Management of Upper Gastrointestinal Bleeding in the Patient With Chronic Liver Disease

Jutabha, Rome; Jensen, Dennis M.

doi:10.1016/s0025-7125(05)70479-x

Cited by 97 publications

(50 citation statements)

References 189 publications

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“…In this context, acute bleeding stemming directly from the tumor itself would be a less common event (2.9% to 4% of all cases), since these patients commonly present chronic blood loss [6]. Chemotherapy, nonsteroidal antiinflammatory drugs, and anticoagulants are potential agents that can contribute to erosive lesions and bleeding in cancer patients.…”

Section: Etiology Of Upper Gastrointestinal Bleeding In Patients Withmentioning

confidence: 99%

Upper Gastrointestinal Bleeding in Oncological Patients

Alberti

Santos

Àlex

et al. 2016

GHOA

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Bleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions. AbstractBleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. The objective of this article is to review the etiology, clinical manifestations, and treatment of acute upper gastrointestinal bleeding in cancer patients, understanding that chronic and occult blood losses are not within the scope of this text. To achieve better outcomes in the management of this entity, a multidisciplinary approach is mandatory. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions.

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Section: Etiology Of Upper Gastrointestinal Bleeding In Patients Withmentioning

confidence: 99%

Upper Gastrointestinal Bleeding in Oncological Patients

Alberti

Santos

Àlex

et al. 2016

GHOA

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“…The prevalence of esophageal varices in patients with cirrhosis ranges from 12% to 90% and the average risk of bleeding from 14% to 78%, depending on the patient population studied [11] . Esophageal varices are the most common cause of significant gastrointestinal bleeding secondary to portal hypertension [12] . The acute mortality of variceal hemorrhage has been reported to be 15%-50% and the overall mortality within 1-4 years as high as 70%-80% in those with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Cost saving by reloading the multiband ligator in endoscopic esophageal variceal ligation: A proposal for developing countries

Abbas

Rizvi²,

Ahmed³

et al. 2008

WJG

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AIM:To assess the cost savings of reloading the multiband ligator in endoscopic esophageal variceal ligation (EVL) used on the same patient for subsequent sessions. METHODS:This single centre retrospective descriptive study analysed patients undergoing variceal ligation at a tertiary care centre between 1st January, 2003 and 30th June, 2006. The multiband ligator was reloaded with six hemorrhoidal bands using hemorrhoidal ligator for the second and subsequent sessions. Analysis of cost saving was done for the number of follow-up sessions for the variceal eradication. RESULTS:A total of 261 patients underwent at least one session of endoscopic esophageal variceal ligation between January 2003 and June 2006. Out of 261, 108 patients (males 67) agreed to follow the eradication program and underwent repeated sessions. A total of 304 sessions was performed with 2.81 sessions per patient on average. Thirty-two patients could not complete the programme. In 76 patients (70%), variceal obliteration was achieved. The ratio of the costs for the session with reloaded ligator versus a session with a new ligator was 1:2.37. Among the patients who completed esophageal varices eradication, cost saving with reloaded ligator was 58%.CONCLUSION: EVL using reloaded multiband ligators for the follow-up sessions on patients undergoing variceal eradication is a cost saving procedure. Reloading the

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“…In contrast, others advocate removal of the overlying clot and treatment of underlying stigmata for patients with adherent clot in an ulcer base [1,23]. Two recently published randomized, controlled trials have shown that injection of epinephrine followed by removal of adherent clot and treatment of underlying stigmata significantly reduced the rate of recurrent ulcer bleeding when compared with leaving the clot undisturbed [24,25]. However later on meta-analysis found no clear evidence for need of specific endoscopic interventions in patients with an adherent clot [5].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic vs. Medical Therapy for Bleeding Peptic Ulcers with Adherent Clot: A Randomized Comparative Trial

Telwani¹,

Baba²,

Mujoo³

et al. 2017

J Hepatol Gastroint Dis

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Upper gastrointestinal bleeding is the most common and potentially life threatening emergency. Despite great advances in the field of medicine, the optimal management of bleeding peptic ulcer with adherent clot on endoscopy is still controversial. The aim of this study is to compare the combined endoscopic and medical therapy with medical therapy alone for bleeding peptic ulcer with adherent clot (Forrest type IIB). During two-year study period, around 342 patients presented to our Tertiary care hospital with acute upper gastrointestinal bleeding. Out of these, 81 patients were noted to have adherent clot (Forrest type IIB) during endoscopy and were included in study. 40 patients received combined endoscopic and medical treatment, whereas 41 patients received medical treatment only. The base line characteristics of patients in two groups were comparable and statistically significant. Primary Outcome being recurrence of bleeding within 7 days of treatment was less in combined therapy group compared to medical therapy group (2.5% vs. 17.1%) This was statistically significant. Secondary outcome like recurrence of bleed in 30 days and need for repeat endoscopy were less in combined group compared to medical therapy group. These were statistically significant as well. Other secondary outcomes like necessity for surgery and mortality were fewer in combined group, but these were not statistically significant. In conclusion combination endoscopic therapy consisting of epinephrine injection, removal of the adherent clot, and treatment of underlying stigmata is more effective than medical therapy alone.

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Management of Upper Gastrointestinal Bleeding in the Patient With Chronic Liver Disease

Cited by 97 publications

References 189 publications

Upper Gastrointestinal Bleeding in Oncological Patients

Upper Gastrointestinal Bleeding in Oncological Patients

Cost saving by reloading the multiband ligator in endoscopic esophageal variceal ligation: A proposal for developing countries

Endoscopic vs. Medical Therapy for Bleeding Peptic Ulcers with Adherent Clot: A Randomized Comparative Trial

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