Skip to main content
SpringerLink
Log in

Comment traiter une hémorragie digestive active liée à des varices oesophagiennes et gastriques

Treatment of acute variceal bleeding

  • Hypertension Portale Portal Hypertension
  • Published:
Acta Endoscopica

Résumé

Les hémorragies digestives de l’hypertension portale sont surtout liées aux ruptures de varices œsophagiennes. Leur pronostic reste sévère, lié à l’hémorragie index et à la récidive hémorragique précoce. Elles nécessitent une prise en charge en urgence dans une unité spécialisée. L’endoscopie initiale, une fois le malade réanimé, permet de diagnostiquer leur étiologie et le plus souvent d’effectuer un geste hémostatique. Leur traitement en urgence repose sur des médicaments vaso-actifs et/ou des techniques endoscopiques. Les traitements médicamenteux sont représentés par des médicaments diminuant le flux sanguin portal comme la vasopressine et la terlipressine ou le flux sanguin azygos comme la somatostatine et l’octréotide. Ils peuven être utilisés avant, pendant et après l’endoscopie et peuvent améliorer la prise en charge thérapeutique. En cas d’hémorragie active, la sclérose peut être préférée à la ligature car de réalisation plus facile. La ligature peut être envisagée d’emblée dans le cas inverse. C’est seulement en cas d’échec que les techniques de radiologie interventionnelle ou la chirurgie sont indiquées. Pour les varices gastriques, la sclérose à la colle biologique est actuellement recommandée. La prévention des infections bactériennes par une antibioprophylaxie doit être systématique.

Summary

Variceal haemorrhage is one of the most serious complication of portal hypertension and is associated with a high mortality rate related to index bleeding and early variceal rebleeding. After initial resuscitation in a unit dedicated to gastrointestinal bleeding, emergency endoscopy is conducted to determine the cause of bleeding and generally to perform sclerotherapy or band ligation. Vasoactive drugs which lower portal hypertension like vasopressin and terlipressin or azygos blood flow like somatosatin and octreotide can be used before, during and after endoscopy and may offer an improvement in treatment. Sclerotherapy is generally the treatment of choice in cases of active bleeding. Band ligation is preferred in other cases. When these treatments failed, transjugular intrahepatic portosystemic shunt or surgery are discussed For gastric varices, sclerotherapy with tissue adhesives is the treatment of choice. The prevention of bacterial infection by antibotics must be associated.

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

Références

  1. BRROUGHS A.K., MEZZANOTTE G., PHILIPS A., McCORMICK P.A., McINTYRE, N. — Cirrhotics with variceal hemorrhage: the importance of the time interval between admission and the start of analysis for survival and rebleeding rates.Hepatology, 1989,9, 801–806.

    Article  Google Scholar 

  2. BERNARD B., GRANGE J.D., NGUYEN KHAC E., AMIOT X, OPOLON P., POYNARD T. — Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta analysis.Hepatology, 1999,29, 1655–1661.

    Article  CAS  PubMed  Google Scholar 

  3. Club Francophone pour l’Etude de l’Hypertension Portale: Cales P., Castaing D., Grangé J.D., Lebrec D., Lemoine O., Roynard, T.et al. — Traitement de l’hypertension portale. Recommandations.Gastroenterol. Clin. Biol., 1999,23, 353–354.

    Google Scholar 

  4. SUNG J.J.Y., CHUNG S.C.S. — The use of a detachable miniloop for the treatment of esophageal varices.Gastrointestin. Endsoc., 1998,47, 178–181.

    Article  CAS  Google Scholar 

  5. KOUTSOMANIS D., SEBTI M.F., ESSAID A. — A randomized study of endoscopic haemostatic clipping versus endoscopic variceal ligation (Abstract).Gastroenterology, 1995,108, A630.

    Google Scholar 

  6. D’AMICO G., PAGLIARO L., BOSCH J. — Pharmacological treatment of portal hypertension: an evidence-based approach.Semin. Liver. Dis., 1999,19, 475–505.

    Article  PubMed  Google Scholar 

  7. LEVACHER S., LETOURMELLIN P., PATERON D., BLAISE M., LAPANDRY C., POURRIAT J.L. — Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients.Lancet, 1995,346, 865–868.

    Article  CAS  PubMed  Google Scholar 

  8. JUNQUERA F., LOPEZ-TALAVERA J.C., MEARIN F., SAPERAS E., VIDELA S., ARMENGOL J.R.et al. — Somatostatin plus isosorbide 5-mononitrate versus somatosatin in the control of acute gastro-oesophageal variceal bleeding: a double blind, randomised, placebo controlled trial.Gut, 2000,46, 127–132.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. SILVAIN C., CARPENTIER S., SAUTEREAU D., CZERNICHOW B., METREAU J.M., FORT E.et al. — Terlipressin plus transermal nitroglycerinvs octreotide in the control of acute bleeding from esophageal varices: a multicenter randomized trial.Hepatology, 1993,18, 61–65.

    CAS  PubMed  Google Scholar 

  10. PEDRETTI G., ELIA G., CALZETTI C., MAGNANI G., FIACCADORI F. — Octreotide verus terlipressin in the acute variceal hemorrhage in liver cirrhosis. Emergency control and prevention of early rebleeding.Clin. Invest., 1994,72, 653–659.

    Article  CAS  Google Scholar 

  11. DE FRANCHIS R., PRIMIGNANI M. — Endoscopic treatments for portal hypertension.Semin. Liver. Dis., 1999,19, 439–455.

    Article  PubMed  Google Scholar 

  12. SHIELDS R., JENKINS S.A., BAXTER J.N., KINGSNORTH A.N., ELLENBOGEN S., MAKIN C.A.et al. — A prospective randomised controlled trial comparing the efficacy of somatostatin with injection sclerotherapy in the control of bleeding esophageal varices.J. Hepatol., 1992,16, 128–137.

