Session 6 ‒ Treatment of the Acute Bleeding Episode

Laine, Loren; Burroughs, Andrew K.; Silvain, Christine; Vinel, Jean Pierre; Bosch, Jaime

doi:10.1002/9780470760154.ch10

Cited by 3 publications

(7 citation statements)

References 109 publications

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“…Nowadays, EVL has replaced sclerotherapy as the endoscopic treatment of choice for arresting esophageal variceal hemorrhage. 9 Sung et al first performed a controlled study to evaluate the role of combining octreotide with EVL in the treatment of acute variceal bleeding, and showing that addition of octreotide for 5 days to EVL reduced early rebleeding from 45 to 13%. 25 On the other hand, Sarin et al demonstrated that addition of somatostatin to EVL had a similar rebleeding rate within 5 days to EVL alone (25% vs 30%).…”

Section: Figurementioning

confidence: 99%

“…The adjuvant use of PPI instead of vasoconstrictor after successful hemostasis achieved by EVL proved to be more logical and highly effective in the management of acute variceal hemorrhage and revolutionize the concept that is adopted by most scholars. 6,9,10 Continuous use of vasoconstrictors has been regarded safe and effective as an adjuvant therapy to banding ligation of bleeding varices. Our study did not refute the effect and safety of vasoconstrictors.…”

Section: Figurementioning

confidence: 99%

“…On the other hand, because of fewer complications and higher hemostatic rate, endoscopic variceal ligation (EVL) has replaced endoscopic injection sclerotherapy (EIS) as the endoscopic treatment of choice in the arresting of acute esophageal variceal hemorrhage. [8][9][10] However, early rebleeding due to ligation-induced ulcer may be encountered. [11][12][13] A previous study revealed that pantoprazole reduced the size of postbanding ulcers after EVL.…”

Section: Introductionmentioning

confidence: 99%

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Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding

Perng

Chang

et al. 2013

J of Gastro and Hepatol

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding

Perng

Chang

et al. 2013

J of Gastro and Hepatol

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“…Some studies have compared emergency endoscopic therapy and vasoconstrictor therapy in AEVH and found that vasoconstrictor was as effective as endoscopic injection sclerotherapy (EIS) for controlling bleeding, but with fewer complications [46][47][48][49][50]. Thus, it was claimed that vasoconstrictor can replace EIS as the first-line therapy for AEVH [51].…”

Section: Timing Of Endoscopymentioning

confidence: 99%

“…Complications were more frequently encountered in patients treated with EIS than with EVL. Based on these observations, the 2005 Baveno Consensus has suggested that EVL should be the first choice of endoscopic treatment in the management of AEVH [47]. EIS could be used in cases with rapid bleeding that limits the endoscopist's visual field.…”

Section: Endoscopic Therapy: To Sclerose or To Ligate?mentioning

confidence: 99%

Management of Acute Esophageal Variceal Hemorrhage

2010

The Kaohsiung J of Med Scie

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Acute esophageal variceal hemorrhage (AEVH) is a devastating complication of portal hypertension. Evaluation of the natural history of AEVH showed that it is associated with a mortality rate of 40%, and a high incidence of early rebleeding of 30-50% among the survivors [1]. The factors responsible for AEVH are not well known. Portal pressure, variceal pressure, and the tension of the esophageal variceal wall have been demonstrated to be associated with AEVH. Hepatic venous pressure gradient (HVPG) > 12 mmHg is noted to be a requisite in patients with variceal rupture [2]. Poor hepatic reserve and the appearance numerous red color signs on the large varices are important factors predicting AEVH [3]. In Taiwan, for unknown reasons, gastroenterologists have noted that the incidence of AEVH is higher in the winter season.There are a handful of treatment modalities available for the management of AEVH. Vasoconstrictors and endoscopic therapy are the most frequently used tools to control AEVH. Appropriate use of these modalities should improve the survival of patients with AEVH. This article reviewed the relevant literature and summarized the limitations and advantages of the various treatment modalities used for AEVH; and to provide practical guidance for clinicians to manage this severe medical emergency.

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Primary Prophylaxis of Gastric Variceal Bleeding Comparing Cyanoacrylate Injection and Beta-Blockers in Patients with Liver Cirrhosis: A Randomized Controlled Trial

G¹

2020

ARGH

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Background and study aim: The bleeding from gastric varices are more severe, requiring more blood transfusions, and has a higher mortality rate than esophageal variceal bleeding, there is little data on primary prophylaxis of GV bleeding, we compared the efficacy of cyanoacrylate injection and beta-blockers in primary prophylaxis of gastric variceal bleeding.Methods: Cirrhotics with gastroesophageal varices type 2 with eradicated esophageal varices or large isolated gastric varix type 1, who had never bled from gastric varix, were randomized to cyanoacrylate injection (Group I, n = 30), beta-blockers (Group II, n = 30) or no treatment (Group III, n = 30). Primary endpoints were bleeding from gastric varix or death.Results: bleeding from gastric varices over 6 months follow up was 6.67% in Group I, 20% in Group II, 36.67% in Group III (p = 0.017). GV obliterated or decreased in size 42.86% and 57.14% of group I respectively. No patients neither in group II nor in group III had an obliteration or decrease in GV size. (p < 0.001). Conclusion:Primary prophylaxis in patients with gastric varices is recommended to reduce the risk of first bleeding. Cyanoacrylate injection is more effective than beta-blocker therapy in preventing first gastric variceal bleeding.

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Session 6 ‒ Treatment of the Acute Bleeding Episode

Cited by 3 publications

References 109 publications

Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding

Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding

Management of Acute Esophageal Variceal Hemorrhage

Primary Prophylaxis of Gastric Variceal Bleeding Comparing Cyanoacrylate Injection and Beta-Blockers in Patients with Liver Cirrhosis: A Randomized Controlled Trial

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