Prevention of recurrent variceal bleeding.
Dig Liver Dis
; 40(5): 337-42, 2008 May.
Article
in En
| MEDLINE
| ID: mdl-18291735
ABSTRACT
Patients surviving a first episode of variceal bleeding have a risk of over 60% of experiencing recurrent haemorrhages within 1 year from the index episode. Because of this, all patients surviving a variceal bleeding should receive active treatments for the prevention of rebleeding. beta-Blockers+/-isosorbide-5-mononitrate and band ligation are effective in preventing recurrent bleeding and both can be used. Combination of beta-blockers+/-isosorbide-5-mononitrate and band ligation may be the best treatment to prevent rebleeding but more studies are needed to confirm this issue. In patients with recurrent variceal bleeding despite appropriate medical and endoscopic treatment, transjugular intrahepatic porto-systemic shunt is highly effective in controlling bleeding. The efficacy is not significantly different from that of shunt surgery (distal splenorenal shunt or 8mm H-graft shunt), especially since the introduction of polytetrafluoroethylene-covered stents. Therefore, in this situation, transjugular intrahepatic porto-systemic shunt using polytetrafluoroethylene stents should be the treatment of choice.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Vasoconstrictor Agents
/
Coagulants
/
Esophageal and Gastric Varices
/
Sclerotherapy
/
Hemostasis, Endoscopic
/
Portasystemic Shunt, Transjugular Intrahepatic
/
Gastrointestinal Hemorrhage
Type of study:
Etiology_studies
/
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
Dig Liver Dis
Journal subject:
GASTROENTEROLOGIA
Year:
2008
Document type:
Article
Affiliation country: