Update on management of gastric varices
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摘要
Gastric varices(GV) have different physiology and clinical characteristics compared to oesophageal varices(OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies' recommendations are based are scrutinised in this review and areas of research are identified.
Gastric varices(GV) have different physiology and clinical characteristics compared to oesophageal varices(OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies' recommendations are based are scrutinised in this review and areas of research are identified.
Gastric varices(GV) have different physiology and clinical characteristics compared to oesophageal varices(OV). There is little information about the management of GV. Most part of the recommendations is extrapolated from studies where the majority of participants had OV. Thus, most recommendations lack of strong evidence. This is a comprehensive review on all aspects of management of GV, i.e., primary, secondary prophylaxis and management of acute bleeding. The papers on which international societies' recommendations are based are scrutinised in this review and areas of research are identified.
引文
1 Sarin SK,Lahoti D,Saxena SP,Murthy NS,Makwana UK.Prevalence,classification and natural history of gastric varices:a long-term follow-up study in 568 portal hypertension patients.Hepatology 1992;16:1343-1349[PMID:1446890 DOI:10.1002/hep.1840160607]
2 Teng W,Chen WT,Ho YP,Jeng WJ,Huang CH,Chen YC,Lin SM,Chiu CT,Lin CY,Sheen IS.Predictors of mortality within 6 weeks after treatment of gastric variceal bleeding in cirrhotic patients.Medicine(Baltimore)2014;93:e321[PMID:25546678 DOI:10.1097/MD.0000000000000321]
3 Kim T,Shijo H,Kokawa H,Tokumitsu H,Kubara K,Ota K,Akiyoshi N,Iida T,Yokoyama M,Okumura M.Risk factors for hemorrhage from gastric fundal varices.Hepatology 1997;25:307-312[PMID:9021939 DOI:10.1053/jhep.1997.v25.pm0009021939]
4 Lee CH,Lee JH,Choi YS,Paik SW,Sinn DH,Lee CY,Koh KC,Gwak GY,Choi MS,Yoo BC.Natural history of gastric varices and risk factors for bleeding.Korean J Hepatol 2008;14:331-341[PMID:18815456 DOI:10.3350/kjhep.2008.14.3.331]
5 Sarin SK,Jain AK,Lamba GS,Gupta R,Chowdhary A.Isolated gastric varices:prevalence,clinical relevance and natural history.Dig Surg 2003;20:42-47[PMID:12637804 DOI:10.1159/000068865]
6 Verma N,Kumari S,Kumari P,De A,Singh V.New classification of gastric varices:a twenty-year experience.J Hepatol 2017;66:S543-S750[DOI:10.1016/S0168-8278(17)31540-4]
7 Madsen MS,Petersen TH,Sommer H.Segmental portal hypertension.Ann Surg 1986;204:72-77[PMID:3729585]
8 Komori K,Kubokawa M,Ihara E,Akahoshi K,Nakamura K,Motomura K,Masumoto A.Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding.World J Gastroenterol2017;23:496-504[PMID:28210086 DOI:10.3748/wjg.v23.i3.496]
9 Triantafyllou M,Stanley AJ.Update on gastric varices.World J Gastrointest Endosc 2014;6:168-175[PMID:24891929 DOI:10.4253/wjge.v6.i5.168]