    Article  CAS  PubMed  Google Scholar 

  13. PLANAS R., QUER J.C., BOIX J., CANET J., ARMENGOL M., CABRE E.et al. — A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding.Hepatology, 1994,20, 37–375.

    Article  Google Scholar 

  14. DI FEBO C., SIRINGO M., VACIRCA M., SANTORO P., MERIGHI S., MSTAFA A.et al. — Somatosatin (SMS) and urgent sclerotherapy in active oesophageal variceal bleeding.Gastroenterology, 1990,98, 583.

    Google Scholar 

  15. LO G.H., LAI K.H., CHENG J.S., LIN C.K., HUANG J.S., HSU P.I.et al. — Emergency banding ligation versus sclerotherapy for the treatment for control of active bleeding from esophageal varices.Hepatology, 1997,25, 1101–1104.

    Article  CAS  PubMed  Google Scholar 

  16. BESSON I., INGRAND P., PERSON B., BOUTROUX D., HERESBACH D., BERNARD P.et al. — Sclerotherapy with or without octreotide for acute variceal bleeding.N. Engl. J. Med., 1995,333, 555–560.

    Article  CAS  PubMed  Google Scholar 

  17. French Club For the Study of PHT, CALES P. — Early administration of vapreotide, a new somatostatin analogue, and endoscopic therapy for acute hypertensive bleeding in patients with cirrhosis. A randomised trial (Abst.).Hepatology, 1999,30, 419A.

    Article  Google Scholar 

  18. SUNG J.J.Y., CHUNG S., YUNG M.Y.et al. — Prospective randomized study of effect of octreotide on rebleeding after endoscopic ligation.Lancet, 1995,346, 1666–1669.

    Article  CAS  PubMed  Google Scholar 

  19. AVGERINOS A., NEVENS F., RAPTIS S., FEVERY J., the above study Group. — Early administration of natural somatosatin increases the efficacy of sclerotherapy in acute bleeding esophageal variceal episodes. The European above study.Lancet, 1997,350, 1495–1499.

    Article  CAS  PubMed  Google Scholar 

  20. BRUNATI S., CERJANI R., CURIONI R., BRUNELLI L., REPACI G., MORINI L. — Sclerotherapy alonevs sclerotherapy plus terlipressinvs sclerotherapy plus octreotide in the treatment of acute variceal hemorrhage (Abst).Hepatology, 1996,24, 207A.

    Google Scholar 

  21. SIGNORELLI S., NEGRINI F., PARIS B., BONELLI M., GIROLA M. — Sclerotherapy with or without somatostatin or octreotide in the treatment of acute variceal hemorrhage: our experience. (Abst).Gastrenterology, 1996,110, A1236.

    Google Scholar 

  22. SUNG J.J.Y., YEO W., SUEN R. — Injection sclerotherapy for variceal bleeding in patients with hepatocellular carcinoma: cyanoacrylate versus sodium tetradecyl sulfate.Gastrointestin. Endosc., 1998,47, 235–239.

    Article  CAS  Google Scholar 

  23. SUNG J.J.Y., LEE Y.T., SUEN R., CHUNG S.C.S. — Banding is superior to cyanoacrylate for the treatment of esophageal variceal bleeding: a prospective randomized study (abst).Gastrointesti Endosc., 1998,47, AB77.

    Google Scholar 

  24. THAKEB F., SALAMA Z., SALAM H., ABDEL RAUF T., ABDEL KADER S., ABDEL HAMID S. — The value of combined use ofN-butyl-2-cyano-acrylate and ethanolamine in the management of esophagogastric varices.Endoscopy, 1995,27, 358–364

    Article  CAS  PubMed  Google Scholar 

  25. FERETIS C., DIMOPOULOS C., BENAKIS P., KALLIAK-MANIS B., APOSTOLIDIS N. —N-butyl-2-cyano-acrylate (Histoacryl) plus sclerotherapyvs sclerotherapy alone in the treatment of bleeding esophageal varices: a randomized prospective study.Endoscopy, 1995,27, 355–357.

    Article  CAS  PubMed  Google Scholar 

  26. SARIN S.K. — Long-term follow up of gastric variceal sclero-therapy: an eleven-year experience.Gastrointestin. Endosc., 1997,46, 8–14.

    Article  CAS  Google Scholar 

  27. OHO K., IWAO T., SUMINO M., TOYONAGA A., TANIKAWA K. — Ethanolamine oleate versus butyl-cyanoacrylate for bleeding gastric varices: a non randomised study.Endoscopy, 1995,27, 349–354.

    Article  CAS  PubMed  Google Scholar 

  28. CIPOLETTA L., BIANCO M.A., ROTONDANO G., PSCOPO R., PRISCO A., GAROFANO M.L. — Emergency endoscopic ligation of actively bleeding gastric varices with a detachable snare.Gastrointestin. Endosc., 1998,47, 400–403.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Christine SILVAIN Service d’Hépato-Gastroentérologie et d’Assistance Nutritive, CHU Jean Bernard, 86021, Poitiers Cedex, France

    Christine Silvain

Authors
  1. Christine Silvain
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine Silvain.

About this article

Cite this article

Silvain, C. Comment traiter une hémorragie digestive active liée à des varices oesophagiennes et gastriques. Acta Endosc 30, 505–510 (2000). https://doi.org/10.1007/BF03026167

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03026167

Mots-clés

Key-words

Search

Navigation