Prevention of Variceal Rebleeding

Burroughs, Andrew K.; McCormick, P. Aiden

doi:10.1016/s0889-8553(21)00181-3

Cited by 44 publications

(3 citation statements)

References 105 publications

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“…[1][2][3][4] Early rebleed rate after endoscopic sclerotherapy (EST) and endoscopic variceal band-ligation (EVL) ranges from 21% to 52% and 20% to 33%, [5][6][7][8] respectively, with recurrence of bleeding episodes in 29%-50% of patients within the first year after EVL. 9 Chronic sclerotherapy has a rebleed rate of 45%-60% 10 and an eventual failure rate of 35%. 11,12 Patients in whom endotherapy has failed require an alternative second line salvage treatment in the form of surgical intervention for urgent and long-term control of variceal bleeding before hepatic functional decompensation occurs.…”

mentioning

confidence: 99%

Transabdominal Modified Devascularization Procedure with or without Esophageal Stapler Transection—An Operation Adequate for Effective Control of a Variceal Bleed. Is Esophageal Stapler Transection Necessary?

et al. 2006

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mentioning

confidence: 99%

Transabdominal Modified Devascularization Procedure with or without Esophageal Stapler Transection—An Operation Adequate for Effective Control of a Variceal Bleed. Is Esophageal Stapler Transection Necessary?

et al. 2006

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“…The mortality rate of such patients can reach 25%-50% within 1 week without treatment and intervention, and the mortality rate within 1 year is as high as 70% 6 , 7 . Endoscopic hemostasis has been the main method for the treatment of first bleeding from esophagogastric vein rupture 8 , but there are still 10%-20% of patients with first successful hemostasis who experience secondary bleeding, and secondary hemostasis failure is more likely to lead to death 9 . The evaluation of the first hemostatic treatment has been widely reported in many domestic and foreign literatures, but the treatment of hemostasis in patients with rebleeding is rarely evaluated.…”

Section: Discussionmentioning

confidence: 99%

Risk factors analysis of endoscopy and TIPS in the treatment of secondary esophagogastric varicose bleeding with cirrhosis

Liu,

Wang,

Zheng

et al. 2023

Afr H. Sci.

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Objective: To analyse the risk factors of secondary hemorrhage and survival rate in cirrhotic patients with esophagogastric varicealrupture and to compare the efficacy and safety of endoscopic hemostasis and TIPS (transjugular intrahepatic portosystemicshunt). Methods: A total of 120 patients with secondary bleeding after endoscopic treatment of esophagogastric varicose bleeding withcirrhosis in our hospital during the past 3 years were retrospectively analysed. There were 65 males and 55 females, ranging inage from 49 to 74 years old, with an average of (59.5 ± 8.4) years old. The etiology, degree of varicose veins, bleeding location,hemostasis method, Infection, ascites, portal vein thrombosis or cancer thrombus, albumin, platelets, prothrombin activity, ChildPugh (Child-Pugh classification is a diagnostic criterion for liver reserve function) grade were compared in each group. The riskfactors of treatment failure and analyse the survival time was analysed. Results: There were statistically significant differences in varicosis degree, infection, ascites, portal vein thrombosis or cancerthrombus, child Pugh grade, albumin and prothrombin activity between the failed Endoscopy group and the successful hemostasisgroup (P< 0.05). There were statistically significant differences in child Pugh grade, albumin and prothrombin activity betweenthe failed TIPS treatment group and successful hemostasis group (P< 0.05). There was no significant difference in 1-yearsurvival between the endoscopy group and the TIPS group. Conclusion: Severe varicose veins, infection, ascites, portal vein thrombosis or cancer thrombus, child pugh classification, albumin,and prothrombin activity were the major risk factors for failed secondary endoscopic therapy, child Pugh classification,albumin and prothrombin activity were the main risk factors for failure TIPS treatment. There is no significant difference inlong-term survival between the two methods. Keywords: Liver cirrhosis; esophagogastric varicose bleeding; Endoscopy; TIPS.

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“…There is little doubt that the initial acute bleeding episode is more effectively controlled by sclerotherapy than by other means of medical management, such as vasopressin infusion and balloon tamponade [3]. However, when patients are managed with chronic sclerotherapy, 45% to 60% of patients rebleed at some time [10]. Many of these patients are successfully treated with subsequent sclerotherapy sessions, but the eventual failure rate of sclerotherapy is as high as 35% in some series [11,121. Once sclerotherapy has failed and the patient is bleeding acutely, there are limited options other than emergency surgery.…”

Section: Indications For Emergency Surgerymentioning

confidence: 99%

Surgical management of acute variceal hemorrhage

Rikkers

Jin

1994

World j. surg.

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The advent of more effective nonoperative therapies, mainly endoscopic variceal sclerosis, has decreased the need for emergency surgery for control of acute variceal hemorrhage. In centers where it is available, nonoperative portal decompression by transjugular intrahepatic portosystemic shunting (TIPS) is likely to have a further impact. When acute or chronic sclerotherapy fails or when bleeding is secondary to gastric varices or portal hypertensive gastropathy, emergency surgery may be life-saving and should be done promptly before worsening hepatic functional decompensation develops. Child's class C liver disease is not a contraindication to emergency surgery; many patients who fail nonoperative attempts at control of bleeding are of this risk status. The most commonly utilized emergency procedures are portacaval and interposition mesocaval shunts, both of which are effective, and esophageal transection, which is associated with a higher incidence of late rebleeding. An emergency distal splenorenal shunt is appropriate for selected patients who are not actively bleeding at the time of surgery. TIPS is the preferred alternative for acute or chronic endoscopic sclerotherapy failures who are candidates for liver transplantation within the succeeding 6 to 12 months.

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Prevention of Variceal Rebleeding

Cited by 44 publications

References 105 publications

Transabdominal Modified Devascularization Procedure with or without Esophageal Stapler Transection—An Operation Adequate for Effective Control of a Variceal Bleed. Is Esophageal Stapler Transection Necessary?

Transabdominal Modified Devascularization Procedure with or without Esophageal Stapler Transection—An Operation Adequate for Effective Control of a Variceal Bleed. Is Esophageal Stapler Transection Necessary?

Risk factors analysis of endoscopy and TIPS in the treatment of secondary esophagogastric varicose bleeding with cirrhosis

Surgical management of acute variceal hemorrhage

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