scholarly journals OUTCOME OF ENDOSCOPIC VARICEAL LIGATION (EVL) FOR SECONDARY PROPHYLAXIS OF VARICEAL HEMORRHAGE

2006 ◽  
Vol 43 (4) ◽  
pp. E38
Author(s):  
Simon C. Ling ◽  
Daniel Brody ◽  
Vicky L. Ng ◽  
Eve A. Roberts
Keyword(s):  
Secondary Prophylaxis ◽  
Endoscopic Variceal Ligation ◽  
Variceal Hemorrhage

scholarly journals Comparison of Endoscopic Variceal Ligation with Endoscopic Sclerotherapy for Secondary Prophylaxis of Variceal Hemorrhage: A Randomized Trial

Cureus ◽  
2018 ◽  
Author(s):  
H Sakthivel ◽  
Ashok Kumar Sahoo ◽  
Sakthivel Chinnakkulam Kandhasamy ◽  
Anandhi Amaranathan ◽  
Mangala Goneppanavar ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Secondary Prophylaxis ◽  
Endoscopic Sclerotherapy ◽  
Endoscopic Variceal Ligation ◽  
Variceal Hemorrhage

scholarly journals Endoscopic variceal ligation combined with sclerotherapy for management of gastroesophageal variceal bleeding in pediatric patients

2021 ◽  
Author(s):  
Ming-Ming Li ◽  
Fang Sun ◽  
Man-Xiu Huai ◽  
Chun-Ying Qu ◽  
Feng Shen ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Pediatric Patients ◽  
Median Number ◽  
Gastric Varices ◽  
Secondary Prophylaxis ◽  
Endoscopic Management ◽  
Endoscopic Variceal Ligation ◽  
Variceal Hemorrhage ◽  
Clinical Center ◽  
The Mean

Abstract Background Portal hypertension (PH) frequently gives rise to severe and life-threatening complications, including hemorrhage accompanied by the rupture of esophageal and gastric varices. In contrast to the widely studied guidelines for the management of PH in adults, there remains controversial about the optimal endoscopic management of variceal bleeding in children for secondary prophylaxis. The study aims to determine the efficacy and safety of endoscopic variceal ligation (EVL) and sclerotherapy (EST) to control bleeding in children in our clinical center. Methods The retrospective study included 21 children with gastroesophageal variceal bleeding who were treated by endoscopic variceal ligation or sclerotherapy at Xinhua Hospital, Shanghai Jiaotong University School of Medicine between January 2007 and July 2020. The treatment outcome involving short-term hemostatic rate and long-term rebleeding rate were investigated. Adverse events related to the procedures, such as esophageal ulcer, esophageal stricture, abnormal embolization, pneumonia and perforation were also observed. Results The 21 pediatric patients who were diagnosed as moderate to severe esophageal varices concurrent with gastric varices experienced EVL or EST successfully. Hemostasis was achieved in 45 of 47 (95.7%) episodes of upper gastrointestinal bleeding. The mean volume of each single aliquot of cyanoacrylate injected was 0.3 ± 0.1 mL (range: 0.1–0.5 mL). Twenty-four patients (75%) reach varices eradication in the EVL group with a median number of procedures before eradication of 2 (1–4) and a median time to eradication of 3.40 months (1.10-13.33). Eleven patients (52.4%) developed rebleeding events, with the mean duration of hemostasis being 11.1 ± 11.6 mo (range: 1.0-39.2 mo). No treatment-related complications, for example, distal embolism, were noted with the exception of abdominal pain in one patient (4.8%). Conclusions Endoscopic variceal sclerotherapy or in combination with EVL turns out to be an effective and safe approach to treat variceal hemorrhage in children for secondary prophylaxis.

scholarly journals Esophageal Variceal Ligation Monotherapy versus Combined Ligation and Sclerotherapy for the Treatment of Esophageal Varices

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Jianbo Wang ◽  
Shenghui Chen ◽  
Yehia M. Naga ◽  
Junwei Liu ◽  
Mugen Dai ◽  
...  
Keyword(s):  
Chest Pain ◽  
Hospital Stay ◽  
Esophageal Varices ◽  
Length Of Hospital Stay ◽  
Injection Sclerotherapy ◽  
Endoscopic Variceal Ligation ◽  
Variceal Hemorrhage ◽  
Esophageal Variceal ◽  
Gastroesophageal Varices ◽  
Number Of Treatment

