A therapeutic shoot-out for esophageal varices: Head to head multi-randomized comparison of ?Singleshot? ligation versus the saeed six-shooter

Saeed, ZA; Aa, Khan; Alam, Altaf; Shafqat, Farzana; Butt, Arshad Kamal; Hassan, Wafaa A.

doi:10.1016/s0016-5107(96)80217-3

Cited by 4 publications

(1 citation statement)

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“…The Speedband ® (Microvasive) and the Six-shooters ® (Wilson-Cook) allow applications of five and six rubber bands, respectively. These multifire banding devices shorten the duration of each treatment session and reduce patient discomfort [28,29]. Although attractive because of a faster eradication rate and fewer complications, EVL is associated with a higher incidence of early variceal recurrences within 6-12 months after obliteration [17][18][19].…”

Section: Sclerotherapy Versus Variceal Ligation For Bleeding Esophagementioning

confidence: 99%

Update on Treatment of Variceal Hemorrhage

Sung²

2002

Dig Dis

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Variceal hemorrhage accounts for one third of all deaths related to cirrhosis. To date, many modalities of treating variceal bleeding have been devised, including pharmacological therapy. Treatment of variceal hemorrhage includes resuscitation, initial hemostasis, and prevention of complications and recurrent bleeding. Intravenous vasoactive agents such as terlipressin, somatostatin, octreotide, or vapreotide should be administered in patients with suspected variceal bleeding. Endoscopic treatment remains the mainstay of treatment. Endoscopic variceal ligation is safer and more efficacious than sclerotherapy as initial treatment of bleeding esophageal varices, whereas cyanoacrylate injection is the endoscopic treatment of choice for gastric varices. An adjuvant vasoactive agent is useful for the prevention of early rebleeding. Prophylactic antibiotics are increasingly used for prevention of infection, notably spontaneous bacterial peritonitis. Follow-up endoscopic treatment is necessary in order to obliterate residual varices. The combination of a beta blocker and nitrate is an essential component of secondary prophylaxis for recurrent variceal bleeding. Transjugular intrahepatic portosystemic shunt or surgery offers the best salvage therapy in patients with failed hemostasis or breakthrough recurrent bleeding despite medical and endoscopic therapy. Endoscopic ultrasonography is useful in the prediction of recurrence of varices and facilitates visualization and guidance of further treatment of gastric varices. Despite advances in the treatment of variceal bleeding, liver function remains the determining factor of patient survival. Liver transplantation is the only definitive treatment that can alter the course of the disease.

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