Gastrointestinal varices secondary prevention: Difference between revisions
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==Secondary Prevention== | ==Secondary Prevention== | ||
Secondary prevention of gastrointestinal varices involves prevention of rebleeding. The following options are available, according to the condition of the patient: | Secondary prevention of gastrointestinal varices involves prevention of rebleeding. The following options are available, according to the condition of the patient:<ref name="pmid17060770">{{cite journal |vauthors=Krige JE, Kotze UK, Bornman PC, Shaw JM, Klipin M |title=Variceal recurrence, rebleeding, and survival after endoscopic injection sclerotherapy in 287 alcoholic cirrhotic patients with bleeding esophageal varices |journal=Ann. Surg. |volume=244 |issue=5 |pages=764–70 |year=2006 |pmid=17060770 |pmc=1856595 |doi=10.1097/01.sla.0000231704.45005.4e |url=}}</ref><ref name="pmid15925423">{{cite journal |vauthors=de Franchis R |title=Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension |journal=J. Hepatol. |volume=43 |issue=1 |pages=167–76 |year=2005 |pmid=15925423 |doi=10.1016/j.jhep.2005.05.009 |url=}}</ref><ref name="urlEsophageal varices: from appearance to rupture; natural history and prognostic indicators | SpringerLink">{{cite web |url=https://link.springer.com/chapter/10.1007/978-94-007-1042-9_17 |title=Esophageal varices: from appearance to rupture; natural history and prognostic indicators | SpringerLink |format= |work= |accessdate=}}</ref><ref name="pmid12939586">{{cite journal |vauthors=D'Amico G, De Franchis R |title=Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators |journal=Hepatology |volume=38 |issue=3 |pages=599–612 |year=2003 |pmid=12939586 |doi=10.1053/jhep.2003.50385 |url=}}</ref> | ||
'''Time to start secondary prophylaxis''' | '''Time to start secondary prophylaxis''' | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Secondary Prevention
Secondary prevention of gastrointestinal varices involves prevention of rebleeding. The following options are available, according to the condition of the patient:[1][2][3][4]
Time to start secondary prophylaxis
- Secondary prophylaxis should start as soon as possible from day 6 of the index variceal bleeding episode
- The time of initiation of secondary prophylaxis should be recorded.
Patients with cirrhosis who have not received primary prophylaxis
- In these patients, a combination of beta blockers and endoscopic band ligation may be used as a measure for secondary prophylaxis
- Rebledding risk may be predicted by using the patient's response to pharmacological therapy as a prognostic factor
Patients with cirrhosis who are on beta blockers for primary prevention and bleed
- Band ligation should be considered in addition to beta blockers
Patients who have contraindications or intolerance to beta blockers
- Band ligation is the treatment of choice for prevention of rebleeding
Patients who fail endoscopic and pharmacological treatment for prevention of rebleeding
- TIPS or surgical shunts (distal splenorenal shunt or 8 mm H-graft) are effective for those with Child class A/B cirrhosis
- In non-surgical candidates, TIPS is the sole option available
- Transplantation is associated with good long-term outcomes in Child class B/C cirrhosis and should be considered
- TIPS serves as a bridge to transplantation
Patients who have bled from isolated gastric varices, type 1 (IGV1) or gastro-oesophageal varices, type 2 (GOV 2)
- N-butyl-cyanoacrylate
- TIPS
- Beta blockers
Patients who have bled from gastro-esophageal varices, type 1 (GOV 1)
- May be treated via band ligation of oesophageal varices with cyanoacrylate or beta blockers
Patients who have bled from portal hypertensive gastropathy
- Beta blockers to prevent recurrent bleeding
Patients in whom beta blockers are contraindicated or fail and who cannot be managed by non-shunt therapy
- TIPS
- Surgical shunts
References
- ↑ Krige JE, Kotze UK, Bornman PC, Shaw JM, Klipin M (2006). "Variceal recurrence, rebleeding, and survival after endoscopic injection sclerotherapy in 287 alcoholic cirrhotic patients with bleeding esophageal varices". Ann. Surg. 244 (5): 764–70. doi:10.1097/01.sla.0000231704.45005.4e. PMC 1856595. PMID 17060770.
- ↑ de Franchis R (2005). "Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension". J. Hepatol. 43 (1): 167–76. doi:10.1016/j.jhep.2005.05.009. PMID 15925423.
- ↑ "Esophageal varices: from appearance to rupture; natural history and prognostic indicators | SpringerLink".
- ↑ D'Amico G, De Franchis R (2003). "Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators". Hepatology. 38 (3): 599–612. doi:10.1053/jhep.2003.50385. PMID 12939586.