Current endoscopic therapy of variceal bleeding
| Autor: | Carlos Guarner, Càndid Villanueva, Carlos Aracil, Alan Colomo |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Portal venous pressure Adrenergic beta-Antagonists Lypressin Hemodynamics Esophageal and Gastric Varices Endoscopy Gastrointestinal Recurrence medicine Sclerotherapy Humans Antibiotic prophylaxis Ligation medicine.diagnostic_test business.industry Hemostasis Endoscopic Gastroenterology medicine.disease Surgery Endoscopy Portal hypertension Tissue Adhesives Isosorbide Portasystemic Shunt Transjugular Intrahepatic Somatostatin business Varices Terlipressin |
| Zdroj: | Best Practice & Research Clinical Gastroenterology. 22:261-278 |
| ISSN: | 1521-6918 |
| Popis: | Variceal ligation has proved more effective and safer than sclerotherapy and is currently the endoscopic treatment of choice for oesophageal varices. In acute bleeding, vasoactive drugs should be started before endoscopy and maintained for 2-5 days. The efficacy of drugs is improved when associated with emergency endoscopic therapy. Antibiotic prophylaxis should also be used. To prevent rebleeding, both endoscopic ligation and the combination of beta-blockers and nitrates may be used. Adding beta-blockers improves the efficacy of ligation. Haemodynamic responders to beta-blockers+/-nitrates (those with a decrease in portal pressure gradient HVPG to12 mmHg or by20% of baseline) have a marked reduction in the risk of haemorrhage and will not need further treatment. Beta-blockers significantly reduce the risk of a first haemorrhage in patients with large varices, and they improve survival. As compared to beta-blockers, endoscopic ligation reduces the risk of first bleeding without affecting mortality, and should be used in patients with contraindications or intolerance to beta-blockers. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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