[Endoscopic methods of treatment of variceal haemorrhages].
Haemorrhages from oesophagal varices are one of the most lifethreatening complications of the portal hypertension. Among various methods of treatment, endoscopic techniques are accepted and acknowledged as basic ones. The object of this paper is:--to present the variety of endoscopic procedures--to analyse the methodology and techniques of endoscopic procedures--to compare the effectiveness, safety and possible complications of different endoscopic techniques--to analyse the recommendations for treatment of acute variceal haemorrhages, primary and secondary prophylaxis. Endoscopic methods of haemostasis are essential in the treatment of acute variceal haemorrhages. Medical centres having at their disposal endoscopic methods of treating variceal haemorrhages can use the following techniques: EIS-endoscopic injection sklerotherapy--obliterating bleeding varices by injecting polidocanol or alcohol); rubber bands (EVL-Endoscopic Variceal Ligation); clipsing (closing varices with metal clipses). There are also different possibilities of combining methods mentionned above. In the primary prophylaxis of variceal haemorrhages, as the results of different studies are ambiguous, the endoscopic methods are used cautiously and for special indications only; pharmacological methods (non-selective b-blockers) have a leading role here. In the secondary prophylaxis of haemorrhages (in patients with history of previous variceal haemorrhages) endoscopic techniques have an acknowledged and leading role among other therapeutic methods. When comparing different endoscopic methods, crucial differences can be observed between their effectiveness, safety and technical possibilities of performing the procedures.
Wojskowy Instytut Medyczny w Warszawie, Klinika Gastroenterologii CSK MON.
Dariusz
D
Jaklewicz
Waldemar
W
Rózański
Stanisław
S
Wojtuń
Jerzy
J
Gil
D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004945:Esophagoscopy / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008026:Ligation; D012008:Recurrence; D012307:Risk Factors