The role of endoscopy in the management of variceal hemorrhage

Hwang, Joo Ha; Shergill, Amandeep K.; Acosta, Ruben D.; Chandrasekhara, Vinay; Chathadi, Krishnavel V.; Decker, G. Anton; Early, Dayna S.; Evans, John A.; Fanelli, Robert D.; Fisher, Deborah A.; Foley, Kimberly; Fonkalsrud, Lisa; Jue, Terry L.; Khashab, Mouen A.; Lightdale, Jenifer R.; Muthusamy, V. Raman; Pasha, Shabana F.; Saltzman, John R.; Sharaf, Ravi; Cash, Brooks D.

doi:10.1016/j.gie.2013.07.023

Cited by 192 publications

(158 citation statements)

References 74 publications

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“…Despite the development in diagnostic and therapeutic measures, mortality of VH remains high at 15-20% [2] . Endoscopic variceal ligation (EVL) is current first line treatment for VH [3] . It's recommended to perform endoscopy urgently (within 12 hours of admission) for suspected VH [3] .…”

Section: Resultsmentioning

confidence: 99%

“…Endoscopic variceal ligation (EVL) is current first line treatment for VH [3] . It's recommended to perform endoscopy urgently (within 12 hours of admission) for suspected VH [3] . Urgent endoscopy for upper gastrointestinal bleeding has been associated more than 10 times higher complication rates (8%) comparing to non-urgent endoscopy (0.7%) [4,5] .…”

Section: Resultsmentioning

confidence: 99%

“…In the meantime, concurrent hepatic encephalopathy worsen patient's ability of airway protection, which reasonably concerns clinician about EGD induced aspiration. Both AASLD (American Association for the Study of Liver Diseases) and ASGE (American Society for Gastrointestinal Endoscopy) postulated in their practice guidelines that intubation before EGD is highly recommended for aspiration prevention [3,9].…”

Section: Discussionmentioning

confidence: 99%

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Prophylactic Endotracheal Intubation Prior to Urgent Endoscopy in Patients with Suspected Variceal Hemorrhage: An Evaluation of Outcomes and Complications

Tang

Wang

2017

Journal of Gastroenterology and Hepatology Research

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and one without. Primary outcomes for the study were immediate aspiration, post EGD pneumonia, death, and other complications. Secondary outcomes included post EGD intensive care unit (ICU) stay, total ICU stay and total hospital stay. Retrospective comparison between cohorts was performed. RESULTS: Total 110 occurrences of urgent EGD were included. Prophylactic intubation was performed in 65 occurrence. Demographics, clinical background and significant comorbidities were similar in both cohorts. Immediate aspiration, post EGD pneumonia, and mortality were similar in both cohorts. Complications other than cardiac and pulmonary related were higher in prophylactic intubation group than no intubation group (40% vs 17.78%, p = 0.02). Overall average hospital stay of both cohorts and overall average ICU stay were similar. Average ICU stay post EGD was significant longer in prophylactic intubation group than no intubation group (4.7 ± 3.9 days vs 2.6 ± 2.6 days, p = 0.002). CONCLUSION: Our study revealed that prophylactic intubation prior to urgent EGD for variceal hemorrhage (VH) did not improve clinical outcomes. Our finding would suggest against routine prophylactic intubation in patients having VH with only mild encephalopathy and no ongoing hemorrhage. ABSTRACT AIM: There is limited evidence that suggests prophylactic intubation improves patient outcomes despite wide utilization. Our study aims to evaluate outcomes and complications related to prophylactic intubation through a retrospective comparison. METHODS: Urgent esophagogastroduodenoscopy (EGD) for suspected variceal hemorrhage were included in the study and categorized into two cohorts, one with prophylactic intubation

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prophylactic Endotracheal Intubation Prior to Urgent Endoscopy in Patients with Suspected Variceal Hemorrhage: An Evaluation of Outcomes and Complications

Tang

Wang

2017

Journal of Gastroenterology and Hepatology Research

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“…Terlipressin, octreotide, somatostatin or vasopressin must be started according to the American Society for Gastrointestinal Endoscopy guidelines. [4] Patients must be continuously monitored throughout the treatment procedures. Ideally, upper endoscopy must be accomplished as soon as the first measures have taken place and the patient is hemodynamically stabilized.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…Furthermore, it is also performed for prophylaxis of recurrent bleeding and even before the first episode when the patient is insensitive to β-blockers. [3,4] The procedure aims to obliterate the perforating veins that connect the submucosal varices to extraesophageal collaterals in the esophageal palisade zone. For most patients, it leads to the formation of shallow ulcers that heal in two weeks, without substantial blood loss.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Lima

Silva

Romeiro

2018

CRIM

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Esophageal varices develop in half of cirrhotic patients. Endoscopic variceal band ligation is the current treatment for acute bleeding and applicable for primary and secondary prophylaxis. However, there is a risk of complications, including ligationinduced ulcer bleeding. The aim of this study is to review the current diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band-ligation ulcers in cirrhotic patients. PubMed and Google Scholar were searched for English language articles about the theme. The main findings were that Child-Pugh class C, higher model of end-stage liver disease, emergency ligation, presence of hepatocellular carcinoma, peptic esophagitis and bacterial infection were reported as the most important risk factors for post-banding ulcer hemorrhage. There are few studies with proton pump inhibitors and sucralfate showing size reduction of post-banding ulcers. Many treatment modalities have been used to control post band ulcer bleeding, such as band local injection of epinephrine or cyanoacrylate, balloon tamponade, stent placement and ligation of the ulcerated bleeding site. However, the optimal management remains uncertain. The principal conclusions of the study were that post-banding ulcer bleeding is potentially life-threatening and must be suspected in the presence of hematemesis, melena or anemia after endoscopic variceal band ligation (EVL). Predictors of rebleeding must be assessed and controlled as much as possible before band ligation. The post-banding treatment with proton pump inhibitors or sucralfate seems advisable, in particular for high-risk patients. Further investigation and new approaches are still required to achieve optimal management of this complication.

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Endoscopic Management of Acute Variceal Bleeding

Robertson

Hayes

2017

Endoscopy in Liver Disease

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The role of endoscopy in the management of variceal hemorrhage

Cited by 192 publications

References 74 publications

Prophylactic Endotracheal Intubation Prior to Urgent Endoscopy in Patients with Suspected Variceal Hemorrhage: An Evaluation of Outcomes and Complications

Prophylactic Endotracheal Intubation Prior to Urgent Endoscopy in Patients with Suspected Variceal Hemorrhage: An Evaluation of Outcomes and Complications

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Endoscopic Management of Acute Variceal Bleeding

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