Management of Refractory Variceal Bleed in Cirrhosis

Rodge, Gajanan Ashokrao; Goenka, Usha; Goenka, Mahesh Kumar

doi:10.1016/j.jceh.2021.08.030

Cited by 7 publications

(10 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The standard management for variceal bleeding includes red blood cell transfusion (without transfusion overload), prophylactic antibiotics, and oral nutrition. 38 In randomized controlled trials (RCTs), lactulose and rifaximin were shown to be effective for the treatment of HE. 39,40 Patients with suspected variceal bleeding must receive vasoactive drugs, such as terlipressin.…”

Section: Prevention and Treatment Of Bleeding As Precipitantmentioning

confidence: 99%

To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

Kimmann

Laleman

et al. 2023

Semin Liver Dis

View full text Add to dashboard Cite

Variceal bleeding is a consequence of severe portal hypertension in patients with liver cirrhosis. Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high-risk of treatment failure and short-term mortality. Treatment and/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic systemic shunts (TIPS), especially in the pre-emptive situation, have been found to efficiently control bleeding, prevent rebleeding and reduce short-term mortality. Therefore, TIPS placement should be considered as an option in the management of ACLF patients with variceal bleeding.

show abstract

Section: Prevention and Treatment Of Bleeding As Precipitantmentioning

confidence: 99%

To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

Kimmann

Laleman

et al. 2023

Semin Liver Dis

View full text Add to dashboard Cite

show abstract

“…According to Wang et al, BRTO was not more challenging to complete than TIPS [ 48 ]. In addition, Othita et al [ 49 ] reported that for all patients, splenectomy with gastric devascularization significantly increased overall survival (OS) compared to BRTO [ 3 ]. The two groups' rates of rebleeding occurrence were the same.…”

Section: Reviewmentioning

confidence: 99%

“…Gastrointestinal bleeding is often encountered in patients with cirrhosis, with an incidence of 85% in Child Class C versus 45% in Child Class A [ 2 ]. Patients in Child Class C also have up to 30% mortality risk compared to other classes [ 3 ]. Nearly half of the patients diagnosed with liver cirrhosis have already developed gastroesophageal varices, which can lead to variceal bleeding.…”

Section: Introductionmentioning

confidence: 99%

Use of Balloon Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: A Narrative Review

Khakwani¹,

Trivedi²,

Afzal³

et al. 2023

Cureus

View full text Add to dashboard Cite

Gastric Varices occur as a result of portal hypertension. Balloon Retrograde Transvenous Obliteration (BRTO) is a modality for managing gastric varices. The ultimate goal of this review is to promote the broader adoption of BRTO in managing gastric varices and to promote further research to improve patient outcomes. Before this study, an electronic literature search was undertaken based on identified concepts, keywords, and other pertinent descriptions. Search databases were developed and included “Gastric varices” AND “BRTO” OR “intervention” OR “treatment” OR “procedure” OR “glue” OR “adhesive”. The databases selected and thoroughly searched were PubMed, Cochrane Library and ScienceDirect. Following the first search, 274 articles were found in total. By applying inclusion criteria of full-text articles and a period of fewer than five years, the database was reduced to 37 articles, which was then further filtered to include only articles on adults over 19 years old, leaving a total count of 17 articles. BRTO is a relatively simple procedure to perform once the essential skill is attained and helpful in both emergency and elective management of gastric varices. Its use still needs to be improved by the unavailability and lack of skills. However, there are side effects associated with BRTO as it causes elevation of portal hypertension, recurrent bleeding, hemoglobinuria and pain post procedure. This review emphasizes the need for further research in this field, focusing on refining patient selection criteria, improving the technical aspect of the procedure and enhancing long-term outcomes.

show abstract

“…67,69,79 In about 10%-20% patients, AVB cannot be controlled or reoccurs despite adequate endoscopic interventions or timely vasoconstrictor therapy. 80,81 For patients in whom an early TIPS is not performed, intravenous vasoactive drugs should be continued for 2-5 days and NSBBs initiated once vasoactive drugs are discontinued. Rescue TIPS is indicated in these patients if hemorrhage cannot be controlled or if bleeding recurs despite vasoactive drugs.…”

Section: Gastroesophageal Varicesmentioning

confidence: 99%