[Treatment of digestive hemorrhages caused by rupture of esophagogastric varices in liver cirrhosis].
Bleeding from oesophageal and gastric varices is one of the most dramatic and important complications of cirrhosis. Non surgical options are favoured as first line treatment because the operative mortality in cirrhotic patients is high. These options include vasoactive drugs (terlipressin or somatostatin) and endoscopic treatment or a combination of these two treatments. Vasoactive drugs could be given before endoscopic treatment and perhaps even earlier during transfer to hospital to permit a therapeutic measure to be given at initial diagnostic endoscopy when bleeding is controlled and the patient stable. Balloon tamponade should be used only in patients with uncontrolled bleeding. Surgical portacaval shunt or transjugular intrahepatic portosystemic stent shunts is used as a second line treatment when all else has failed to control bleeding and because of an increased mortality risk surgery should never be too much delayed.
Naveau
S
S
Service d'hépato-gastro-entérologie, Hôpital Antoine-Béclère, Clamart.
Franco
D
D
D004932:Esophageal and Gastric Varices / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D012422:Rupture, Spontaneous
Traitement des hémorragies digestives par rupture de varices oeso-gastriques au cours de la cirrhose.