Skip to main content
SpringerLink
Log in

Endoscopic treatments for portal hypertension

  • Special Issue - Portal Hypertension
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Acute esophageal variceal hemorrhage is a dreaded complication of portal hypertension. Its management has evolved rapidly in recent years. Endoscopic therapy is often employed to arrest bleeding varices as well as to prevent early rebleeding. The combination of vasoconstrictor and endoscopic therapy is superior to vasoconstrictor or endoscopic therapy alone for control of acute esophageal variceal hemorrhage. After control of acute variceal bleeding, combination of banding ligation and beta-blockers is generally recommended to prevent variceal rebleeding. To prevent the catastrophic event of acute variceal bleeding, endoscopic banding ligation is an important tool in the prophylaxis of first bleeding. Endoscopic obturation with cyanoacrylate is usually utilized to arrest acute gastric variceal hemorrhage as well as to prevent rebleeding. It can be concluded that endoscopic therapies play a pivotal role in management of portal hypertensive bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis. 2001;5:645–663

    Article  PubMed  Google Scholar 

  2. Bosch J, Garcia-Pagan JC. Prevention of variceal rebleeding. Lancet. 2003;361:952–954

    Article  PubMed  Google Scholar 

  3. Lo GH. The role of endoscopy in secondary prophylaxis of esophageal varices. Clin Liver Dis. 2010;14:307–323

    Article  PubMed  Google Scholar 

  4. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Levy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40:652–659

    Article  PubMed  Google Scholar 

  5. de Franchis R. Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol. 2000;33:846–852

    Article  PubMed  Google Scholar 

  6. Cheung J, Soo I, Bastiampillai R, Zhu Q, Ma M. Urgent vs. non-urgent endoscopy in stable acute variceal bleeding. Am J Gastroenterol. 2009;104:1125–1129

    Article  PubMed  Google Scholar 

  7. Hsu YC, Chung CS, Tseng CH, Lin TL, Liou JM, Wu MS, et al. Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage. J Gastroenterol Hepatol. 2009;24:1294–1299

    Article  PubMed  Google Scholar 

  8. Chen PH, Chen WC, Hou MC, Liu TT, Chang CJ, Liao WC, et al. Delayed endoscopy increases re-bleeding and mortality in patients with hematemesis and active esophageal variceal bleeding: a cohort study. J Hepatol. 2012;57:1207–1213

    Article  PubMed  Google Scholar 

  9. Westaby D, Macdougall BRD, Malia W, Theodossi A, William R. A prospective randomized study of two sclerotherapy techniques for oesophageal varices. Hepatology. 1983;3:681–684

    Article  CAS  PubMed  Google Scholar 

  10. Sarin SK, Sachdeva GK, Nanda R, Vij JC, Anand BS. Endoscopic sclerotherapy using absolute alcohol. Gut. 1985;26:120–124

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Conn HO. Endoscopic sclerotherapy: an analysis of variants. Hepatology 1983;3:769–771

    Article  CAS  PubMed  Google Scholar 

  12. Stiegmann GV, Cambre T, Sun JH. A new endoscopic elastic band ligation device. Gastrointest Endosc. 1986;32:230–123

    Article  PubMed  Google Scholar 

  13. Holderman WH, Etzkorn KP, Patel SA, Harig JM, Watkins JL. Endoscopic findings and overtube-related complications associated with esophageal variceal ligation. J Clin Gastroenterol. 1995;21:91–94

    Article  CAS  PubMed  Google Scholar 

  14. Ramirez FC, Colon VJ, Landan DJ, Grade AJ, Evanich E. The effects of the number of rubber bands placed at each endoscopic session upon variceal outcomes: a prospective, randomized study. Am J Gastroenterol. 2007;102:1372–1376

    Article  PubMed  Google Scholar 

  15. Lo GH, Lai KH. The optimal interval of endoscopic variceal ligation. Hepatology. 2008;47:1429

    Article  PubMed  Google Scholar 

  16. Wang HM, Lo GH, Chen WC, Chan HH, Tsai WL, Yu HC, et al. Randomized controlled trial of monthly versus biweekly endoscopic variceal ligation for the prevention of esophageal variceal rebleeding. J Gastroenterol Hepatol. 2014;29:1229–1236