10 de Franchis R;Baveno VI Faculty.Expanding consensus in portal hypertension:Report of the Baveno VIConsensus Workshop:Stratifying risk and individualizing care for portal hypertension.J Hepatol 2015;63:743-752[PMID:26047908 DOI:10.1016/j.jhep.2015.05.022]
11 Mishra SR,Sharma BC,Kumar A,Sarin SK.Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers:a randomized controlled trial.J Hepatol 2011;54:1161-1167[PMID:21145834 DOI:10.1016/j.jhep.2010.09.031]
12 Tripathi D.Primary prophylaxis against gastric variceal bleeding:is there a sticky solution at last?Hepatology 2011;54:1094-1096[PMID:22179988 DOI:10.1002/hep.24499]
13 Garcia-Tsao G,Abraldes JG,Berzigotti A,Bosch J.Portal hypertensive bleeding in cirrhosis:Risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases.Hepatology 2017;65:310-335[PMID:27786365 DOI:10.1002/hep.28906]
14 Tripathi D,Stanley AJ,Hayes PC,Patch D,Millson C,Mehrzad H,Austin A,Ferguson JW,Olliff SP,Hudson M,Christie JM;Clinical Services and Standards Committee of the British Society of Gastroenterology.U.K.guidelines on the management of variceal haemorrhage in cirrhotic patients.Gut2015;64:1680-1704[PMID:25887380 DOI:10.1136/gutjnl-2015-309262]
15 Mishra SR,Chander Sharma B,Kumar A,Sarin SK.Endoscopic cyanoacrylate injection versus betablocker for secondary prophylaxis of gastric variceal bleed:a randomised controlled trial.Gut 2010;59:729-735[PMID:20551457 DOI:10.1136/gut.2009.192039]
16 Hung HH,Chang CJ,Hou MC,Liao WC,Chan CC,Huang HC,Lin HC,Lee FY,Lee SD.Efficacy of non-selectiveβ-blockers as adjunct to endoscopic prophylactic treatment for gastric variceal bleeding:a randomized controlled trial.J Hepatol 2012;56:1025-1032[PMID:22266602 DOI:10.1016/j.jhep.2011.12.021]
17 Tripathi D,Therapondos G,Jackson E,Redhead DN,Hayes PC.The role of the transjugular intrahepatic portosystemic stent shunt(TIPSS)in the management of bleeding gastric varices:clinical and haemodynamic correlations.Gut 2002;51:270-274[PMID:12117893 DOI:10.1136/gut.51.2.270]
18 Lo GH,Liang HL,Chen WC,Chen MH,Lai KH,Hsu PI,Lin CK,Chan HH,Pan HB.A prospective,randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding.Endoscopy 2007;39:679-685[PMID:17661241 DOI:10.1055/s-2007-966591]
19 Villanueva C,Colomo A,Bosch A.Transfusion for acute upper gastrointestinal bleeding.N Engl J Med2013;368:1362-1363[PMID:23550677 DOI:10.1056/NEJMoa1211801]
20 Rimola A,Bory F,Teres J,Perez-Ayuso RM,Arroyo V,Rodes J.Oral,nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage.Hepatology 1985;5:463-467[PMID:3873389]
21 Fernández J,Acevedo J.New antibiotic strategies in patients with cirrhosis and bacterial infection.Expert Rev Gastroenterol Hepatol 2015;9:1495-1500[PMID:26465070 DOI:10.1586/17474124.2015.1100075]
22 Hou MC,Lin HC,Liu TT,Kuo BI,Lee FY,Chang FY,Lee SD.Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage:a randomized trial.Hepatology 2004;39:746-753[PMID:14999693 DOI:10.1002/hep.20126]
23 Chavez-Tapia NC,Barrientos-Gutierrez T,Tellez-Avila FI,Soares-Weiser K,Uribe M.Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding.Cochrane Database Syst Rev 2010;CD002907[PMID:20824832 DOI:10.1002/14651858.CD002907.pub2]
