For adults with decompensated liver cirrhosis, how do interventions to treat acute bleeding esophageal varices compare?

Objective: to evaluate the effectiveness of the application of beta-blockers for primary prevention of bleeding esophageal varices in patients with liver cirrhosis. Material and methods. A retrospective study included 46 patients with liver cirrhosis of various etiology having II-III stage esophageal varices. All the patients were divided into two equal groups. The basic group was made up of 23 (50 %) patients who were prescribed beta-blockers at recommended dosages continuously over the observation period from 2009 till 2018 for the purpose of primary prevention of bleeding esophageal varices. The control group included 23 (50 %) patients with liver cirrhosis in whom the primary prevention of the bleedings was not performed. Results. The assessment of the effectiveness of beta-blockers was performed with two indicators: the frequency of bleeding esophageal varices and their mortality. The application of beta-blockers made it possible to reduce the bleeding frequency from 34.8 % to 13 % (р = 0.10) and the mortality from 21.7 % to 0 % (р = 0.02). Conclusion. In order to detect early stages of esophageal varices, endoscopic screening should be performed for all patients with liver cirrhosis. The presence of II-III stage esophageal varices requires primary prevention of the bleedings. The drug-of-choice are non-selective beta-blockers. Timely and adequately prevention reduces the risk of the bleedings and their mortality.

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Action of the Triglycyl Hormonogen of Vasopressin (Glypressin) in Patients With Liver Cirrhosis and Bleeding Esophageal Varices

Gastroenterology ◽

10.1016/s0016-5085(77)80140-6 ◽

1977 ◽

Vol 72 (4) ◽

pp. 605-609 ◽

Cited By ~ 48

Author(s):

Jiří Vosmík ◽

Karel Jedlička ◽

Jan L. Mulder ◽

Joseph H. Cort

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Bleeding Esophageal Varices

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Prevention of recurrent bleeding from varicose veins of the esophagus and stomach among patients with decompensated liver cirrhosis

Kazan medical journal ◽

10.17816/kmj2019-333 ◽

2019 ◽

Vol 100 (2) ◽

pp. 333-339

Author(s):

I E Onnitsev ◽

S A Bugaev ◽

S Ya Ivanusa ◽

I I Dzidzava ◽

A V Khokhlov ◽

...

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Varicose Veins ◽

Treatment Method ◽

Recurrent Bleeding ◽

Gastric Bleeding ◽

Decompensated Liver Cirrhosis ◽

Risk Of Bleeding ◽

Results Of Treatment ◽

Endoscopic Ligation

Aim. To evaluate the efficiency of laparoscopic devascularization of the esophagus and stomach with endoscopic ligation of varicose esophageal veins in the prevention of esophageal-gastric bleeding among patients with decompensated liver cirrhosis. Methods. The results of treatment of 73 patients with decompensated liver cirrhosis and high risk of bleeding were analyzed. To prevent recurrent bleeding from esophageal and gastric veins, all patients underwent endoscopic ligation at the first step of treatment. In case of inefficiency of ligation and recurrence of varicose veins of esophagus, laparoscopic devascularization of esophagus and stomach was performed. The efficiency of laparoscopic devascularization with intraoperative endoscopic ligation of varicose esophageal veins and ligation as an independent method of treatment for the prevention of upper gastrointestinal bleeding was estimated by comparison of the frequency of recurrence of esophageal and gastric bleeding and recurrence of esophageal varices according to upper endoscopy in comparison groups. Results. In 6 months, 1 and 2 years after laparoscopic devascularization of the esophagus and stomach in combination with endoscopic ligation, the risk of bleeding is less compared to endoscopic ligation as an isolated treatment method (p=0.05; p=0.052; p=0.06). Laparoscopic devascularization with ligation reduces the risk of recurrence of esophageal varices during the first year after surgery by 20% (χ2=2.61; p=0.106), in 2 years by 23% (χ2=1.75; p=0.091) compared to endoscopic ligation only. Conclusion. Patients with liver cirrhosis with decompensated hepatic failure satisfactorily postpone endovideosurgical interventions; laparoscopic gastric devascularization with the intersection of the main inflows to the esophageal varicose veins is an effective method to prevent esophageal-gastric hemorrhage among patients with decompensated liver cirrhosis after ineffective endoscopic ligation.

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