scholarly journals Emergency Management of Bleeding Esophageal Varices: Drugs, Bands or Sleep?

2006 ◽  
Vol 20 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Brian M Yan ◽  
Samuel S Lee
Keyword(s):  
Emergency Management ◽  
Variceal Bleeding ◽  
Pharmacological Treatment ◽  
Endoscopic Treatment ◽  
Treatment Options ◽  
Pharmacological Treatments ◽  
Balloon Tamponade ◽  
Acute Variceal Bleeding ◽  
Endoscopic Band Ligation ◽  
Meta Analyses

Variceal bleeding is a severe complication of cirrhosis leading to significant morbidity and mortality. Treatment of acute variceal bleeding has improved dramatically since the era of the mechanical balloon tamponade. These advances include endoscopic band ligation or sclerotherapy, and vasoactive pharmacological options such as somatostatin, octreotide, vasopressin and terlipressin. Evidence from a multitude of clinical trials and meta-analyses comparing endoscopic and pharmacological treatments suggests near equivalence in efficacy for initial hemostasis, mortality and rate of rebleeding. This raises the question of whether on-call gastroenterologists should be performing emergency endoscopic treatment in the middle of the night or start pharmacological treatment and delay endoscopy until optimal patient and working conditions the next morning. The present review analyzes the available comparative data between endoscopic and pharmacological treatment options. Although the literature cannot yet definitively answer the question posed, the authors suggest that delaying endoscopic treatment until the next morning may be the most reasonable practical approach.

Endoscopic Treatment of Acute Variceal Bleeding

2014 ◽  
pp. 147-161
Author(s):  
Christos Triantos ◽  
Maria Kalafateli ◽  
Andrew Kenneth Burroughs
Keyword(s):  
Variceal Bleeding ◽  
Endoscopic Treatment ◽  
Acute Variceal Bleeding

scholarly journals Alternative pharmacological treatment options for agitation in Alzheimer’s disease

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Francesco Panza ◽  
Vincenzo Solfrizzi ◽  
Bruno P. Imbimbo ◽  
Andrea Santamato ◽  
Madia Lozupone ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Pharmacological Treatment ◽  
Neuropsychiatric Symptoms ◽  
Treatment Options ◽  
Pharmacological Treatments ◽  
Risk Of Mortality ◽  
Novel Drugs ◽  
Phase Ii And Iii ◽  
Ongoing Phase

In patients with dementia and Alzheimer’s disease (AD), treatment of neuropsychiatric symptoms (NPS) is a major concern in the management of these devastating diseases. Among NPS in AD, agitation and aggression are common with earlier institutionalization, increased morbidity and mortality, and greater caregiver burden. Pharmacological treatments for AD-related agitation, specifically off-label use of atypical antipsychotics, showed only modest improvements, with increased side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred firstline option. However, when such treatments fail, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for agitation/aggression in AD and dementia. Unfortunately, progresses have been slow, with a small number of methodologically heterogeneous randomized controlled trials (RCTs), with disappointing results. However, evidence coming from recently completed RCTs on novel or repositioned drugs (mibampator, dextromethorphan/ quinidine, cannabinoids, and citalopram) showed some promise in treating agitation in AD, but still with safety concerns. Further evidence will come from ongoing Phase II and III trials on promising novel drugs for treating these distressing symptoms in patients with AD and dementia.

Balloon Tamponade and Esophageal Stenting for Esophageal Variceal Bleeding in Cirrhosis: A Systematic Review and Meta-analysis

2019 ◽  
Vol 39 (02) ◽  
pp. 178-194 ◽  
Author(s):  
Susana Rodrigues ◽  
Andrés Cárdenas ◽  
Àngels Escorsell ◽  
Jaime Bosch
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Medium Term ◽  
Short Term ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Balloon Tamponade ◽  
Acute Variceal Bleeding

AbstractFailure to control variceal bleeding with current recommendations occurs in 10 to 20% of cases. This systematic review and meta-analysis analyzes the experience, results, and complications of “bridge” therapies for failure to control acute variceal bleeding: balloon tamponade and esophageal stents. The main outcomes assessed were failure to control bleeding and mortality in the short-term and medium-term follow-up, and adverse events. Balloon tamponade studies had a pooled rate of short-term failure to control bleeding of 35.5%, and adverse events in over 20% of cases; 9.7% resulting in death. Stenting failed to control bleeding in the short term and medium term in 12.7 and 21.5% of cases of severe or refractory variceal bleeding, respectively, despite stent migration in 23.8% of cases. Medium-term mortality rates were similar in both therapies. Although only one trial compared these treatments, the available evidence consistently supports that stents serve as a better and safer bridge therapy in refractory acute variceal bleeding.

scholarly journals Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta-analysis

Hepatology ◽  
2002 ◽  
Vol 35 (3) ◽  
pp. 609-615 ◽  
Author(s):  
Rafael Bañares ◽  
Agustín Albillos ◽  
Diego Rincón ◽  
Sonia Alonso ◽  
Mónica González ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Endoscopic Treatment ◽  
Meta Analysis ◽  
Pharmacologic Treatment ◽  
Acute Variceal Bleeding

scholarly journals Balloon tamponade sequentially combined with TIPS for refractory acute variceal bleeding: efficacy, safety and procedure techniques

2020 ◽  
Author(s):  
Chongtu Yang ◽  
Jiacheng Liu ◽  
Chen Zhou ◽  
Jingqiang Ma ◽  
Songlin Song ◽  
...  
Keyword(s):  
Variceal Bleeding ◽  
Portal Pressure ◽  
Recurrent Bleeding ◽  
Technical Success Rate ◽  
Balloon Tamponade ◽  
Acute Variceal Bleeding ◽  
Safe Strategy ◽  
Overt Hepatic Encephalopathy ◽  
Intrahepatic Portosystemic Shunt

Abstract Background This study aimed to evaluate the efficacy and safety of a therapeutic strategy, balloon tamponade (BT) sequentially combined with transjugular intrahepatic portosystemic shunt (TIPS), in cirrhotic patients with refractory acute variceal bleeding (AVB), and to introduce technique points of performing TIPS under BT. Methods Fifteen consecutive patients with refractory AVB who had been treated with balloon tamponade sequentially combined with TIPS between February 2017 and November 2019 were retrospectively analyzed. We evaluated the technical success rate, efficacy and procedure-related complications, and compared pre- and post-TIPS portal pressure gradient (PPG). Variceal rebleeding, overt hepatic encephalopathy (OHE), TIPS patency was assessed periodically and survival at 6 weeks and 1 year were recorded during follow-up. Results The procedure was successfully performed in all patients. Balloon was deflated during TIPS procedure in seven patients, after TIPS in three and before TIPS in five. Mean PPG decreased from 27.7 ± 4.3 mmHg to 10.7 ± 2.8 mmHg (P < 0.001). No TIPS- and balloon-related complications were observed. Two patients died during a median follow-up of 12 months (range 1–34 months). The 6-week and 1-year survival rate was 100% and 76% respectively. The incidence of OHE was 21% (3/14). The probability of remaining free of recurrent bleeding was 100%, and the probability of maintaining TIPS patency was 100%. Conclusions Balloon tamponade sequentially combined with TIPS should be considered an effective and safe strategy for patients with refractory AVB (especially bleeding from esophageal varices). This strategy could increase bleeding control rate and reduce the incidence of procedure-related complications and rebleeding.

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