Application of Endoscopy in Improving Survival of Cirrhotic Patients with Acute Variceal HemorrhageReport as inadecuate




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International Journal of HepatologyVolume 2011 2011, Article ID 893973, 8 pages

Review Article

Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital-I-Shou University, Kaohsiung 824, Taiwan

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei 220, Taiwan

Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei 100, Taiwan

Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei 100, Taiwan

Received 15 March 2011; Accepted 12 May 2011

Academic Editor: Deepak Amarapurkar

Copyright © 2011 Yao-Chun Hsu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Playing a central role in the modern multidisciplinary management of acute gastroesophageal variceal hemorrhage, endoscopy is essential to stratify patient at risk, control active hemorrhage, and prevent first as well as recurrent bleeding. Before endoscopic procedure, antibiotic prophylaxis along with vasoactive medication is now routine practice. Intravenous erythromycin effectively cleanses stomach and may improve the quality of endoscopy. The timing of endoscopy should be on an urgent basis as delay for more than 15 hours after presentation is associated with mortality. Active variceal bleeding on endoscopy in a patient with hepatic decompensation heralds poor prognosis and mandates consideration of aggressive strategy with early portosystemic shunting. Band ligation has become the preferred modality to control and prevent bleeding from esophageal varices, although occasionally sclerotherapy may still be used to achieve hemostasis. Addition of pharmacotherapy with nonselective beta blockade to endoscopic ligation has become the current standard of care in the setting of secondary prophylaxis but remains controversial with inconsistent data for the purpose of primary prophylaxis. Gastric varices extending from esophagus may be treated like esophageal varices, whereas variceal obliteration by tissue glue is the endoscopic therapy of choice to control and prevent bleeding from fundic and isolated gastric varices.





Author: Yao-Chun Hsu, Chen-Shuan Chung, and Hsiu-Po Wang

Source: https://www.hindawi.com/



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