    Article  PubMed  Google Scholar 

  17. Sheibani S, Khemichian S, Kim JJ, Hou L, Yan AW, Buxbaum J, et al. Randomized trial of 1-week versus 2-week intervals for endoscopic ligation in the treatment of patients with esophageal variceal bleeding. Hepatology. 2016;64:549–555

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. ASGE Standards of Practice Committee. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc. 2014;80:221–227

    Article  Google Scholar 

  19. Soehendra N, Nam VC, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy. 1986;18:25–26

    Article  CAS  PubMed  Google Scholar 

  20. Sung JJY, Yeo W, Suen R, Lee TLYT, Chung SCS, Chan FKL, et al. Injection sclerotherapy for variceal bleeding in patients with hepatocellular carcinoma: cyanoacrylate versus sodium tetradecyl sulfate. Gastrointest Endosc. 1998;47:235–239

    Article  CAS  PubMed  Google Scholar 

  21. D’Amico G, Pietrosi G, Tarantino I, Pagliaro L. Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis: a Cochrane meta-analysis. Gastroenterology. 2003;124:1277–1291

    Article  PubMed  Google Scholar 

  22. Triantos CK, Goulis J, Patch D, Papatheodoridis GV, Leandro G, Samonakis D, et al. An evaluation of emergency sclerotherapy of varices in randomized trials: looking the needle in the eye. Endoscopy. 2006;38:E74–E90

    Article  Google Scholar 

  23. Paquet KJ, Feussner H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial. Hepatology. 1985;5:580–583

    Article  CAS  PubMed  Google Scholar 

  24. Stiegmann GV, Goff JS, Michaletz-Onody PA, Korula J, Lieberman D, Saeed ZA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med. 1992;326:1527–1532

    Article  CAS  PubMed  Google Scholar 

  25. Laine L, El-Newihi HM, Migikovsky B, Solane R, Garcia F. Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices. Ann Intern Med. 1993;119:1–7

    Article  CAS  PubMed  Google Scholar 

  26. Lo GH, Lai KH, Cheng JS, Hwu JH, Chang CF, Chen SM, et al. A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology. 1995;22:466–471

    Article  CAS  PubMed  Google Scholar 

  27. Sarin SK, Govil A, Jain AK, Guptan RC, Issar SK, Jain M, et al. Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence. J Hepatol. 1997;26:826–832

    Article  CAS  PubMed  Google Scholar 

  28. Hou MC, Lin HC, Kuo BI, Chen CH, Lee FY, Lee SD. Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial. Hepatology. 1995;21:1517–1522

    CAS  PubMed  Google Scholar 

  29. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med. 1995;123:280–287

    Article  CAS  PubMed  Google Scholar 

  30. Lo GH, Lai KH, Cheng JS, Lin CK, Huang JS, Hsu PI, et al. Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices. Hepatology. 1997;25:1101–1104

    Article  CAS  PubMed  Google Scholar 

  31. Avgerinos A, Armonis A, Stefanidis G, Mathou N, Vlachogiannakos J, Kougioumtzian A, et al. Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis. Hepatology. 2004;39:1623–1630

    Article  PubMed  Google Scholar 

  32. Laine L, Planas R, Nevens F, Rafael Bañares, David Patch Jaime Bosch. Treatment of the acute bleeding episode. In: de Franchis R. Portal hypertension IV: proceedings of the fourth Baveno International Consensus Workshop. Blackwell Publishing 2006; p 217–242

  33. Chen WC, Lo GH, Tsai WL, Hsu PI, Lin CK, Lai KH. Emergency endoscopic variceal ligation versus somatostatin for acute esophageal variceal bleeding. J Chin Med Assoc. 2006;69:60–67

    Article  PubMed  Google Scholar 

  34. Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M, Ruiz-del-Arbol L, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment of acute variceal bleeding: a meta-analysis. Hepatology. 2002;35:609–615

    Article  PubMed  Google Scholar 

  35. Lo GH, Chen WC, Wang HM, Lin CK, Tsai WL, et al. Low-dose terlipressin plus banding ligation vs. low-dose terlipressin alone in the prevention of very early rebleeding of esophageal varices. Gut. 2009;58:1275–1280

