Acute bleeding from oesophageal varices
Authors:
P. Drastich
Authors‘ workplace:
Klinika hepatogastroenterologie IKEM, Praha, Přednosta: prof. MUDr. Julius Špičák, CSc.
Published in:
Prakt. Lék. 2012; 92(9): 494-498
Category:
Various Specialization
Overview
Urgent endoscopic sclerotherapy or ligation at the time of initial diagnostic endoscopy, represent the gold standard of care for patients with liver cirrhosis and bleeding esophageal varices following resuscitation measures leading to hemodynamic stability. Terlipressin and somatostatin are vasoactive drugs of choice and they should be given to patients with suspected variceal bleeding before admission or, at the latest, immediately after admission to hospital and prior to endoscopic treatment. Further studies are necessary to evaluate the role of tissue or fibrin glue in patients without adequate answers to the administration of vasoactive drugs and endoscopic therapy. Due to a favorable effect on short-term survival, antibiotic treatment is an integral part of the therapy for bleeding in patients with liver cirrhosis; their administration is initiated immediately after admission to hospital. In the case of uncontrolled bleeding the emergency introduction of TIPS (transjugular intrahepatic portosystemic shunt) using coated metallic stent represent a rescue therapy. We are waiting for results of further randomized controlled studies that will examine the role of metallic esophageal stents compared with standard therapy, especially with ligation and TIPS.
Key words:
acute bleeding from oesophageal varices, portal hypertension, liver cirrhosis.
Sources
1. Feu, F., García-Pagán, J.C., Bosch, J., et al.: Relation between portal pressure response to pharmacotherapy and risk of reccurent variceal haemorrhage in patients with cirrhosis. Lancet, 1995; 346(8982), p.1056–1059.
2. Levacher, S., Letoumelin, P., Pateron, D., et al.: Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet, 1995; 346(8979), p. 865–868.
3. Avgerinos, A., Nevens, F., Raptis, S., Fevery, J.: Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial. Lancet, 1997; 350(9090), p. 1495–1499.
4. Bañares, R., Albillos, A., Rincón, D., et al.: Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a metaanalysis. Hepatology, 2002, 35(3), p. 609–615.
5. de Franchis, R., Baveno V Faculty.: Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010, 53(4), p. 762–768.
6. D’Amico, G., Pagliaro, L., Bosch, J.: The treatment of portal hypertension: a metaanalytic review. Hepatology, 1995, 22(1), p. 332–354.
7. Bosch, J., Groszmann, R.J., García-Pagán, J.C., et al.: Association of transdermal nitroglycerin to vasopressin infusion in the treatment of variceal hemorrhage: a placebo-controlled clinical trial. Hepatology, 1989, 10(6), p. 962–968.
8. Bosch, J., García-Pagán, J.C.: Complications of cirrhosis. I. Portal hypertension. J Hepatol, 2000; 32(1 Suppl), p. 141–156.
9. D’Amico, G., Pagliaro, L., Bosch, J.: Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis, 1999, 19(4), p. 475–505.
10. Bosch, J., Lebrec, D., Jenkins, S.A. Development of analogues: successes and failures. Scand J Gastroenterol Suppl, 1998, 226, p. 3–13.
11. Escorsell, A., Ruiz del Arbol, L., Planas, R., et al.: Multicenter randomized controlled trial of terlipressin versus sclerotherapy in the treatment of acute variceal bleeding: the TEST study. Hepatology, 2000, 32(3), p. 471–476.
12. Ioannou, G., Doust, J., Rockey, D.C.: Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev, 2001, (1), CD002147.
13. Feu, F., Ruiz del Arbol, L., Bañares, R., et al.: Double-blind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage. Variceal Bleeding Study Group. Gastroenterology, 1996, 111(5), p. 1291–1299.
14. Bruha, R., Marecek, Z., Prochazka, V., et al.: Double-blind randomized multicenter study comparing the efficacy and safety of 10-day to 5-day terlipressin treatment of bleeding esophageal varices. Hepatogastroenterology, 2009, 56(90), p. 390–394.
15. Moreau, R., Durand, F., Poynard, T., et al.: Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology, 2002, 122(4), p.923–930.
16. Ioannou, G.N., Doust, J., Rockey, D.C.: Systematic review: terlipressin in acute oesophageal variceal haemorrhage. Aliment Pharmacol Ther, 2003, 17(1), p. 53–64.
17. Freeman, J.G., Cobden, I., Record, C.O.: Placebo-controlled trial of terlipressin (glypressin) in the management of acute variceal bleeding. J Clin Gastroenterol, 1989, 11(1), p.58–60.
18. Söderlund, C., Magnusson, I., Törngren, S., Lundell, L.: Terlipressin (triglycyl-lysine vasopressin) controls acute bleeding oesophageal varices. A double-blind, randomized, placebo-controlled trial. Scand J Gastroenterol, 1990, 25(6), p. 622–630.
19. Sonnenberg, G.E., Keller, U., Perruchoud, A., et al.: Effect of somatostatin on splanchnic hemodynamics in patients with cirrhosis of the liver and in normal subjects. Gastroenterology, 1981, 80(3), p.526–532.
20. Bosch, J., Kravetz, D., Rodes, J.: Effects of somatostatin on hepatic and systemic hemodynamics in patients with cirrhosis of the liver: comparison with vasopressin. Gastroenterology, 1981,80(3), p.518–525.
21. Bosch, J., Kravetz, D., Mastai, R., et al.: Effects of somatostatin in patients with portal hypertension. Horm Res, 1988, 29 (2-3), p. 99–102.
