Endoscopic Management of Acute Variceal Bleeding

Robertson, Marcus; Hayes, Peter

doi:10.1002/9781118660799.ch5

Cited by 4 publications

(10 citation statements)

References 265 publications

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“…The presence of large varices has been demonstrated to be a major risk factor for the development of variceal hemorrhage; in patients with nearly identical portal hypertension, the likelihood of AVB is markedly increased in patients with large varices. In addition, certain high-risk variceal stigmata, collectively termed ''red signs'' (red wale markings, cherry red spots, nipple sign, hematocystic spots) have been associated with a significantly increased risk of AVB [2,5]. Patients with advanced liver disease (Child-Pugh score C) are also more likely to experience AVB.…”

Section: Risk-factors For Variceal Bleedingmentioning

confidence: 99%

“…A HVPG of 12 mmHg (normal HVPG \ 5 mmHg) is the baseline elevated pressure above which variceal bleeding may occur. Reducing the HVPG below 12 mmHg or by at least 20% from baseline is associated with significant protection against bleeding [2]. In practice, however, HVPG is rarely measured due to the invasiveness of the test.…”

Section: Risk-factors For Variceal Bleedingmentioning

confidence: 99%

“…Improvements in management along with an expansion in the therapeutic armamentarium have resulted in a significant improvement in the mortality rate associated with an episode of AVB, although this remains around 15-20% [1]. Thus, variceal bleeding continues to be a leading cause of death in patients with cirrhosis [2].…”

Section: Introductionmentioning

confidence: 99%

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Primary prophylaxis of variceal bleeding

Robertson

Hayes

2018

Hepatol Int

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Section: Risk-factors For Variceal Bleedingmentioning

confidence: 99%

Section: Risk-factors For Variceal Bleedingmentioning

confidence: 99%

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Primary prophylaxis of variceal bleeding

Robertson

Hayes

2018

Hepatol Int

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“…The most appropriate therapeutic modality may depend on the clinical condition of the patient, the cause of portal hypertension, and locally available expertise or facilities. Management may also include transfer to a tertiary referral centre for specialized therapy [7]. A proposed treatment algorithm is presented in Fig.…”

Section: Management Of Bleeding Anorectal Varicesmentioning

confidence: 99%

“…In portal hypertension, a combination of increased splanchnic blood flow and intrahepatic resistance to portal blood flow leads to a pathological increase in portal pressures, which results in the development of portosystemic collaterals, the most clinically significant of which are gastroesophageal varices [7]. The hepatic venous pressure gradient (HVPG) is a useful clinical measure of portal pressures and is defined as the gradient between the wedged hepatic venous pressure and the free hepatic venous pressure [8][9][10].…”

Section: Pathophysiology Aetiology and Prevalence Of Anorectal Varicesmentioning

confidence: 99%

The Management of Bleeding from Anorectal Varices

Robertson

Thompson

Hayes

2017

Curr Hepatology Rep

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Purpose of Review The purpose of this review is to summarize available strategies for the diagnosis and management of bleeding anorectal varices. Recent Findings Interventional radiological procedures, including TIPS, BRTO and/or embolization, have been established as efficacious treatments, particularly in the setting of treatment failure. Summary Anorectal varices are prevalent in patients with portal hypertension. Acute bleeding is uncommon, but can be massive and life-threatening. Anorectal varices should be considered as a differential diagnosis in any patient with cirrhosis or portal hypertension who presents with lower gastrointestinal bleeding. No evidence-based guidelines exist to guide the management of bleeding anorectal varices, which typically requires a multidisciplinary team of endoscopists, hepatologists, surgeons and interventional radiologists. Administration of prophylactic antibiotics and vasoactive therapy is recommended based on efficacy in bleeding oesophageal varices. Urgent endoscopy should be performed in all patients. Endoscopic sclerotherapy has the greatest body of evidence and should be considered the first-line therapy; efficacy and safety may be increased if this is performed with endoscopic ultrasound. Endoscopic banding or obturation are alternative first-line treatments; all methods offer a technically simple and efficacious method of achieving haemostasis, and local expertise will determine which procedure is employed.

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Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding

Robertson

Shawish

et al. 2019

Digestive Endoscopy

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Background and Aim Risk stratification is recommended in all patients with acute variceal bleeding (AVB). It remains unclear whether liver disease severity or upper gastrointestinal bleeding (UGIB) scoring algorithms offer superior predictive ability. We aimed to validate the AIMS65 score as a predictor of mortality in AVB, and to compare AIMS65 with established UGIB and liver disease severity risk stratification scores. Methods International Classification of Diseases, Tenth Revision codes identified patients presenting with AVB to three tertiary centers over a 48‐month period. Patients were risk‐stratified using AIMS65, Rockall, pre‐endoscopy Rockall, Child‐Pugh, Model for End‐stage Liver Disease (MELD) and United Kingdom MELD (UKELD) scores. Primary outcomes were inpatient and 6‐week mortality and inpatient rebleeding. Results Two hundred and twenty‐three patients were included. Inpatient and 6‐week mortality were 13.9% and 15.5% respectively. Prediction of inpatient mortality by AIMS65 (area under the receiver‐operating characteristic curve [AUROC: 0.84]) was equivalent to UGIB (Rockall: 0.79, pre‐Rockall: 0.78) and liver risk scores (MELD: 0.81, UKELD: 0.79, Child‐Pugh: 0.78). AIMS65 score ≥3 best defined high‐ and low‐risk groups for inpatient mortality (mortality 37.7% vs 4.9%). AIMS65 (AUROC: 0.62) was equivalent to UGIB risk scores (pre‐Rockall: 0.64, Rockall: 0.70) in predicting inpatient rebleeding and superior to liver risk scores (MELD: 0.56, UKELD: 0.57, Child‐Pugh: 0.60). Conclusions AIMS65 is equivalent to established UGIB and liver disease severity risk stratification scores in predicting mortality, and superior to liver scores in predicting rebleeding.

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Endoscopic Management of Acute Variceal Bleeding

Cited by 4 publications

References 265 publications

Primary prophylaxis of variceal bleeding

Primary prophylaxis of variceal bleeding

The Management of Bleeding from Anorectal Varices

Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding

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