24 Sanchez-Jimenez B,Chavez-Tapia NC,Jakobsen JC.Cochrane Database of Systematic Reviews.Antibiotic prophylaxis versus placebo or no intervention for people with cirrhosis and variceal bleeding Cochrane Systematic Review.[Accessed 08 November 2018]Intervention.Protocol Version[DOI:10.1002/14651858.CD013214]
25 Wells M,Chande N,Adams P,Beaton M,Levstik M,Boyce E,Mrkobrada M.Meta-analysis:vasoactive medications for the management of acute variceal bleeds.Aliment Pharmacol Ther 2012;35:1267-1278[PMID:22486630 DOI:10.1111/j.1365-2036.2012.05088.x]
26 Zhou X,Tripathi D,Song T,Shao L,Han B,Zhu J,Han D,Liu F,Qi X.Terlipressin for the treatment of acute variceal bleeding:A systematic review and meta-analysis of randomized controlled trials.Medicine(Baltimore)2018;97:e13437[PMID:30508958 DOI:10.1097/MD.0000000000013437]
27 Ioannou G,Doust J,Rockey DC.Terlipressin for acute esophageal variceal hemorrhage.Cochrane Database Syst Rev 2003;CD002147[PMID:12535432 DOI:10.1002/14651858.CD002147]
28 Trudeau W,Prindiville T.Endoscopic injection sclerosis in bleeding gastric varices.Gastrointest Endosc1986;32:264-268[PMID:3488937]
29 Hwang JH,Shergill AK,Acosta RD,Chandrasekhara V,Chathadi KV,Decker GA,Early DS,Evans JA,Fanelli RD,Fisher DA,Foley KQ,Fonkalsrud L,Jue T,Khashab MA,Lightdale JR,Muthusamy VR,Pasha SF,Saltzman JR,Sharaf R,Cash BD;American Society for Gastrointestinal Endoscopy.The role of endoscopy in the management of variceal hemorrhage.Gastrointest Endosc 2014;80:221-227[PMID:25034836 DOI:10.1016/j.gie.2013.07.023]
30 Shiha G,El-Sayed SS.Gastric variceal ligation:a new technique.Gastrointest Endosc 1999;49:437-441[PMID:10202055]
31 Lee TH,Shih LN.Clinical experience of endoscopic banding ligation for bleeding gastric varices.Hepatogastroenterology 2008;55:766-769[PMID:18613450]
32 Tan PC,Hou MC,Lin HC,Liu TT,Lee FY,Chang FY,Lee SD.A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage:N-butyl-2-cyanoacrylate injection versus band ligation.Hepatology 2006;43:690-697[PMID:16557539 DOI:10.1002/hep.21145]
33 Qiao W,Ren Y,Bai Y,Liu S,Zhang Q,Zhi F.Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding:Meta-Analysis of Randomized,Controlled Studies Based on the PRISMA Statement.Medicine(Baltimore)2015;94:e1725[PMID:26469912 DOI:10.1097/MD.0000000000001725]
34 ASGE Technology Committee.Bhat YM,Banerjee S,Barth BA,Chauhan SS,Gottlieb KT,Konda V,Maple JT,Murad FM,Pfau PR,Pleskow DK,Siddiqui UD,Tokar JL,Wang A,Rodriguez SA.Tissue adhesives:cyanoacrylate glue and fibrin sealant.Gastrointest Endosc 2013;78:209-215[PMID:23867370 DOI:10.1016/j.gie.2013.04.166]
35 Franco MC,Gomes GF,Nakao FS,de Paulo GA,Ferrari AP,Libera ED.Efficacy and safety of endoscopic prophylactic treatment with undiluted cyanoacrylate for gastric varices.World J Gastrointest Endosc 2014;6:254-259[PMID:24932378 DOI:10.4253/wjge.v6.i6.254]
36 Kang EJ,Jeong SW,Jang JY,Cho JY,Lee SH,Kim HG,Kim SG,Kim YS,Cheon YK,Cho YD,Kim HS,Kim BS.Long-term result of endoscopic Histoacryl(N-butyl-2-cyanoacrylate)injection for treatment of gastric varices.World J Gastroenterol 2011;17:1494-1500[PMID:21472110 DOI:10.3748/wjg.v17.i11.1494]
