Prophylaxis of first variceal bleeding.
Surgical, endoscopic and pharmacological treatment options are available for prophylaxis of first upper intestinal haemorrhage in cirrhotic patients. Randomized controlled trials have revealed that a prophylactic portocaval shunt operation should not be performed because its beneficial effect on the bleeding rate is outweighed by a slightly increased mortality. Prophylactic portal non-decompressive surgery (mainly gastro-oesophageal vascular disconnection) has been shown to reduce the bleeding rate and mortality in Japanese cirrhotic patients. However, further trials in different populations must confirm this positive effect. beta-blockers have fewer side-effects and are probably more effective for prophylaxis of the first bleed than sclerotherapy, but survival is only marginally influenced. Nadolol is preferable to propranolol. The effect of sclerotherapy is in part related to the technical experience of the physician. Although sclerotherapy has only minor effects on the bleeding rate, it is associated with a trend towards a prolonged survival. This may be caused by non-specific effects. On the basis of the published trials, only preliminary recommendations can be given. Prophylactic treatment may be useful in cirrhotic patients who are at high risk of bleeding. Life quality may be improved with continuous beta-blocker treatment. Some studies suggest that alcoholics with large varices may also profit from regular prophylactic sclerotherapy performed by experienced physicians.
Medical Department II, Klinikum Crosshadern, University of Munich, Germany.
G
G
Kleber
H
H
Ansari
T
T
Sauerbruch
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000401:mortality / Q000628:therapy; D004947:Esophagus / Q000098:blood supply; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000401:mortality / Q000628:therapy; D011167:Portacaval Shunt, Surgical; D012307:Risk Factors; D015911:Sclerotherapy; D015996:Survival Rate; D014680:Veins / Q000601:surgery
D000319:Adrenergic beta-Antagonists