Risk and Predictors of Variceal Bleeding in Cirrhosis Patients Receiving Primary Prophylaxis With Non-Selective Beta-Blockers

2016 ◽  
Vol 111 (12) ◽  
pp. 1778-1787 ◽  
Author(s):  
Richa Shukla ◽  
Jennifer Kramer ◽  
Yumei Cao ◽  
Jun Ying ◽  
Aylin Tansel ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Beta Blockers ◽  
Primary Prophylaxis

scholarly journals Primary prophylaxis of variceal bleeding in cirrhotics unable to take beta-blockers: a randomized trial of ligation

2005 ◽  
Vol 21 (12) ◽  
pp. 1435-1443 ◽  
Author(s):  
C. Triantos ◽  
J. Vlachogiannakos ◽  
A. Armonis ◽  
A. Saveriadis ◽  
A. Kougioumtzian ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Variceal Bleeding ◽  
Beta Blockers ◽  
Primary Prophylaxis

scholarly journals Motion – Prophylactic Banding of Esophageal Varices Is Useful: Arguments against the Motion

2002 ◽  
Vol 16 (10) ◽  
pp. 693-695 ◽  
Author(s):  
Kris V Kowdley
Keyword(s):  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Beta Blockers ◽  
Low Cost ◽  
Cost Effective ◽  
Primary Prophylaxis ◽  
Ease Of Use ◽  
Endoscopic Sclerotherapy ◽  
Variceal Hemorrhage ◽  
Band Ligation

Bleeding from esophageal varices leads to substantial morbidity and mortality. Despite advances in pharmacological and endoscopic therapy, as well as general supportive care, the mortality rate associated with acute variceal hemorrhage has not improved significantly over the past two decades. Prophylactic therapy with nonselective beta-blockers or long acting nitrates reduces the incidence of variceal bleeding in patients with cirrhosis, is cost effective and may improve survival. Surgical portosystemic shunting reduces the risk of bleeding but is associated with significant operative mortality and a high risk of portosystemic encephalopathy. Endoscopic sclerotherapy causes adverse effects in a large proportion of patients and is, therefore, not suitable for primary prophylaxis of bleeding. Although variceal band ligation is effective in reducing the rate of bleeding and is safer than sclerotherapy, it has not been shown to provide a survival advantage compared with beta-blockers. A significant reduction in the rate of variceal bleeding with band ligation, compared with beta-blockers, was shown in only one study. Beta-blockers offer several advantages, including low cost, ease of use and safety. The available data do not yet support the prophylactic use of variceal band ligation, and this procedure should be reserved for patients who are either unwilling or unable to take beta-blockers. It is hoped that additional large, multicentre trials of band ligation versus beta-blockers will examine the efficacy, cost effectiveness and impact on quality of life among patients with cirrhosis.

Banding ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children

2013 ◽  
Author(s):  
Juan Cristóbal Gana ◽  
Lorena I Cifuentes ◽  
Jaime Cerda ◽  
Luis A Villarroel del Pino ◽  
Alfredo Peña ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Beta Blockers ◽  
Primary Prophylaxis ◽  
Banding Ligation

scholarly journals Management of variceal hemorrhage: current concepts

2014 ◽  
Vol 27 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Fabricio Ferreira COELHO ◽  
Marcos Vinícius PERINI ◽  
Jaime Arthur Pirola KRUGER ◽  
Gilton Marques FONSECA ◽  
Raphael Leonardo Cunha de ARAÚJO ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Surgical Treatment ◽  
Variceal Bleeding ◽  
Endoscopic Therapy ◽  
Beta Blockers ◽  
Primary Prophylaxis ◽  
Underlying Disease ◽  
Secondary Prophylaxis ◽  
Variceal Hemorrhage ◽  
Cirrhotic Patients

INTRODUCTION: The treatment of portal hypertension is complex and the the best strategy depends on the underlying disease (cirrhosis vs. schistosomiasis), patient's clinical condition and time on it is performed (during an acute episode of variceal bleeding or electively, as pre-primary, primary or secondary prophylaxis). With the advent of new pharmacological options and technical development of endoscopy and interventional radiology treatment of portal hypertension has changed in recent decades. AIM: To review the strategies employed in elective and emergency treatment of variceal bleeding in cirrhotic and schistosomotic patients. METHODS: Survey of publications in PubMed, Embase, Lilacs, SciELO and Cochrane databases through June 2013, using the headings: portal hypertension, esophageal and gastric varices, variceal bleeding, liver cirrhosis, schistosomiasis mansoni, surgical treatment, pharmacological treatment, secondary prophylaxis, primary prophylaxis, pre-primary prophylaxis. CONCLUSION: Pre-primary prophylaxis doesn't have specific treatment strategies; the best recommendation is treatment of the underlying disease. Primary prophylaxis should be performed in cirrhotic patients with beta-blockers or endoscopic variceal ligation. There is controversy regarding the effectiveness of primary prophylaxis in patients with schistosomiasis; when indicated, it is done with beta-blockers or endoscopic therapy in high-risk varices. Treatment of acute variceal bleeding is systematized in the literature, combination of vasoconstrictor drugs and endoscopic therapy, provided significant decline in mortality over the last decades. TIPS and surgical treatment are options as rescue therapy. Secondary prophylaxis plays a fundamental role in the reduction of recurrent bleeding, the best option in cirrhotic patients is the combination of pharmacological therapy with beta-blockers and endoscopic band ligation. TIPS or surgical treatment, are options for controlling rebleeding on failure of secondary prophylaxis. Despite the increasing evidence of the effectiveness of pharmacological and endoscopic treatment in schistosomotic patients, surgical therapy still plays an important role in secondary prophylaxis.

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