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Hemostasis of Acute Esophageal Variceal Bleeding

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GI Endoscopic Emergencies

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Abstract

Acute bleeding from esophageal varices (EV) is a potentially lethal complication in patients with portal hypertension and cirrhosis. Advances in medical and intensive care support, use of antibiotic prophylaxis and vasoactive drugs, and more effective endoscopic therapy have contributed to a decrease in mortality in patients with bleeding EV, although the mortality rate remains significant at about 20 %. Adequate resuscitation of the bleeding patient is vital in the initial management of esophageal variceal hemorrhage. The use of antibiotic prophylaxis has led to reduced bacterial infections and mortality in cirrhotic patients with variceal bleeding. The combination of vasoactive drugs and endoscopic therapy improves control of initial bleeding and 5-day hemostasis. Endoscopic band ligation is the preferred endoscopic therapy. In patients who fail vasoactive drugs and endoscopic therapy, rescue modalities, such as balloon tamponade, transjugular intrahepatic portosystemic shunt, and shunt surgery, can be considered in selected patients.

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Authors and Affiliations

  1. Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Room 94020, 7/F, Clinical Science Building, Shatin, New Territories, Hong Kong

    Raymond S. Y. Tang & Joseph J. Y. Sung

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Correspondence to Joseph J. Y. Sung .

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Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

    Louis M. Wong Kee Song

  2. Medical College of Wisconsin-Green Bay Campus, Prevea Center for Digestive Health, Green Bay, Wisconsin, USA

    Emmanuel C. Gorospe

  3. Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA

    Todd H. Baron

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Endoscopic band ligation of actively bleeding esophageal varix (MP4 23,965 kb)

Endoscopic band ligation of esophageal varix with a fibrin plug (MP4 25,611 kb)

Sclerosant injection as second-line therapy for failed band ligation of actively bleeding esophageal varix (MP4 15,755 kb)

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Tang, R.S.Y., Sung, J.J.Y. (2016). Hemostasis of Acute Esophageal Variceal Bleeding. In: Wong Kee Song, L., Gorospe, E., Baron, T. (eds) GI Endoscopic Emergencies. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-3085-2_12

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