Current endoscopic therapy of variceal bleeding.
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 to <12 mmHg or by >20% 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.
Villanueva
Càndid
C
Servei de Patologia Digestiva, Hospital de la Santa Creu i Sant Pau, Avgda Sant Antoni M. Claret, 167, 08025 Barcelona, Spain. cvillanueva@santpau.es
Colomo
Alan
A
Aracil
Carlos
C
Guarner
Carlos
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007547:Isosorbide / Q000627:therapeutic use; D008026:Ligation; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012008:Recurrence; D013004:Somatostatin / Q000627:therapeutic use; D000077585:Terlipressin; D014014:Tissue Adhesives / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D014014:Tissue Adhesives; D008236:Lypressin; D013004:Somatostatin; D000077585:Terlipressin; D007547:Isosorbide