Life-threatening hemorrhage of the digestive tract in cirrhotic patients

Prandi, D; Rueff, B; Roche-Sicot, J; Sicot, C; Maillard, J N; Benhamou, J P; Fauvert, R

doi:10.1016/0002-9610(76)90098-2

Cited by 49 publications

(13 citation statements)

References 15 publications

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“…Bleeding is often severe and, in about 25% of patients, may rapidly lead to exsanguination without specific intervention [2]. Those with Child class C cirrhosis and actively spurting varices are most likely to continue to bleed [3], and it is estimated that at least 50% of patients require an urgent life-saving intervention to arrest the hemorrhage.…”

Section: Natural Historymentioning

confidence: 99%

The use and misuse of transjugular intrahepatic portasystemic shunts

Sanyal

2000

Curr Gastroenterol Rep

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Transjugular intrahepatic portasystemic shunts, or TIPS, are used to create a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein by deployment of an expandable metal stent. TIPS function like side-to-side surgical portacaval shunts, but their placement does not require anesthesia and major surgery. This article reviews the uses and misuses of TIPS in current practice. The uses include variceal hemorrhage and ascites as well as miscellaneous indications such as Budd-Chiari syndrome, veno-occlusive disease, bleeding ectopic and rectal varices, hepatic hydrothorax, and portal hypertensive gastropathy. TIPS is not indicated for primary prophylaxis of variceal hemorrhage, prehepatic portal hypertension, correction of hypersplenism and thrombocytopenia, pulmonary hypertension and hepatopulmonary syndrome, and portal hypertension associated with polycystic liver disease or Caroli's disease. Also reviewed herein is the management of patients after TIPS placement.

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Section: Natural Historymentioning

confidence: 99%

The use and misuse of transjugular intrahepatic portasystemic shunts

Sanyal

2000

Curr Gastroenterol Rep

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“…Bleeding usually occurs at the GE junction as varices are most superficial and have the thinnest wall at this anatomic location. Approximately 50% of the acute variceal bleeding ceases spontaneously 8 . After an index bleeding episode, most of the episodes of rebleeding occurs in the first 6 weeks 9,10 , and over 50% of such rebleeding episodes occur within 3 to 4 days from the time of admission for the initial bleeding episode -9,11,12,13,14 .…”

mentioning

confidence: 99%

Nonendoscopic Management Strategies for Acute Esophagogastric Variceal Bleeding

Sanyal¹

2014

Gastroenterology Clinics of North America

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Acute variceal bleeding is a potentially life threatening complication of portal hypertension. Management consists of emergent hemostasis, therapy directed at hemodynamic resuscitation, protection of the airway, and prevention and treatment of complications including prophylactic use of antibiotics. Endoscopic treatment remains the mainstay in the management of acute variceal bleeding in combination with pharmacotherapy aimed at reducing portal pressure. Patients failing first-line therapy are triaged for non-endoscopic means of achieving hemostasis such as TIPS, BRTO or surgically created shunt procedures as rescue procedures, the choice depends on the source of bleeding (esophageal or gastric), size of the varices, portal vein patency, presence or absence of gastro-renal shunt, hepatic reserve and local expertise. The current chapter, intends to highlight only the current non endoscopic treatment approaches for control of acute variceal bleeding.

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“…Aspiration pneumo nia has a dire prognosis in patients who are actively bleeding or have recently bled [9,15], Patients with advanced cirrhosis may not be able to clear oropharyngeal secretions, espe cially following sedation, and are at high risk for aspiration. Careful attention to clearance of such secretions is mandatory during and after the procedure until sedation wears off.…”

Section: Intraoperative Medical Managementmentioning

confidence: 99%

“…Also, in some cases (bleeding fundic varices), sclerotherapy is not feasible. Although highly effective in arresting hemorrhage, surgery is associated with con siderable morbidity and mortality [4,6,9,15] due to the risks of general anesthesis and major surgery. TIPS also achieves portal de compression while avoiding the risks of anes thesia and surgery.…”

Section: Variceal Hemorrhagementioning

confidence: 99%

“…Such surgical porto systemic shunts are highly effective in correct ing portal hypertension and preventing vari ceal hemorrhage [4][5][6][7], Unfortunately, surgi cal portocaval shunts are associated with a sig nificant morbidity and mortality [8,9] due to the risks of general anesthesia and surgery. Indeed, when performed for primary pre vention of variceal hemorrhage, portocaval shunts actually decreased long-term survival [10].…”

Section: Introductionmentioning

confidence: 99%

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Transjugular Intrahepatic Portosystemic Shunt: A Medical Perspective

Sanyal¹,

Shiffman²

1995

Dig Dis

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The transjugular intrahepatic portosystemic shunt (TIPS) is an exciting new addition to the therapeutic armamentarium against portal hypertension. It is currently indicated for salvage of patients with active variceal hemorrhage despite sclerotherapy or where sclerotherapy is not feasible. Its use for recurrent episodes of bleeding despite chronic sclerotherapy and for ascites and hepatorenal syndrome remains experimental. It is contraindicated in patients with right-heart failure and portal vein thrombosis. TIPS is not indicated for primary prophylaxis of variceal hemorrhage or portal decompression prior to liver transplantation. TIPS is associated with its unique spectrum of complications which can occasionally be lifethreatening. Although initial experience with this procedure is encouraging, a great amount of work remains to be done to fully define its role in clinical practice.

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Life-threatening hemorrhage of the digestive tract in cirrhotic patients

Cited by 49 publications

References 15 publications

The use and misuse of transjugular intrahepatic portasystemic shunts

The use and misuse of transjugular intrahepatic portasystemic shunts

Nonendoscopic Management Strategies for Acute Esophagogastric Variceal Bleeding

Transjugular Intrahepatic Portosystemic Shunt: A Medical Perspective

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