Acute Management of Refractory Variceal Bleeding in Liver Cirrhosis by Self-Expanding Metal Stents

Dechêne, Alexander; Fouly, Amr Hafez El; Bechmann, Lars P.; Jochum, Christoph; Saner, F; Gerken, Guido; Canbay, Ali

doi:10.1159/000335081

Cited by 66 publications

(64 citation statements)

References 36 publications

(29 reference statements)

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“…This solution originated through many years experience when managing perforations of the esophagus in advanced cancer which prevented mediastinitis. Once the haemorrhage had been stopped and the patient's general condition significantly improved, the stent was removed endoscopically no later than 10 days after the procedure [22,23,24]. Signs of tamponade of the bladder by blood clots was an indication for continuous flushing of the bladder with saline through a 3-way Foley catheter.…”

Section: Discussionmentioning

confidence: 99%

Acetaminophen (Paracetamol) induced acute liver failure – A social problem in an era of increasing tendency to self-treatment

Wróblewski¹,

Kobryń²,

Kozieł³

et al. 2015

Ann Agric Environ Med.

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Introduction.The widespread availability of medication without prescription, so-called over the counter (OTC), and the rapid development of health consciousness of Poles is associated with broad access to medical information in the mass media. This causes patients to recognize their own disease, cancel doctor's appointments, and begin self-treatment. This time and money-saving behavior, often signaled by pain, usually leads to the treatment of symptoms alone, without seeking the cause of the disease.The aim of the study was to present life-threatening paracetamol poisoning, and the treatment of acute liver failure. Material and Methods. In 2002-2014, 35 patients were hospitalized due to acute paracetamol poisoning: 17 female and 18 male patients aged between 17-59 (mean 32.3 years). Patients were treated in the surgical intensive care unit, where their parameters of liver and renal function were continuously monitored. If there was no improvement in the liver function, patients underwent albumin dialysis with the Prometheus system and were qualified for liver transplantation (LTx). Results. 26 patients were treated pharmacologically and 7 out of 9 patients who underwent LTx were dialyzed. Overall, 11 patients had 26 albumin dialysis in total; 4 patients died -1 post-transplant and 3 pre-transplant. Conclusions. Paracetamol is the cause of many poisonings resulting from the lack of public awareness about toxic interactions with alcohol, and suicide attempts. Acetaminophen-induced acute liver failure concerns a small percentage of patients but can be successfully treated with albumin dialysis, and in extreme cases by liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Acetaminophen (Paracetamol) induced acute liver failure – A social problem in an era of increasing tendency to self-treatment

Wróblewski¹,

Kobryń²,

Kozieł³

et al. 2015

Ann Agric Environ Med.

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“…Hasta el momento, este dispositivo cuenta con cuatro estudios realizados, el mayor de ellos con 34 pacientes y que ha demostrado resultados favorables en términos de control inmediato de la hemorragia, con un 77% a 100% de éxito y baja proporción de complicaciones, como técnica de salvación (9,10). En el caso especial de las várices gás-tricas, el balón de Linton-Nachlass todavía desempeña un papel importante (11).…”

Section: Discussionunclassified

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura

Rey

Solano

Sierra

et al. 2015

Rev. Colomb. Gastroenterol.

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ResumenLos inicios del manejo del sangrado variceal con compresión directa datan de 1930 por Westphal y colaboradores. Después, en 1950, se desarrolló el balón de Sengstaken-Blakemore, defi nido por Panes y colaboradores como la primera línea de terapia; en 1980, a nivel de várices esofágicas y en várices gástricas, se empleaba el balón de Linton-Nachlass (1, 2). Se presenta el caso clínico de un paciente con cirrosis hepática por hepatitis C, Child B, con várices esofágicas, a las cuales se les realizó ligadura en dos ocasiones por sangrado y en la segunda ocasión por inminencia de ruptura, esta última llevada a cabo dos semanas antes del evento. El paciente muestra un cuadro clínico compatible con hemorragia de vías digestivas altas masiva, con evidencia endoscópica de úlcera esofágica sangrante que no mejora con terlipresina, ni escleroterapia con adrenalina, ni compresión local con balón de acalasia. En consecuencia, como terapia de rescate se decide colocar un stent esofágico metálico autoexpandible parcialmente recubierto (por no contar con totalmente recubierto en el momento), con control parcial del sangrado. Es recomendable el uso del stent como terapia de rescate para el sangrado por várices esofágicas refractarias. Debe emplearse el diseñado especialmente para esta indicación (SX-Ella Danis), como un puente para poder estabilizar al paciente y realizar una terapia defi nitiva como la TIPS, tal cual como se procedió en un nuestro paciente. Palabras claveStent esofágico, hemorragia variceal refractaria, úlcera esofágica. AbstractEarly treatment of bleeding varices with direct compression dates from the work by Westphal et al. in 1930. Later in 1950, Sengstaken-Blakemore developed their balloon which Panes and collaborators defi ned as the fi rst line of therapy for esophageal varices in 1980 while they used the Linton-Nachlass balloon for gastric varices (1, 2).This study presents the clinical case of a patient with liver cirrhosis due to hepatitis C, (Child B) with esophageal varices which were ligated on two different occasions because of bleeding. On the second occasion a rupture was imminent and ligation occurred two weeks prior to the event. The patient presented a clinical picture compatible with massive upper gastrointestinal bleeding with endoscopic evidence of a bleeding esophageal ulcer that did not improve with terlipressin, sclerotherapy with adrenaline, or balloon dilatation. Consequently, it was to use a partially covered self-expanding metal esophageal stent for salvage therapy since a completely covered stent was not available at that time. Stenting achieved partial control of bleeding. We recommend the use of stenting with a stent specifi cally designed for this indication (SX-Ella Danis) as salvage therapy for refractory bleeding from esophageal varices. The stent can be used as a bridge to stabilize the patient in order to perform TIPS as the defi nitive treatment, as in the case of our patient.

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“…Sin embargo, al menos en el 10% de los casos no hay respuesta, por lo que se mantiene el sangrado activo a pesar de las medidas hemostáticas convencionales como lo pueden ser la ligadura con bandas y la inyección de soluciones esclerosantes utilizadas simultáneamente con vasodilatadores esplácnicos como la terlipresina, la somatostatina o el octreótido (4).…”

Section: Introductionunclassified

¿Son útiles las prótesis metálicas autoexpandibles en el control de hemorragia digestiva variceal refractaria?

Sánchez

2018

Rev. Colomb. Gastroenterol.

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El sangrado variceal es una urgencia médica con altas tasas de morbi-mortalidad. De los pacientes que llegan para manejo hospitalario hasta un 10% no responden a medidas hemostáticas convencionales por lo que se ha planteado el uso de prótesis metálicas autoexpandibles para el manejo de dichos pacientes con resultados prometedores.En el presente documento se discute la literatura mundial disponible acerca de la experiencia en el uso de dichos dispositivos, eficacia en el control agudo y el pronóstico a largo plazo, el tipo de prótesis utilizadas así como las alternativas, complicaciones y retos del manejo de pacientes con esta técnica que puede considerarse emergente en nuestro medio.

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Acute Management of Refractory Variceal Bleeding in Liver Cirrhosis by Self-Expanding Metal Stents

Cited by 66 publications

References 36 publications

Acetaminophen (Paracetamol) induced acute liver failure – A social problem in an era of increasing tendency to self-treatment

Acetaminophen (Paracetamol) induced acute liver failure – A social problem in an era of increasing tendency to self-treatment

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura

¿Son útiles las prótesis metálicas autoexpandibles en el control de hemorragia digestiva variceal refractaria?

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