37 McAvoy NC,Plevris JN,Hayes PC.Human thrombin for the treatment of gastric and ectopic varices.World J Gastroenterol 2012;18:5912-5917[PMID:23139607 DOI:10.3748/wjg.v18.i41.5912]
38 Ramesh J,Limdi JK,Sharma V,Makin AJ.The use of thrombin injections in the management of bleeding gastric varices:a single-center experience.Gastrointest Endosc 2008;68:877-882[PMID:18534583 DOI:10.1016/j.gie.2008.02.065]
39 Jhajharia A,Wanjari SJ,Ashdhir P,Pokharna R,Nijhawan S.Role and safety of human thrombin injection for the treatment of bleeding gastric varices.Indian J Gastroenterol 2018;37:321-325[PMID:30196518 DOI:10.1007/s12664-018-0877-2]
40 Ibrahim M,El-Mikkawy A,Abdalla H,Mostafa I,Devière J.Management of acute variceal bleeding using hemostatic powder.United European Gastroenterol J 2015;3:277-283[PMID:26137303 DOI:10.1177/2050640615570148]
41 Ibrahim M,El-Mikkawy A,Abdel Hamid M,Abdalla H,Lemmers A,Mostafa I,Devière J.Early application of haemostatic powder added to standard management for oesophagogastric variceal bleeding:a randomised trial.Gut 2018[PMID:29730601 DOI:10.1136/gutjnl-2017-314653]
42 Holster IL,Poley JW,Kuipers EJ,Tjwa ET.Controlling gastric variceal bleeding with endoscopically applied hemostatic powder(Hemospray?).J Hepatol 2012;57:1397-1398[PMID:22864337 DOI:10.1016/j.jhep.2012.07.024]
43 Carbonell N,Pauwels A,Serfaty L,Fourdan O,Lévy VG,Poupon R.Improved survival after variceal bleeding in patients with cirrhosis over the past two decades.Hepatology 2004;40:652-659[PMID:15349904 DOI:10.1002/hep.20339]
44 Sarin SK,Nundy S.Balloon tamponade in the management of bleeding oesophageal varices.Ann R Coll Surg Engl 1984;66:30-32[PMID:6607022]
45 Panés J,Terés J,Bosch J,Rodés J.Efficacy of balloon tamponade in treatment of bleeding gastric and esophageal varices.Results in 151 consecutive episodes.Dig Dis Sci 1988;33:454-459[PMID:3280273]
46 Cook D,Laine L.Indications,technique,and complications of balloon tamponade for variceal gastrointestinal bleeding.J Intensive Care Med 1992;7:212-218[PMID:10147943 DOI:10.1177/088506669200700408]
47 Chau TN,Patch D,Chan YW,Nagral A,Dick R,Burroughs AK."Salvage"transjugular intrahepatic portosystemic shunts:gastric fundal compared with esophageal variceal bleeding.Gastroenterology 1998;114:981-987[PMID:9558287]
48 García-Pagán JC,Caca K,Bureau C,Laleman W,Appenrodt B,Luca A,Abraldes JG,Nevens F,Vinel JP,M?ssner J,Bosch J;Early TIPS(Transjugular Intrahepatic Portosystemic Shunt)Cooperative Study Group.Early use of TIPS in patients with cirrhosis and variceal bleeding.N Engl J Med 2010;362:2370-2379[PMID:20573925 DOI:10.1056/NEJMoa0910102]
49 Procaccini NJ,Al-Osaimi AM,Northup P,Argo C,Caldwell SH.Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding:a single-center U.S.analysis.Gastrointest Endosc 2009;70:881-887[PMID:19559425 DOI:10.1016/j.gie.2009.03.1169]
