Prevention of first variceal bleed: an appraisal of current therapies

Shahi, Hansa M; Sarin, Shiv Kumar

doi:10.1016/s0002-9270(98)00470-5

Cited by 9 publications

(9 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ligation should have a role particularly in the treatment of patients with high-risk varices in whom beta-blockers are contraindicated or must be discontinued because of side effects. 38 Our findings also suggest that the combination of both therapies should be evaluated to determine whether even better results can be achieved.…”

Section: Discussionmentioning

confidence: 77%

Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding

et al. 1999

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 77%

Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding

et al. 1999

View full text Add to dashboard Cite

show abstract

“…One such intervention, screening for high-risk varices, has been recommended by the ACG and the AASLD [11–13] Screening and surveillance for high-risk varices according to the published guidelines has been shown to be a cost-effective intervention [18]. Therefore, given the efficacy of primary prophylaxis [19] and the economical feasibility of screening, we would expect that the majority of practitioners embrace such a preventive strategy.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns in screening for varices: An American survey

Barritt

Arguedas

2009

Digestive and Liver Disease

View full text Add to dashboard Cite

Background and aims Guidelines recommend screening for gastroesophageal varices. Regional studies suggest screening is underutilized, but information from across the United States is unavailable. We explored practice patterns and adherence to guidelines in a random sample of physicians and sought to define whether differences existed according to practice type, setting and years of practice. Materials and Methods Surveys were randomly sent to 600 gastroenterologists and hepatologists. Descriptive data is presented as percentage and comparisons were performed by chi-square analysis. Significance was defined at a p value <0.05. Results 180 completed surveys were returned. Mean age was 48.9 ± 10 years and 87% were male. 50% were community-based and 74% had been in practice >10 years. 53% (78% hepatologists versus 45% of gastroenterologists) screened consistently (>75% of the time), (p < 0.001). No differences in screening frequency were found according to practice setting or years in practice. 62% screened all cirrhotics whereas 38% screened based on clinical characteristics. In patients without gastroesophageal varices, 60% repeated esophagogastroduodenoscopy in 2–3 years. In those with small gastroesophageal varices, repeat esophagogastroduodenoscopy was recommended in 1–2 years by 73%. In patients with small and large varices, 40% and 54% of physicians respectively, recommended prophylaxis. 6% of physicians recommend prophylaxis regardless of the presence or size of varices. Conclusions Screening for varices is under-implemented. Many screened based on clinical findings that have not been shown to reliably predict high-risk gastroesophageal varices. Continued education and removal of financial barriers to screening are central to increasing screening rates and improving patient outcomes.

show abstract

“…As a consequence, most authorities believe that variceal injection sclerotherapy should not be used in this situation 64 , . 70 …”

Section: Primary Prophylaxis (Prevention Of the First Variceal Bleed)mentioning

confidence: 99%

Current endoscopic therapeutic options in the management of variceal bleeding

Helmy

Hayes

2001

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Variceal bleeding is a frequent and life‐threatening complication of portal hypertension. The first episode of variceal bleeding is not only associated with a high mortality, but also with a high recurrence rate in those who survive. Therefore, many studies and randomized clinical trials have focused on different therapeutic strategies aiming to prevent the first episode of variceal bleeding (primary prophylaxis), to control haemorrhage during the acute bleeding episode (emergency treatment), and to prevent re‐bleeding (secondary prophylaxis). These strategies involve pharmacological, endoscopic, surgical, and interventional radiological modalities. This review concentrates on the clinical aspects of the endoscopic modalities used to treat oesophageal variceal haemorrhage, including variceal injection sclerotherapy, variceal band ligation, and the use of tissue adhesives (glue) and their substitutes. We also draw conclusions from the available literature regarding the use of endoscopic modalities in primary prophylaxis, emergency treatment, and secondary prophylaxis of variceal re‐bleeding. The management of gastric varices and variceal bleeding during pregnancy is also addressed.

show abstract

Prevention of first variceal bleed: an appraisal of current therapies

Cited by 9 publications

References 82 publications

Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding

Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding

Practice patterns in screening for varices: An American survey

Current endoscopic therapeutic options in the management of variceal bleeding

Contact Info

Product

Resources

About