Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding

Abstract

Gastroesophageal variceal hemorrhage is a medical emergency with high morbidity and mortality. Endoscopic therapy is the mainstay of management of bleeding varices. It requires attention to technique and the appropriate choice of therapy for a given patient at a given point in time. Subjects must be monitored continuously after initiation of therapy for control of bleeding and second line definitive therapies introduced quickly if endoscopic and pharmacologic treatment fails.

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

“…[18,19,50] The main goal of the initial approach of a patient with suspected variceal bleeding include severity assessment and identification of the hemorrhage source. [51] Active hemorrhagic varices are a challenge and the best strategy for management of post-banding ulcer bleeding remains undefined. Clinical management must be implemented before endoscopy for any variceal bleeding in cirrhotic patients, including post-banding ulcer bleeding.…”

“…Airway protection in the presence of significant hematemesis in patients who are unable to protect their airway is vital. [51] At the same time, adequate intravenous lines must be prepared for infusions of crystalloids and blood transfusions to maintain hemodynamic stability achieving hemoglobin concentration of approximately 7 to 8 g/dl. Transfusions of platelets and/or fresh frozen plasma must be performed for individuals with severe thrombocytopenia or coagulopathy.…”

“…Ideally, upper endoscopy must be accomplished as soon as the first measures have taken place and the patient is hemodynamically stabilized. [51] Ideally, it must be done within 12 hours. [25] When bleeding after EVL occurs due to variceal recurrence, new ligations should be accomplished at or around the hemorrhage source.…”

Endoscopic sclerotherapy of esophageal varices

“…Э ндоскопическое склерозирование варикозно расширенных вен пищевода (ВРВП) часто применяется для профилактики и лечения кровотечений при портальной гипертензии. К эндоскопическим методикам следует прибегать сразу после надлежащей реанимации и стабилизирования гемодинамики [1,2]. В рекомендациях Американской ассоциации по изучению заболеваний печени указано оптимальное время для выполнения эндоскопического гемостаза -в течение 12 часов при остром ВРВП [3].…”

“…Для результативной профилактики показаны повторные плановые сеансы склеротерапии через 1-3 недели до полной облитерации варикозно расширенных вен. Эффективность метода составляет 60-100% [1,4]. Вероятность возобновления кровотечения, по данным разных авторов, варьирует от 5-10 до 37-89% [1,5,6].…”