New Developments in Managing Variceal Bleeding

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Ibrahim M.; Mostafa I.; Devière J.

Journal: Gastroenterology

Publisher: W.B. Saunders

Publication Date: May 2018

Volume / Issue: Volume 154 / Issue 7

Pages: 1964–1969

ISSN: 165085

DOI: 10.1053/j.gastro.2018.02.023

Scopus: View on Scopus

PubMed: 29481777

Document Type: Article

Authors and Affiliations

Ibrahim M., Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium, Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt; Mostafa I., Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt; Devière J., Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

Abstract

Liver cirrhosis is the end stage of chronic liver disease, independent of etiology, and is characterized by accumulation of fibrotic tissue and conversion of the normal liver parenchyma into abnormal regenerative nodules. Complications include portal hypertension (PH) with gastroesophageal varices, ascites, hepatorenal syndrome, hepatic encephalopathy, bacteremia, and hypersplenism. The most life-threatening complication of liver cirrhosis is acute variceal bleeding (AVB) which is associated with increased mortality that, despite recent progress in management, is still around 20% at 6 weeks. Combined treatment with vasoactive drugs, prophylactic antibiotics, and endoscopic techniques is the recommended standard of care for patients with acute variceal bleeding. There are many promising new modalities including the combination of coil and glue injection for management of bleeding or non-bleeding gastric varices and hemostatic powder application, that requires minimal expertise, when performed early after admission of a cirrhotic patient with AVB and overt hematemesis acting as a bridge therapy till definitive endoscopic therapy can be performed in hemodynamically stable conditions and without acute bleeding. © 2018 AGA Institute

Keywords

Hemostatic Powder; Portal Hypertension; Variceal Bleeding; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; antibiotic agent; beta adrenergic receptor blocking agent; carvedilol; cyanoacrylate; erythromycin; glue; hemostatic agent; midazolam; monoethanolamine oleate; nadolol; octreotide; polidocanol; polysaccharide; prokinetic agent; propranolol; proton pump inhibitor; sclerosing agent; somatostatin; terlipressin; vasoactive agent; vasopressin; antibiotic prophylaxis; Article; bacteremia; balloon occluded retrograde transvenous obliteration; balloon occlusion; coil embolization; endoscopic sclerotherapy; endoscopic therapy; endoscopic ultrasonography; endoscopic ultrasonography guided angiotherapy; endoscopy; esophagus varices; esophagus varices bleeding; hematemesis; hepatic encephalopathy; hepatorenal syndrome; human; hypersplenism; liver cirrhosis; liver parenchyma; liver transplantation; powder; priority journal; sedation; stomach varices; stomach varices bleeding; transjugular intrahepatic portosystemic shunt; vein ligation; hemostatic technique; procedures

Citation Information

Scopus Citations: 77

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