    Article  CAS  PubMed  Google Scholar 

  36. Villanueva C, Piqueras M, Aracil C, Gomez C, López-Balaguer JM, Gonzalez B, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol. 2006;45:560–567

    Article  PubMed  Google Scholar 

  37. de Franchis R, Primignani M. Endoscopic treatments for portal hypertension. Sem Liver Dis. 1999;19:439–455

    Article  Google Scholar 

  38. Lo GH, Lai KH, Shen MT, Chang CF. A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices. Gastrointest Endosc. 1994;40:675–679

    CAS  PubMed  Google Scholar 

  39. Hou MC, Lin HC, Lee FY, Chang FY, Lee SD. Recurrence of esophageal varices following endoscopic treatment and its impact on rebleeding: comparison of sclerotherapy and ligation. J Hepatol. 2000;32:202–208

    Article  CAS  PubMed  Google Scholar 

  40. Bernard B, Lebrec D, Mathurin P, Opolon P, Poynard T. Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis. J Hepatol. 1997;26:312–324

    Article  CAS  PubMed  Google Scholar 

  41. Villanueva C, Balanzo J, Novella MT, Soriano G, Sáinz S, Torras X, et al. Nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rebleeding. N Engl J Med. 1996;334:1624–1629

    Article  CAS  PubMed  Google Scholar 

  42. Villanueva C, Minyana J, Ortiz J, Gallego A, Soriano G, Torras X, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal rebleeding. N Engl J Med. 2001;345:647–655

    Article  CAS  PubMed  Google Scholar 

  43. Lo GH, Chen WC, Chen MH, Lin CP, Lo CC, Hsu PI, et al. A prospective, randomized trial of endoscopic variceal ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding. Gastroenterology. 2002;123:728–734

    Article  PubMed  Google Scholar 

  44. Patch D, Sabin CA, Goulis J, Gerunda G, Greenslade L, Merkel C, et al. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology. 2002;123:1013–1019

    Article  CAS  PubMed  Google Scholar 

  45. Romero G, Kravetz D, Argonz J, Vulcano C, Suarez A, Fassio E, et al. Comparative study between nadolol and 5-isosorbide mononitrate vs. endoscopic band ligation plus sclerotherapy in the prevention of variceal rebleeding in cirrhotic patients: a randomized controlled trial. Aliment Pharmacol Ther. 2006;24:601–611

    Article  CAS  PubMed  Google Scholar 

  46. Sarin SK, Wadhawan M, Gupta R, Shahi H. Evaluation of endoscopic variceal ligation (EVL) versus propanolol plus isosorbide mononitrate/nadolol (ISMN) in the prevention of variceal rebleeding: comparison of cirrhotic and noncirrhotic patients. Dig Dis Sci. 2005;50:1538–1547

    Article  PubMed  Google Scholar 

  47. Ahmad I, Khan AA, Alam A, Butt AK, Shafqat F, Sarwar S. Propranolol, isosorbide mononitrate and endoscopic band ligation—alone or in varying combinations for the prevention of esophageal variceal rebleeding. JCPSP. 2009;19:283–286

    PubMed  Google Scholar 

  48. Garcia-Pagan JC, Bosch J. Endoscopic band ligation in the treatment of portal hypertension. NCP Gastroenterol Hepatol. 2005;2:526–535

    Google Scholar 

  49. Lo GH, Chen WC, Lin CK, Tsai WL, Chan HH, Chen TA, et al. Improved survival in patients receiving medical therapy as compared with banding ligation for the prevention of esophageal variceal rebleeding. Hepatology. 2008;48:580–587

    Article  PubMed  Google Scholar 

  50. Lo GH, Lai KH, Cheng JS, Huang RL, Wang SJ, Chiang HT. Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy. Gastrointest Endosc. 1999;49:428–436

    Article  CAS  PubMed  Google Scholar 

  51. Singh P, Pooran N, Indaram A, Bank S. Combined ligation and sclerotherapy versus ligation alone for secondary prophylaxis of esophageal variceal bleeding: a meta-analysis. Am J Gastroenterol. 2002;97:623–629

