Management of Variceal Hemorrhage

Abstract

Variceal hemorrhage is a frequent and lethal complication of portal hypertension. Bleeding occurs in 30%-40% of patients with cirrhosis and varices. The first episode of variceal bleeding is associated with a high mortality as well as a high incidence of rebleeding. Thus, management of variceal hemorrhage should be categorized into 3 phases: primary prophylaxis (prevention of the first episode of bleeding), emergency treatment (management of acute bleeding), and secondary prophylaxis (prevention of re-bleeding). Modalities involved include pharmacological, endoscopic, surgical, interventional radiological therapy and balloon tamponade. This review summarizes the current choices of management during each phase, and concentrates on the following questions, what can we do to prevent the formation and development of varices; how can we predicate the risk of bleeding; what should we do in case of bleeding; what is the first-line therapy; what should we do when current therapy fails; when should we give up and what is the optimal strategy for secondary prophylaxis.

Colorectal adenocarcinoma with hepatic neuroendocrine carcinoma: A case report

“…Surgery remains the primary treatment, just as lobectomy or liver transplantation; local ablation, TACE, and cytotoxic drugs [12] serve as options for non-surgical treatment, and the efficacy of mTOR inhibitors and small-molecule TKI drugs or biological agents such as growth inhibitor analogs requires more research.…”

Enhancing the Quality of Upper Gastrointestinal Endoscopy: Current Indicators and Future Trends

“…Screening for esophageal varices is recommended for patients newly diagnosed with cirrhosis, with subsequent monitoring depending on the size of the varices and the presence of liver injury or other cofactor diseases. EVL is typically performed in a series of treatments until the varices are eradicated, with follow-up endoscopy scheduled every 6-12 months [56]. In gastric varices, endoscopic cyanoacrylate glue injection is the first-line treatment, with TIPS reserved for cases of acute bleeding not controlled by endoscopic means [57,58].…”