Volume 26, Issue 2, Pages 55-67 (February 2010)

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ABSTRACT

ABSTRACT + REFS

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Management of Acute Esophageal Variceal Hemorrhage

Received 22 October 2009; accepted 23 October 2009.

Acute esophageal variceal hemorrhage (AEVH) is a severe complication of portal hypertension. Its management has rapidly evolved in recent years. Traditional methods included vasoconstrictor and balloon tamponade. Vasoconstrictors were shown to control approximately 80% of the bleeding episodes and are generally used as a first-line therapy. Following the use of vasoconstrictors, endoscopic therapy is often used to arrest the bleeding varices and prevent early rebleeding. A meta-analysis showed that the combination of vasoconstrictor and endoscopic therapy is superior to endoscopic therapy alone for controlling AEVH. Balloon tamponade may be used to achieve temporary control of the hemorrhage in case of severe bleeding. A transjugular intrahepatic portosystemic stent shunt may be needed in patients with refractory acute variceal hemorrhage. Surgical intervention is now widely contraindicated during acute variceal hemorrhage, except for patients with good liver reserve. Conversely, apart from the control of acute variceal hemorrhage, prophylactic antibiotics were shown to be helpful in the prevention of bacterial infection and to prevent early variceal rebleeding. With the introduction of new treatment modalities and the measures taken to manage patients with AEVH, the mortality due to AEVH has significantly decreased in recent years.

Key Words: acute variceal hemorrhage , banding ligation , sclerotherapy , vasoconstrictors

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References

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Department of Medical Education, Digestive Center, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

Address correspondence and reprint requests to: Dr Gin-Ho Lo, Department of Medical Education, Digestive Center, E-Da Hospital, 1 Yi-Da Road, Kaohsiung 824, Taiwan

PII: S1607-551X(10)70009-7

doi:10.1016/S1607-551X(10)70009-7

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