Role of self-expanding metal stents in the management of variceal haemorrhage: Hype or hope?

World Journal of Gastrointestinal Endoscopy
Brian Hogan, James O'Beirne

Abstract

Despite the advances of medical, endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 years. Early transjugular intrahepatic portosystemic shunt has proved to be an effective therapy for selected groups of patients with a high risk of re-bleeding and moderate liver disease. However, there is an unmet need for a therapy that can be applied in patients with a high risk of re-bleeding and advanced liver disease either as definitive therapy or as a bridge to permanent therapy. Self-expanding metal stents can be placed without the need for endoscopic or fluoroscopic control and, once in place, will provide effective haemostasis and allow a route for oral fluids and nutrition. They can remain in place whilst liver function recovers and secondary prophylaxis is initiated. We review the results of 6 case series including a total of 83 patients and the first randomised controlled trial of self-expanding metal stents vs balloon tamponade (BT) in the management of refractory variceal haemorrhage. We report that self-expanding metal stents provide effective haemostasis and perform better than BT in refractory ble...Continue Reading

Citations

May 25, 2016·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Frank Weilert, Kenneth F Binmoeller
Jan 21, 2017·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Àngels EscorsellJaime Bosch
Aug 3, 2016·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Angels Escorsell, Jaime Bosch
Jan 26, 2018·Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology·M K GoenkaVijay Rai
Sep 28, 2017·Current Opinion in Critical Care·Alain D'HondtJean-Charles Preiser
Apr 10, 2019·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·S Manekeller, J C Kalff

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