    Article  PubMed  Google Scholar 

  52. Lo GH, Lai KH, Cheng JS, Lin CK, Huang JS, Hsu PI, et al. The additive effect of sclerotherapy to patients receiving repeated endoscopic variceal ligation: a prospective, randomized trial. Hepatology. 1998;28:391–395

    Article  CAS  PubMed  Google Scholar 

  53. Cheng YS, Pan S, Lien GS, Suk FM, Wu MS, Chen JN, et al. Adjuvant sclerotherapy after ligation for the treatment of esophageal varices: a prospective, randomized long-term study. Gastrointest Endosc. 2001;53:566–571

    Article  CAS  PubMed  Google Scholar 

  54. Nakamura S, Mitsunaga A, Murata Y, Suzuki S, Hayashi N. Endoscopic induction of mucosal fibrosis by argon plasma coagulation (APC) for esophageal varices: a prospective randomized trial of ligation plus APC vs. ligation alone. Endoscopy. 2001;33:210–215

    Article  CAS  PubMed  Google Scholar 

  55. Cipolletta L, Bianco MA, Rotondano G, Marmo R, Meucci C, Piscopo R. Argon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial. Gastrointest Endosc. 2002;56:467–471

    Article  PubMed  Google Scholar 

  56. Lo GH, Lai KH, Cheng JS, Chen MH, Huang HC, Hsu PI, et al. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology. 2000;32:461–465

    Article  CAS  PubMed  Google Scholar 

  57. De la Pena J, Brullet E, Sanchez-Hernandez E, Rivero M, Vergara M, Martin-Lorente JL, et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology. 2005;41:572–578

    Article  PubMed  Google Scholar 

  58. Gonzalez R, Zamora J, Gomez-Camarero J, Molinero LM, Bañares R, Albillos A. Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis. Ann Intern Med. 2008;15(149):109–122

    Article  Google Scholar 

  59. Lo GH, Chen WC, Chen MH, Tsai WL, Hsu PI, Lin CK, et al. A randomized, controlled trial of banding ligation plus drug therapy vs drug therapy alone in the prevention of esophageal variceal rebleeding. J Gastroenterol Hepatol. 2009;24:982–987

    Article  CAS  PubMed  Google Scholar 

  60. Puente A, Hernandez-Gea V, Graupera I, Roque M, Colomo A, Poca M, et al. Drugs plus ligation to prevent rebleeding in cirrhosis: an updated systematic review. Liver Int. 2014;34:823–833

    Article  PubMed  Google Scholar 

  61. Sanyal AJ, Freedman AM, Luketic VA, Purdum PP, Shiffman ML, Tisnado J, et al. Transjugular intrahepatic portosystemic stent shunt compared with endoscopic therapy for the prevention of recurrent variceal hemorrhage: a randomized, controlled trial. Ann Intern Med. 1997;126:849–857

    Article  CAS  PubMed  Google Scholar 

  62. Jalan R, Forrest EH, Stanley AJ, Redhead DN, Forbes J, Dillon JF, et al. A randomized trial comparing transjugular intrahepatic portosystemic stent shunt with variceal band ligation in the prevention of rebleeding from esophageal varices. Hepatology. 1997;26:1115–1122

    CAS  PubMed  Google Scholar 

  63. Papatheodoridis G, Goulis J, Leandro G, Patch D, Burroughs AK. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding. Heptology. 1999;30:612–622

    Article  CAS  Google Scholar 

  64. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology. 2001;120:726–748

    Article  CAS  PubMed  Google Scholar 

  65. de Franchis R, Eisen GM, Laine L, Fernandez-Urien I, Herrerias JM, Brown RD, et al. Esophageal capsule endoscopy for screening and surveillance of esophageal varices in patients with portal hypertension. Hepatology. 2008;47:1595–1603

    Article  PubMed  Google Scholar 

  66. Wang HM, Lo GH, Chen WC, Hsu PI, Yu HC, Lin CK, et al. Efficacy of transient elastography in screening for large esophageal varices in patients with suspicious or proven liver cirrhosis. J Dig Dis. 2012;13:430–438

    Article  PubMed  Google Scholar 

  67. The Veterans Affairs Cooperative Variceal Sclerotherapy Group. Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease. A randomized, single-blind, multicenter clinical trial. N Engl J Med. 1991;324:1779–1784

