Endoscopic treatment of oesophageal varices.
Major variceal bleeding is a life-threatening complication of portal hypertension. Therapy for bleeding may be difficult and requires expertise and appropriate facilities. Endoscopic therapy using either injection sclerotherapy or band ligation after adequate resuscitation and diagnostic endoscopy is the preferred first-line treatment. Bleeding not controlled by initial endoscopic therapy requires balloon tamponade followed by repeat variceal ligation or sclerotherapy. Patients who continue to bleed after endoscopic therapy are best treated with percutaneous radiological transjugular intrahepatic portosystemic shunt stent (TIPSS) insertion. After variceal eradication, patients require lifelong surveillance endoscopy and re-obliteration of varices by endoscopic therapy if they recur. Beta-blockers to prevent recurrent bleeding are reserved for selected patients. Patients with severe liver decompensation have a poor prognosis and should be evaluated for liver transplantation. Prophylactic endoscopic therapy in patients who have never bled from varices is contraindicated as it is associated with increased morbidity and mortality.
Krige
J E
JE
Surgical Gastro-enterology, Department of Surgery and Medical Research Council Liver Research Centre, University of Cape Town and Groote Schuur Hospital.
Bornman
P C
PC
D000359:Aftercare / Q000379:methods; D000465:Algorithms; D021721:Balloon Occlusion; D002404:Catheterization / Q000379:methods; D003663:Decision Trees; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008026:Ligation / Q000379:methods; D016031:Liver Transplantation; D009017:Morbidity; D018579:Patient Selection; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D011379:Prognosis; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*