An update on the management of acute esophageal variceal bleeding

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• 作者：Lourdes Cabrera ; Puneeta Tandon ; Juan G. Abraldes ; ^{juan.g.abraldes@ualberta.ca}
• 关键词：Acute variceal haemorrhage ; Treatment ; Vasoactive drugs ; Endoscopic ligation ; Early TIPS ; Baveno VI recommendations
• 刊名：Gastroenterología y Hepatología (English Edition)
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：40
• 期：1
• 页码：34-40
• 全文大小：315 K
• 卷排序：40

文摘

The mortality rate in acute variceal haemorrhage remains high (around 15%). Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and prophylactic antibiotics. Effective resuscitation (haemostasis, volume management) is essential to prevent complications. Treatment failure is best managed by transjugular intrahepatic portosystemic shunt (TIPS). Balloon tamponade or specifically designed covered oesophageal stents can be used as a bridge to definitive therapy in unstable patients. Early, pre-emptive TIPS should be the first choice in patients at high risk of treatment failure (Child-Pugh B with active bleeding or Child-Pugh C < 14). This article reviews the most recent advances in the management of variceal bleeding and discusses the recent recommendations of the Baveno VI consensus conference.