Variceal Bleeding: Update of Recommendations From the Brazilian Association of Hepatology

Abstract

-Since the publication of the Brazilian Association of Hepatology recommendations for the prevention and treatment of variceal bleeding in 2010, new evidence-based data were reported in the literature. This has changed our current management for portal hypertension. This review updates the previous recommendations. It takes the new prognostic staging of cirrhosis into account allowing tailored treatment for advanced fibrosis, compensated or decompensated cirrhosis. An organizing panel of five experts reviewed all recommendations according to available data, which were subsequently scrutinized by all members of the Brazilian Association of Hepatology using a web-based approach. The accepted recommendations are presented in this manuscript.

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

“…In this document, the role of endoscopic and endovascular inter ventions for primary and secondary prophylaxis of PH related bleeding, as well as for the management of acute bleeding will be addressed. Details about clinical approach of patients with PH regarding noninvasive therapies are outside the scope of this docu ment and were previously addressed in the paper Variceal Bleeding: Update of Recommendations from the Brazilian Association of Hepatology (33) .…”

“…Primary prophylaxis is recommended for all patients with medium or largesize esophageal varices, and also for those with small varices with red signs or CP C (33) . Both endoscopic therapies and pharmacologic approaches with traditional nonselective beta blockers (NSBB) such as propranolol or nadolol, or carvedilol can be used in this setting.…”

“…Sclerotherapy, on the other hand, failed to demonstrate ef ficacy for primary prophylaxis and is currently not recommended in this setting (33,3739) .…”

“…Here we will discuss invasive procedures used for controlling acute bleeding. Details about general measures and pharmacologic therapy in this setting can be found at the paper variceal bleeding: update of recommendations from the Brazilian Association of Hepatology (33) .…”

“…Patients who recover from the first episode of variceal bleeding have a high rebleeding risk and, therefore, should be considered candidates for secondary prophylaxis (33,41) . For patients treated with TIPS in AVB, no specific therapies for portal hypertension or varices are recommended at this time.…”