Updated strategies in the management of acute variceal haemorrhage.
Journal
Current opinion in gastroenterology
ISSN: 1531-7056
Titre abrégé: Curr Opin Gastroenterol
Pays: United States
ID NLM: 8506887
Informations de publication
Date de publication:
01 05 2021
01 05 2021
Historique:
entrez:
26
3
2021
pubmed:
27
3
2021
medline:
16
10
2021
Statut:
ppublish
Résumé
This article reviews the most recent studies regarding the management of acute esophageal variceal haemorrhage. New randomized control trials and meta-analyses confirmed the role of early transjugular intrahepatic portosystemic shunt (TIPS) in the management of acute variceal haemorrhage in Child-Pugh C (10-13) and B patients with active bleeding. A recent randomized controlled trial focused on the duration of vasoactive therapy showed no difference between 2 and 5 days of octreotide. A randomized trial showed decreased use of blood products for the correction of coagulopathy using a thromboelastography-guided approach (vs. conventional parameters) as well as decreased bleeding rates when compared with standard of care. A meta-analysis found that for rescue of variceal bleeding, self-expanding metallic stents were more efficacious and safer than balloon tamponade. In addition, studies showed that Child-Pugh C patients and those with hepatic vein pressure gradient more than 20 were at the highest risk of treatment failure, while model for end-stage liver disease was highly predictive of in-hospital mortality. In patients with severe coagulopathy and uncontrolled bleeding, TEG-based transfusion strategies are recommended. Antibiotics should be used for all cirrhotic patients presenting with upper gastrointestinal bleeding, but should be tailored in accordance to local resistance patterns. Early TIPS for high-risk patients has been shown to have a significant survival benefit. Certain aspects of the management of variceal bleeding remain poorly studied such as the role of early TIPS in Child-B patients as well as strategies for rescue therapy in patients who are not TIPS candidates, and require further investigation.
Identifiants
pubmed: 33769373
doi: 10.1097/MOG.0000000000000723
pii: 00001574-202105000-00003
pmc: PMC8691141
mid: NIHMS1713228
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
167-172Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK123704
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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