Currently, endoscopic variceal ligation (EVL) monotherapy is the standard therapy for managing esophageal variceal hemorrhage. Patients generally need several sessions of endoscopy to achieve optimal variceal ablation, and the varices can recur afterward. Endoscopic injection sclerotherapy (EIS) is an older technique, associated with certain complications. This study aimed to evaluate the clinical efficacy of EVL alone versus combined EVL and EIS in the treatment of esophageal varices. This retrospective study included 84 patients, of which 40 patients were treated with EVL monotherapy and 44 patients were treated with combined EVL + EIS. The main outcomes were rebleeding rates, recurrence at six months, number of treatment sessions, length of hospital stay, cost of hospitalization, and procedural complications. At six months, the rebleeding rate and recurrence were significantly lower in the EVL + EIS group compared to the EVL group (2.3% versus 15.0%; and 9.1% versus 27.5%, respectively). The number of treatment sessions, length of hospital stay, and cost of hospitalization were significantly lower in the EVL + EIS group compared to those in the EVL group (2.3 ± 0.6 versus 3.2 ± 0.8 times; 14.5 ± 3.4 versus 23.5 ± 5.9 days; and 23918.6 ± 4220.4 versus 26165.2 ± 4765.1 renminbi, respectively). Chest pain was significantly lower in the EVL + EIS group compared to that in the EVL group (15.9% versus 45.0%). There were no statistically significant differences in the presence of fever or esophageal stricture in both groups. In conclusion, combined EVL + EIS showed less rebleeding rates and recurrence at six months and less chest pain and was more cost effective compared to EVL alone in the treatment of gastroesophageal varices.

scholarly journals Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pathophysiologic Basics, Actual Indications and Results with Review of the Literature

2018 ◽  
Vol 190 (08) ◽  
pp. 701-711 ◽  
Author(s):  
Holger Strunk ◽  
Milka Marinova
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Endoscopic Therapy ◽  
Secondary Prophylaxis ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Variceal Hemorrhage ◽  
Line Therapy ◽  
Intrahepatic Portosystemic Shunt ◽  
Pugh Class ◽  
Early Tips

Background Transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt created using endovascular techniques. During recent years technical improvements and new insights into pathophysiology have modified indications for TIPS placement. In this article we therefore want to discuss current knowledge. Method A literature review was performed to review and discuss the pathophysiology, indications and results of the TIPS procedure. Results Established TIPS indications are persistent bleeding despite combined pharmacological and endoscopic therapy and rebleeding during the first five days. A new indication in the European recommendations is early TIPS placement within 72 hours, ideally within 24 hours, in patients bleeding from esophageal or gastroesophageal varices at high risk for treatment failure (e. g. Child-Pugh class C < 14 points or Child-Pugh class B with active bleeding) after initial pharmacological and endoscopic therapy. For prevention of recurrent variceal hemorrhage in the recommendations, covered TIPS placement is the treatment of choice only after failed first-line therapy, although numerous TIPS studies show a prolonged time to rebleeding and a reduction of mortality. Similarly for secondary prophylaxis in patients with refractory ascites, covered TIPS placement may be considered only if the patient continues to be intolerant to NSBBs and is an appropriate TIPS candidate even though studies show that the TIPS procedure controls ascites, improves survival and renal function better than paracentesis. Potential indications for TIPS implantation are Budd-Chiari syndrome, acute portal vein thromboses, hydrothorax, hepatopulmonary and hepatorenal syndrome (Typ 2), portal hypertensive gastropathy (PHG) and prophylaxis of complications of abdominal surgery, very rarely bleeding in ectopic varices or in patients with chylothorax or chylous ascites. Conclusion TIPS placement is an established procedure with a new indication as “early TIPS”. In the European recommendations it is only the second-line therapy for prevention of recurrent variceal hemorrhage and for secondary prophylaxis in patients with refractory ascites although several studies showed a clear benefit of the TIPS procedure compared to ligation and NSBBs. Key Points  Citation Format

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