50 Kochhar GS,Navaneethan U,Hartman J,Mari Parungao J,Lopez R,Gupta R,Kapoor B,Mehta P,Sanaka M.Comparative study of endoscopy vs.transjugular intrahepatic portosystemic shunt in the management of gastric variceal bleeding.Gastroenterol Rep(Oxf)2015;3:75-82[PMID:25673803 DOI:10.1093/gastro/gou095]
51 Choi YH,Yoon CJ,Park JH,Chung JW,Kwon JW,Choi GM.Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding:its feasibility compared with transjugular intrahepatic portosystemic shunt.Korean J Radiol 2003;4:109-116[PMID:12845306 DOI:10.3348/kjr.2003.4.2.109]
52 Katoh K,Sone M,Hirose A,Inoue Y,Fujino Y,Onodera M.Balloon-occluded retrograde transvenous obliteration for gastric varices:the relationship between the clinical outcome and gastrorenal shunt occlusion.BMC Med Imaging 2010;10:2[PMID:20074342 DOI:10.1186/1471-2342-10-2]
53 Jang SY,Kim GH,Park SY,Cho CM,Tak WY,Kim JH,Choe WH,Kwon SY,Lee JM,Kim SG,Kim DY,Kim YS,Lee SO,Min YW,Lee JH,Paik SW,Yoo BC,Lim JW,Kim HJ,Cho YK,Sohn JH,Jeong JY,Lee YH,Kim TY,Kweon YO.Clinical outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage in Korean patients with liver cirrhosis:a retrospective multicenter study.Clin Mol Hepatol 2012;18:368-374[PMID:23323252 DOI:10.3350/cmh.2012.18.4.368]
54 Kim SK,Lee KA,Sauk S,Korenblat K.Comparison of Transjugular Intrahepatic Portosystemic Shunt with Covered Stent and Balloon-Occluded Retrograde Transvenous Obliteration in Managing Isolated Gastric Varices.Korean J Radiol 2017;18:345-354[PMID:28246514 DOI:10.3348/kjr.2017.18.2.345]
55 Lee SJ,Kim SU,Kim MD,Kim YH,Kim GM,Park SI,Won JY,Lee DY,Lee KH.Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis.J Gastroenterol Hepatol 2017;32:1487-1494[PMID:28085232 DOI:10.1111/jgh.13729]
56 Hamdeh S,Altayar O,Aziz M.Balloon-Occluded Retrograde Transvenous Obliteration(BRTO)versus Transjugular Intrahepatic Portosystemic Shunt(TIPS)in the management of gastric variceal bleeding:Asystematic review and meta-analysis.Hepatology 2018;68S475A
57 Orozco H,Mercado MA.The evolution of portal hypertension surgery:lessons from 1000 operations and 50 Years'experience.Arch Surg 2000;135:1389-93;discussion 1394[PMID:11115336 DOI:10.1001/archsurg.135.12.1389]
2 Teng W,Chen WT,Ho YP,Jeng WJ,Huang CH,Chen YC,Lin SM,Chiu CT,Lin CY,Sheen IS.Predictors of mortality within 6 weeks after treatment of gastric variceal bleeding in cirrhotic patients.Medicine(Baltimore)2014;93:e321[PMID:25546678 DOI:10.1097/MD.0000000000000321]
3 Kim T,Shijo H,Kokawa H,Tokumitsu H,Kubara K,Ota K,Akiyoshi N,Iida T,Yokoyama M,Okumura M.Risk factors for hemorrhage from gastric fundal varices.Hepatology 1997;25:307-312[PMID:9021939 DOI:10.1053/jhep.1997.v25.pm0009021939]
4 Lee CH,Lee JH,Choi YS,Paik SW,Sinn DH,Lee CY,Koh KC,Gwak GY,Choi MS,Yoo BC.Natural history of gastric varices and risk factors for bleeding.Korean J Hepatol 2008;14:331-341[PMID:18815456 DOI:10.3350/kjhep.2008.14.3.331]
5 Sarin SK,Jain AK,Lamba GS,Gupta R,Chowdhary A.Isolated gastric varices:prevalence,clinical relevance and natural history.Dig Surg 2003;20:42-47[PMID:12637804 DOI:10.1159/000068865]
