scholarly journals Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

2013 ◽  
Vol 2013 ◽  
pp. 1-20 ◽  
Author(s):  
Erwin Biecker
Keyword(s):  
Portal Hypertension ◽  
Beta Blockers ◽  
Treatment Options ◽  
Gastric Varices ◽  
Portal Hypertensive Gastropathy ◽  
Pharmacologic Treatment ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Band Ligation ◽  
Ectopic Varices

Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology.

scholarly journals Duodenal Varices: A Rare Manifestation of Portal Hypertension

2019 ◽  
Vol 37 (3) ◽  
pp. 156-159
Author(s):  
Deepankar Kumar Basak ◽  
Richmond Ronald Gomes ◽  
Md Samsul Arfin
Keyword(s):  
Portal Hypertension ◽  
Short Review ◽  
Injection Sclerotherapy ◽  
Endoscopic Variceal Ligation ◽  
Endoscopic Injection ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Duodenal Varices ◽  
Vein Thrombosis ◽  
Ectopic Varices

We report a case of haematemesis & melaena due to ectopic varices located in the duodenum in a patient with NASH related CLD. Duodenal varices are a rare but potentially serious consequence of portal hypertension in the event of a bleeding. The etiology of duodenal varices can be classified into hepatic (e.g. cirrhosis) or extra hepatic (e.g. portal, splenic or superior mesenteric vein thrombosis). Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are widely accepted as primary therapies for esophageal variceal bleeding whereas bleeding gastric fundal varices are usually treated with cyanoacrylate injection or shunt procedures. However there is no widely accepted treatment modality for duodenal varices. In the case presented, we used injection sclerotherapy with ethanolamine oleate, to obliterate varices and control bleeding. A short review on the etiology pathogenesis and management of ectopic varices is presented. J Bangladesh Coll Phys Surg 2019; 37(3): 156-159

Balloon-Occluded Retrograde Transvenous Obliteration: Emergence as a Treatment for Gastric Varices and Medically Refractory Hepatic Encephalopathy

2017 ◽  
Vol 01 (04) ◽  
pp. 286-292
Author(s):  
Ronnie Chen ◽  
Edward Lee ◽  
Sung Cho
Keyword(s):  
Variceal Bleeding ◽  
Treatment Options ◽  
Alternative Therapy ◽  
Splenic Vein ◽  
Major Complication ◽  
The United States ◽  
Gastric Varices ◽  
Western World ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

AbstractGastric or esophageal variceal bleeding is a major complication of portal hypertension in patients with liver cirrhosis. Currently, liver transplant is still considered a gold standard treatment for gastric or esophageal variceal bleeding. What about varices associated with splenic vein thrombosis? In the United States and Europe, endoscopic treatment and transjugular intrahepatic portosystemic shunt (TIPS) have been considered as effective treatment options for these variceal bleeding. However, in South Korea and Japan, balloon-occluded retrograde transvenous obliteration (BRTO) has been considered as a well-accepted treatment option for the gastric variceal bleeding. In recent years, based on favorable outcomes of BRTO in Asia and unfavorable outcomes/complications of TIPS, BRTO has emerged as an alternative therapy for gastric varices in the Western world. In this review, we describe the indications/contraindications, techniques, and outcomes of BRTO.

Active Esophageal Variceal Bleeding Treated with Band Ligation

1999 ◽  
Vol 17 (3) ◽  
pp. 180-180
Author(s):  
Richard S. Bloomfeld ◽  
Scott R. Brazer
Keyword(s):  
Variceal Bleeding ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Band Ligation

scholarly journals Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

2019 ◽  
Vol 03 (03) ◽  
pp. 214-226
Author(s):  
Alexander Dabrowiecki ◽  
Eric J. Monroe ◽  
Rene Romero ◽  
Anne E. Gill ◽  
C. Matthew Hawkins
Keyword(s):  
Portal Hypertension ◽  
Small Bowel ◽  
Endovascular Treatment ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Percutaneous Treatment ◽  
Roux Limb ◽  
Case Review ◽  
Gastroesophageal Varices ◽  
Ectopic Varices

AbstractPortal hypertension is a significant cause of morbidity and mortality in pediatric patients. Complications of portal hypertension include development of portosystemic varices. The most common type of portosystemic varices are gastroesophageal varices; however, other ectopic varices can also be a cause of recurrent, life-threatening gastrointestinal bleeding. Problematic ectopic varices include isolated gastric, anorectal, small bowel, roux-limb, and stomal varices. There are no standardized treatment guidelines on how to manage ectopic varices in children; however, new innovations in endovascular treatment options provide potential therapeutic alternatives when varices are refractory to conventional therapy. This review provides a case-based literature review for endovascular treatment of isolated gastric, anorectal, small bowel, roux-limb, and stomal ectopic varices in children (age 0-9 years) and adolescents (age 10-19 years).

scholarly journals Massive Esophageal Variceal Bleeding as the Initial Presentation of Peripancreatic Tuberculoma with Portal Hypertension

2009 ◽  
Vol 21 (2) ◽  
pp. 172-177
Author(s):  
Chih-Lung Chiu ◽  
Yi-Jen Peng ◽  
Wei-Kuo Chang ◽  
Tsai-Yuan Hsieh ◽  
You-Chen Chao ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Initial Presentation ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding
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