Endoscopic Management of Variceal Haemorrhage

Abstract

One of the most important complications of portal hypertension, in the setting of liver cirrhosis or of non-cirrhotic portal hypertension, is upper gastrointestinal bleeding from ruptured gastroesophageal varices and portal hypertensive gastropathy. The management of the acute variceal bleeding is a multidisciplinary process that includes the initial assessment of the patient, effective resuscitation, timely diagnosis, control of bleeding and prevention of early rebleeding and complications such as infection, hepatorenal syndrome, or hepatic encephalopathy. Antibiotic prophylaxis, conservative targets for blood transfusions and combination therapy with vasoactive drugs and endoscopic treatments are the first-line measures in the management of acute variceal bleeding; transjugular intrahepatic portosystemic shunts should be proposed early to high-risk patients or as a rescue therapy for those who fail first-line treatment.

Von Willebrand factor and esophageal varices in children with chronic liver diseases

“…We found that patients categorized as CPS-B formed the highest percentage (44%), followed by CPS-A and CPS-C, in agreement with Thajeel et al [10], who reported the highest percentage of their pediatric study group as CPS-B (49%) in contrast to 32% and 19% as CPS-A and C, and in the study of Maher et al [12] groups A, B and C comprised 26.7%, 50% and 23.3%, respectively. According to upper endoscopic findings, 40% of patients were classified as group I (patients had EVs) and 60% as group II (patients had no EVs), which was generally in agreement with Dell'Era et al [13] and Hanquinet et al [14], who documented that EVs were found in about 50% and 54% of their pediatric population. Also D' Amico et al [15] and Garcia-Tsao et al [16] reported similar results but in adult patients with CLD.…”

“…According to upper endoscopic findings, 40% of patients were classified as group I (patients had EVs) and 60% as group II (patients had no EVs), which was generally in agreement with Dell’Era et al . [ 13 ] and Hanquinet et al . [ 14 ], who documented that EVs were found in about 50% and 54% of their pediatric population.…”