6 Verma N,Kumari S,Kumari P,De A,Singh V.New classification of gastric varices:a twenty-year experience.J Hepatol 2017;66:S543-S750[DOI:10.1016/S0168-8278(17)31540-4]
7 Madsen MS,Petersen TH,Sommer H.Segmental portal hypertension.Ann Surg 1986;204:72-77[PMID:3729585]
8 Komori K,Kubokawa M,Ihara E,Akahoshi K,Nakamura K,Motomura K,Masumoto A.Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding.World J Gastroenterol2017;23:496-504[PMID:28210086 DOI:10.3748/wjg.v23.i3.496]
9 Triantafyllou M,Stanley AJ.Update on gastric varices.World J Gastrointest Endosc 2014;6:168-175[PMID:24891929 DOI:10.4253/wjge.v6.i5.168]
10 de Franchis R;Baveno VI Faculty.Expanding consensus in portal hypertension:Report of the Baveno VIConsensus Workshop:Stratifying risk and individualizing care for portal hypertension.J Hepatol 2015;63:743-752[PMID:26047908 DOI:10.1016/j.jhep.2015.05.022]
11 Mishra SR,Sharma BC,Kumar A,Sarin SK.Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers:a randomized controlled trial.J Hepatol 2011;54:1161-1167[PMID:21145834 DOI:10.1016/j.jhep.2010.09.031]
12 Tripathi D.Primary prophylaxis against gastric variceal bleeding:is there a sticky solution at last?Hepatology 2011;54:1094-1096[PMID:22179988 DOI:10.1002/hep.24499]
13 Garcia-Tsao G,Abraldes JG,Berzigotti A,Bosch J.Portal hypertensive bleeding in cirrhosis:Risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases.Hepatology 2017;65:310-335[PMID:27786365 DOI:10.1002/hep.28906]
14 Tripathi D,Stanley AJ,Hayes PC,Patch D,Millson C,Mehrzad H,Austin A,Ferguson JW,Olliff SP,Hudson M,Christie JM;Clinical Services and Standards Committee of the British Society of Gastroenterology.U.K.guidelines on the management of variceal haemorrhage in cirrhotic patients.Gut2015;64:1680-1704[PMID:25887380 DOI:10.1136/gutjnl-2015-309262]
15 Mishra SR,Chander Sharma B,Kumar A,Sarin SK.Endoscopic cyanoacrylate injection versus betablocker for secondary prophylaxis of gastric variceal bleed:a randomised controlled trial.Gut 2010;59:729-735[PMID:20551457 DOI:10.1136/gut.2009.192039]
16 Hung HH,Chang CJ,Hou MC,Liao WC,Chan CC,Huang HC,Lin HC,Lee FY,Lee SD.Efficacy of non-selectiveβ-blockers as adjunct to endoscopic prophylactic treatment for gastric variceal bleeding:a randomized controlled trial.J Hepatol 2012;56:1025-1032[PMID:22266602 DOI:10.1016/j.jhep.2011.12.021]
17 Tripathi D,Therapondos G,Jackson E,Redhead DN,Hayes PC.The role of the transjugular intrahepatic portosystemic stent shunt(TIPSS)in the management of bleeding gastric varices:clinical and haemodynamic correlations.Gut 2002;51:270-274[PMID:12117893 DOI:10.1136/gut.51.2.270]
18 Lo GH,Liang HL,Chen WC,Chen MH,Lai KH,Hsu PI,Lin CK,Chan HH,Pan HB.A prospective,randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding.Endoscopy 2007;39:679-685[PMID:17661241 DOI:10.1055/s-2007-966591]
19 Villanueva C,Colomo A,Bosch A.Transfusion for acute upper gastrointestinal bleeding.N Engl J Med2013;368:1362-1363[PMID:23550677 DOI:10.1056/NEJMoa1211801]
20 Rimola A,Bory F,Teres J,Perez-Ayuso RM,Arroyo V,Rodes J.Oral,nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage.Hepatology 1985;5:463-467[PMID:3873389]
