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2007 (EN)
Endoscopic treatment of gastroesophageal varices (EN)

Triantos, Ch.
Manolakopoulos, S.

Variceal bleeding continues to be a leading cause of death in cirrhotic patients. Both vasoactive drugs and endoscopic therapy play a significant role in the acute variceal bleeding setting as well as in primary and secondary prevention of variceal bleeding. All patients with cirrhosis should be screened with endoscopy for varices at diagnosis. In primary prevention, prophylaxis should be offered in patients with medium and large varices. Although endoscopic variceal ligation seems to be more effective than nonselective beta-blockers in preventing first variceal bleeding it does not improve survival rate. Considering the small number of patients enrolled in the randomized trials, the inability of endoscopic ligation to prevent bleeding from portal gastropathy, the cost and the safety issues related to ligation we recommend beta-blockers as the first line treatment. Endoscopic variceal ligation should be offered to patients with at least medium varices and contraindications or intolerance to beta-blockers. In acute variceal bleeding the treatment of choice is the combination of endotherapy with vasoactive drugs, particularly when administration of drugs started early before endoscopy. Endoscopic sclerotherapy has been shown to reduce bleeding and increase survival, but recently endoscopic ligation has been considered to be superior to sclerotherapy in this setting. The risk of recurrent bleeding and death following an episode of variceal bleeding is very high. In patients who have not received primary prophylaxis the combination of EVL and beta blockers should be used in this setting. In patients who are on beta-blockers for primary prevention EVL should be added. Patients who fail endoscopic and pharmacological treatment should undergo TIPS, surgical shunts or liver transplantation. (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 19, No 2 (2006) (EN)

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