    Article  Google Scholar 

  68. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology. 2001;33:802–807

    Article  CAS  PubMed  Google Scholar 

  69. Sarin SK, Lamba GS, Kumar M, Misra A, Murthy NS. Comparison of endoscopic ligation and propranolol for primary prevention of variceal bleeding. N Engl J Med. 1999;340:988–993

    Article  CAS  PubMed  Google Scholar 

  70. Lo GH, Chen WC, Chen MH, Lin CP, Lo CC, Hsu PI, et al. Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis. Gastrointest Endosc. 2004;59:333–338

    Article  PubMed  Google Scholar 

  71. Schepke M, Kleber G, Niirnberg D, Willert J, Koch L, Wilfried VS, et al. Ligation vs. propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2004;40:65–72

    Article  PubMed  Google Scholar 

  72. Jutabha R, Jensen DM, Martin P, Savides T, Han S-H, Gornbein J. Randomized study comparing banding and propranolol to prevent initial variceal hemorrhage in cirrhotics with high risk esophageal varices. Gastroenterology. 2005;128:870–881

    Article  CAS  PubMed  Google Scholar 

  73. Khuroo MS, Khuroo NS, Farahat KL, Khuroo YS, Sofi AA, Dahab ST. Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther. 2005;21:347–361

    Article  CAS  PubMed  Google Scholar 

  74. Tripathi D, Ferguson JW, Kochar N, Leithead JA, Therapondos G, Mcavoy N, et al. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleeding. Hepatology. 2009;50:825–833

    Article  CAS  PubMed  Google Scholar 

  75. Svoboda P, Kantorova I, Ochmann J, Kozumplik L, Marsova J. A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices. Surg Endosc. 1999;13:580–584

    Article  CAS  PubMed  Google Scholar 

  76. Sarin SK, Wadhawan M, Agarwal SR, Tyagi P, Sharma BC. Endoscopic variceal ligation plus propranolol vs. endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. Am J Gastroenterol. 2005;100:797–804

    Article  PubMed  Google Scholar 

  77. Lo GH, Chen WC, Wang HM, Lee CC. A controlled trial of ligation plus nadolol vs. nadolol alone for the prevention of first variceal bleeding. Hepatology. 2010;52:230–237

    Article  CAS  PubMed  Google Scholar 

  78. Sarin SK, Primignani M, Agarwal SR. Gastric varices. In: de Franchis R, editor. Portal hypertension III. In: Proceedings of the third Baveno International Consensus Workshop on definitions, methodology and therapeutic strategies. Oxford: Blackwell, Science 2001; 76–96

  79. Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc. 1986;32:264–268

    Article  CAS  PubMed  Google Scholar 

  80. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in management of bleeding gastric varices. Hepatology. 2001;33:1060–104

    Article  CAS  PubMed  Google Scholar 

  81. Tan PC, Hou MC, Lin HC, Liu TT, Lee FY, Chang FY, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology. 2006;43:690–697

    Article  PubMed  Google Scholar 

  82. Tantau M, Crisan D, Popa D, Vesa S, Tantau A. Band ligation vs. N-butyl-2-cyanoacrylate injection in acute gastric variceal bleeding: a prospective follow-up study. Ann Hepatol. 2013;13:75–83

    PubMed  Google Scholar 

  83. Qiao W, Ren Y, Bai Y, Liu S, Zhang Q, Zhi F. Cyanoacrylate injection versus band ligation in the endoscopic management of acute gastric variceal bleeding: meta-analysis of randomized, controlled studies based on the PRISMA statement. Medicine (Baltimore). 2015;94:e1725

    Article  Google Scholar 

  84. Garcia-Pagan JC, Barrufet M, Cardenas A, Escorsell A. Management of gastric varices. Clin Gastroenterol Hepatol. 2014;12:919–928

    Article  PubMed  Google Scholar 

  85. Lo GH, Lai KH. Should GOV1 be treated as for esophageal varices? Gastroenterology. 2004;127:1014–105 (letter)

    Article  PubMed  Google Scholar 

  86. Lo GH, Lin CW, Perng DS, Chang CY, Lee CT, Hsu CY, et al. A retrospective comparative study of histoacryl injection and banding ligation in the treatment of acute type 1 gastric variceal hemorrhage. Scand J Gastroenterol. 2013;48:1198–1204