21 Fernández J,Acevedo J.New antibiotic strategies in patients with cirrhosis and bacterial infection.Expert Rev Gastroenterol Hepatol 2015;9:1495-1500[PMID:26465070 DOI:10.1586/17474124.2015.1100075]
22 Hou MC,Lin HC,Liu TT,Kuo BI,Lee FY,Chang FY,Lee SD.Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage:a randomized trial.Hepatology 2004;39:746-753[PMID:14999693 DOI:10.1002/hep.20126]
23 Chavez-Tapia NC,Barrientos-Gutierrez T,Tellez-Avila FI,Soares-Weiser K,Uribe M.Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding.Cochrane Database Syst Rev 2010;CD002907[PMID:20824832 DOI:10.1002/14651858.CD002907.pub2]
24 Sanchez-Jimenez B,Chavez-Tapia NC,Jakobsen JC.Cochrane Database of Systematic Reviews.Antibiotic prophylaxis versus placebo or no intervention for people with cirrhosis and variceal bleeding Cochrane Systematic Review.[Accessed 08 November 2018]Intervention.Protocol Version[DOI:10.1002/14651858.CD013214]
25 Wells M,Chande N,Adams P,Beaton M,Levstik M,Boyce E,Mrkobrada M.Meta-analysis:vasoactive medications for the management of acute variceal bleeds.Aliment Pharmacol Ther 2012;35:1267-1278[PMID:22486630 DOI:10.1111/j.1365-2036.2012.05088.x]
26 Zhou X,Tripathi D,Song T,Shao L,Han B,Zhu J,Han D,Liu F,Qi X.Terlipressin for the treatment of acute variceal bleeding:A systematic review and meta-analysis of randomized controlled trials.Medicine(Baltimore)2018;97:e13437[PMID:30508958 DOI:10.1097/MD.0000000000013437]
27 Ioannou G,Doust J,Rockey DC.Terlipressin for acute esophageal variceal hemorrhage.Cochrane Database Syst Rev 2003;CD002147[PMID:12535432 DOI:10.1002/14651858.CD002147]
28 Trudeau W,Prindiville T.Endoscopic injection sclerosis in bleeding gastric varices.Gastrointest Endosc1986;32:264-268[PMID:3488937]
29 Hwang JH,Shergill AK,Acosta RD,Chandrasekhara V,Chathadi KV,Decker GA,Early DS,Evans JA,Fanelli RD,Fisher DA,Foley KQ,Fonkalsrud L,Jue T,Khashab MA,Lightdale JR,Muthusamy VR,Pasha SF,Saltzman JR,Sharaf R,Cash BD;American Society for Gastrointestinal Endoscopy.The role of endoscopy in the management of variceal hemorrhage.Gastrointest Endosc 2014;80:221-227[PMID:25034836 DOI:10.1016/j.gie.2013.07.023]
30 Shiha G,El-Sayed SS.Gastric variceal ligation:a new technique.Gastrointest Endosc 1999;49:437-441[PMID:10202055]
31 Lee TH,Shih LN.Clinical experience of endoscopic banding ligation for bleeding gastric varices.Hepatogastroenterology 2008;55:766-769[PMID:18613450]
32 Tan PC,Hou MC,Lin HC,Liu TT,Lee FY,Chang FY,Lee SD.A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage:N-butyl-2-cyanoacrylate injection versus band ligation.Hepatology 2006;43:690-697[PMID:16557539 DOI:10.1002/hep.21145]
33 Qiao W,Ren Y,Bai Y,Liu S,Zhang Q,Zhi F.Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding:Meta-Analysis of Randomized,Controlled Studies Based on the PRISMA Statement.Medicine(Baltimore)2015;94:e1725[PMID:26469912 DOI:10.1097/MD.0000000000001725]
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