New Developments in Managing Variceal Bleeding

Gastroenterology
Mostafa IbrahimJacques Devière

Abstract

Liver cirrhosis is the end stage of chronic liver disease, independent of etiology, and is characterized by accumulation of fibrotic tissue and conversion of the normal liver parenchyma into abnormal regenerative nodules. Complications include portal hypertension (PH) with gastroesophageal varices, ascites, hepatorenal syndrome, hepatic encephalopathy, bacteremia, and hypersplenism. The most life-threatening complication of liver cirrhosis is acute variceal bleeding (AVB) which is associated with increased mortality that, despite recent progress in management, is still around 20% at 6 weeks. Combined treatment with vasoactive drugs, prophylactic antibiotics, and endoscopic techniques is the recommended standard of care for patients with acute variceal bleeding. There are many promising new modalities including the combination of coil and glue injection for management of bleeding or non-bleeding gastric varices and hemostatic powder application, that requires minimal expertise, when performed early after admission of a cirrhotic patient with AVB and overt hematemesis acting as a bridge therapy till definitive endoscopic therapy can be performed in hemodynamically stable conditions and without acute bleeding.

Citations

Nov 16, 2019·Medicina·Adrian GoldisTraian V Chirila
Feb 23, 2019·Expert Review of Gastroenterology & Hepatology·Hong ZhaoLanjuan Li
Aug 20, 2019·Journal of Clinical Pharmacy and Therapeutics·Qingbo MengHaohao Wang
Feb 28, 2020·Canadian Journal of Gastroenterology & Hepatology·Zi Wen WangJian Zhuang Ren
May 7, 2019·World Journal of Gastroenterology : WJG·Kenya KamimuraShuji Terai
Jan 31, 2019·World Journal of Gastrointestinal Pharmacology and Therapeutics·Umesha BoregowdaShreyas Saligram
Sep 7, 2020·Digestive Diseases and Sciences·C Roberto Simons-LinaresPrabhleen Chahal
Mar 23, 2021·World Journal of Clinical Cases·Jian-Bo WangBin Ye
Apr 20, 2021·Medical Journal, Armed Forces India·Aradhana AnejaRohit Kohli
Dec 11, 2021·Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology·Shivaram P SinghUNKNOWN Indian Society of Gastroenterology Task Force on Upper Gastrointestinal Bleeding

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