    Article  PubMed  Google Scholar 

  87. Hung HH, Chang CJ, Hou MC, Liao WC, Chan CC, Huang HC, et al. Efficacy of non-selective β-blockers as adjunct to endoscopic prophylactic treatment for gastric variceal bleeding: a randomized controlled trial. J Hepatol. 2012;56:1025–1032

    Article  CAS  PubMed  Google Scholar 

  88. Mahadeva S, Bellamy MC, Kessel D, Davies MH, Millson CE. Cost-effectiveness of N-butyl-2-cyanoacrylate (histoacryl) glue injections versus transjugular intrahepatic portosystemic shunt in the management of acute gastric variceal bleeding. Am J Gastroenterol. 2003;98:2688–2693

    Article  CAS  PubMed  Google Scholar 

  89. Procaccini NJ, Al-Osaimi AM, Northup P, Argo C, Caldwell SH. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc. 2009;70:881–887

    Article  PubMed  Google Scholar 

  90. Lo GH, Liang HL, Chen WC, Chen MH, Lai KH, Hsu PI, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt vs. cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007;39:679–685

    Article  PubMed  Google Scholar 

  91. Bai M, Qi XS, Yang ZP, Wu KC, Fan DM, Han GH. EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis: a meta-analysis. World J Gastrointest Pharmacol Ther. 2014;5:97–104

    Article  PubMed  PubMed Central  Google Scholar 

  92. McAvoy NC, Plevris JN, Hayes PC. Human thrombin for the treatment of gastric and ectopic varices. World J Gastroenterol. 2012;7:5912–5917

    Article  Google Scholar 

  93. Mishra SR, Sharma BC, Kumar A, Sarin SK. Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. J Hepatol. 2011;54:1161–1167

    Article  CAS  PubMed  Google Scholar 

  94. Gunnerson AC, Diehl DL, Nguyen VN, Shellenberger MJ, Blansfield J. Endoscopic duodenal variceal ligation: a series of 4 cases and review of the literature. Gastrointest Endosc. 2012;76:900–904

    Article  PubMed  Google Scholar 

  95. Sato T, Yamazaki K, Akaike J, Toyota J, Karino Y, Ohmura T. Retrospective analysis of endoscopic injection sclerotherapy for rectal varices compared with band ligation. Clin Exp Gastroenterol. 2010;3:159–163

    Article  PubMed  PubMed Central  Google Scholar 

  96. Schafer TW, Binmoeller KF. Argon plasma coagulation for the treatment of colonic varices. Endoscopy. 2002;34:661–663

    Article  CAS  PubMed  Google Scholar 

  97. Lo GH, Lai KH, Cheng JS, Hsu PI, Chen TA, Wang EM, et al. The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective controlled trial. Gastrointest Endosc. 2001;53:579–584

    Article  CAS  PubMed  Google Scholar 

  98. Sarin SK, Streenlvas DV, Lahoti D, Saraya A. Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension. Gastroenterology. 1992;102:994–999

    Article  CAS  PubMed  Google Scholar 

  99. Patwardhan VR, Cardenas A. The management of portal hypertensive gastropathy and gastric antral vascular ectasia in cirrhosis. Aliment Pharmacol Ther. 2014;40:354–362

    Article  CAS  PubMed  Google Scholar 

  100. Smith LA, Morris AJ, Stanley AJ. The use of hemospray in portal hypertensive bleeding: a case series. J Hepatol. 2014;60:457–460

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Research, E-Da Hospital, Kaohsiung, School of Medicine for International Students, I-Shou University, 1, Yi-Da Road, Kaohsiung, 824, Taiwan

    Gin-Ho Lo

Authors
  1. Gin-Ho Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gin-Ho Lo.

Ethics declarations

Funding

This study was not funded.

Conflict of Interest

Gin-Ho Lo declares that he has no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by the author.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lo, GH. Endoscopic treatments for portal hypertension. Hepatol Int 12 (Suppl 1), 91–101 (2018). https://doi.org/10.1007/s12072-017-9828-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-017-9828-8

Keywords

Search

Navigation