy) has exacerbated the disputeL. Problems in assessment of therapeutic value are related to many variables2 including the severity of the liver disease and the effectiveness of the measures used to control the haemorrhage3. Non-operative procedures for thc. control of bleeding oesophageal varices have received increased attention in recent y e a r~~3~. This is related to the high mortality rates associated with emergency operations and the frequency of incapacitating encephalopathy.Why patients with portal hypertension bleed from oesophageal varices is not known6. Bleeding is related to variceal size, but size and extent of varices are unrelated to portal pressure7. Gastro-oesophageal reflux does not cause bleedings. Following a variceal bleed, the mortality without surgery, primarily due to bleeding, is 42 per cent at 4-6 weeks"9 varying from 22 to 84 per cent3910. Approximately one-third of patients rebleed within 6 weeks and one-third of the survivors subsequently rebleed if not treated ~u r g i c a l l y~~. Any substantial improvement in this survival requires safe and effective treatment in the early periodI2. In the last few years advances have been made in non-operative procedures for controlling variceal bleeding. Medical treatment Vasopressin (Pitressin)Following Kehne's13 initial successful report on using vasopressin in bleeding oesophageal varices, it is the first line of therapy provided there are no contra-indications to its use. Vasopressin reduces portal pressure and contracts the oesophageal musculature"+Js. Vasopressin can be given intravenously as a bolus, by continuous infusion or selectively into the superior mesenteric arteryl6-I8. The conventional bolus of 20 units vasopressin intravenously over a 2-20 min period will not permanently stop bleedingl9. Intravenous infusion of a low dose of vasopressin (0.4 unitslmin) stopped bleeding in 86 per cent of episodes compared with only 12.5 per cent when boluses of 20 units were administered (P < 0.01) (Reference 20). This study contained only a small number of sequential patients. A controlled study comparing continuous intra-arterial with intravenous infusions of vasopressin in 22 cirrhotic patients showed that either route controlled bleeding in 50 per cent of the patients with equal side effects2'. Continuous intravenous vasopressin can be administered more easily and has distinct advantages over bolus and arterial infusions20-22. The optimum intravenous dose is unknown. Low doses appear to be as effective as a high dose infusion but tachyphylaxis develops21. Several controlled clinical studies have now confirmed the effectiveness of v a s o p r e~s i n~~-~~. Side effects include decreased pulmonary bloodflow and cardiac o u t p~t~~-~~ which can be reversed by intravenous nitroglycerin27. Ischaemic colitis28, emphysematous gastritis29 and local gangrene'O may also occur...

show abstract

Emergency Transumbilical Embolization of Bleeding Esophageal Varices

Cited by 4 publications

References 9 publications

Erfolgreiche Behandlung von rezidivierenden Rektumvarizenblutungen mittels perkutaner paraumbilikaler Embolisation bei Pfortaderhochdruck

Erfolgreiche Behandlung von rezidivierenden Rektumvarizenblutungen mittels perkutaner paraumbilikaler Embolisation bei Pfortaderhochdruck

Sclerotheraphy for Esophageal Varices: A Retrospective Study of 61 Patients Treated at King Faisal Specialist Hospital

Non-operative management of variceal bleeding

Contact Info

Product

Resources

About