22. Moitinho, E., Planas, R., Bañares, R., et al.: Multicenter randomized controlled trial comparing different schedules of somatostatin in the treatment of acute variceal bleeding. J Hepatol, 2001, 35(6), p.712–718.
23. Burroughs, A.K., McCormick, P.A., Hughes, M.D., et al.: Randomized, double-blind, placebo-controlled trial of somatostatin for variceal bleeding. Emergency control and prevention of early variceal rebleeding. Gastroenterology, 1990, 99(5), p.1388–1395.
24. Gøtzsche, P.C., Gjørup, I., Bonnén, H., et al.: Somatostatin v placebo in bleeding oesophageal varices: randomised trial and metaanalysis. BMJ, 1995, 310(6993), p.1495–1498.
25. Valenzuela, J.E., Schubert, T., Fogel, M.R., et al.: A multicenter, randomized, double-blind trial of somatostatin in the management of acute hemorrhage from esophageal varices. Hepatology, 1989, 10(6), p.958–961.
26. Jenkins, S.A., Baxter, J.N., Corbett, W.A., Shields, R.: Effects of a somatostatin analogue SMS 201-995 on hepatic haemodynamics in the pig and on intravariceal pressure in man. Br J Surg, 1985, 72(12), p.1009–1012.
27. McCormick, P.A., Biagini, M.R., Dick, R., et al.: Octreotide inhibits the meal-induced increases in the portal venous pressure of cirrhotic patients with portal hypertension: a double-blind, placebo-controlled study. Hepatology, 1992, 16(5), p.1180–1186.
28. Abraldes, J.G., Bosch, J.: Somatostatin and analogues in portal hypertension. Hepatology, 2002, 35(6), p.1305–1312.
29. Escorsell, A., Bandi, J.C., Andreu, .V, et al.: Desensitization to the effects of intravenous octreotide in cirrhotic patients with portal hypertension. Gastroenterology, 2001,120(1), p. 161–169.
30. Burroughs, A.: International Octreotide Varices Study Group. Double blind RCT of 5 day octreotide versus placebo, associated with sclerotherapy for trial failures (abstract). Hepatology, 1996, 24, 352A.
31. D’Amico, G., Politi, F., Morabito, A., et al.: Octreotide compared with placebo in a treatment strategy for early rebleeding in cirrhosis. A double blind, randomized pragmatic trial. Hepatology, 1998, 28(5), p.1206–1214.
32. Primignani, M., Andreoni, B., Carpinelli, L., et al.: Sclerotherapy plus octreotide versus sclerotherapy alone in the prevention of early rebleeding from esophageal varices: a randomized, double-blind, placebo-controlled, multicenter trial. New Italian Endoscopic Club. Hepatology, 1995, 21(5), p.1322–1327.
33. Morales, G.F., Pereira Lima, J.C., Hornos, A.P., et al.: Octreotide for esophageal variceal bleeding treated with endoscopic sclerotherapy: a randomized, placebo-controlled trial. Hepatogastroenterology, 2007, 54(73), p.195–200.
34. Triantos, C., Goulis, J., Burroughs, A.K.: Portal hypertensive bleeding. Evidence-based gastroenterology and hepatology. 3rd edition. Oxford:Blackwell; 2010, p.562–602.
35. Hubmann, R., Bodlaj, G., Czompo, M., et al.: The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy, 2006,38(9), p.896–901.
36. Zehetner, J., Shamiyeh, A., Wayand, W. et al.: Result of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surgical endoscopy and other interventional techniques, 2008, 22(10), p.2149–2152.
37. Wright, G., Lewis, H., Hogan, B., et al.: A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc, 2010, 71(1), p.71–78.
38. Soares-Weiser, K., Brezis, M., Tur-Kaspa, R., Leibovici, L.: Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev, 2002, (2):CD002907.
39. Deschênes, M., Villeneuve, J.P.: Risk factors for the development of bacterial infections in hospitalized patients with cirrhosis. Am J Gastroenterol, 1999, 94(8), p.2193–2197.
40. Bernard, B., Grangé, J.D., Khac, E.N.: Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a metaanalysis. Hepatology, 1999, 29(6), p.1655–1661.
41. Soares-Weiser, K., Brezis, M., Tur-Kaspa, R.: Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: a metaanalysis of randomized controlled trials. Scand J Gastroenterol, 2003, 38(2), p.193–200.
42. Hou, M.C., Lin, H.C., Liu, T.T., et al.: Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology, 2004, 39(3), p.746–753.
43. Fernández, J., Ruiz del Arbol, L., Gómez, C.: Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology, 2006, 131(4), p.1049–1056.
44. Bosch, J., Thabut, D., Albillos, A., et al.: Recombinant factor VIIA (RFVIIA) for active variceal bleeding in patients with advanced cirrhosis: a multi-centre randomized double-blind placebo-controlled trial. J Hepatol 2007, 46(Suppl 1), p.295.
45. Bosch, J., Thabut, D., Albillos, A., et al.: Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial. Hepatology, 2008, 47(5), p.1604–1614.
46. Hartigan, P.M., Gebhard, R.L., Gregory, P.B.: Sclerotherapy for actively bleeding esophageal varices in male alcoholics with cirrhosis. Veterans Affairs Cooperative Variceal Sclerotherapy Group. Gastrointest Endosc, 1997, 46(1), p.1–7.
47. Gimson, A.E., Ramage, J.K., Panos, M.Z., et al.: Randomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices. Lancet, 1993, 342(8868), p.391–394.
48. Hou, M.C., Lin, H.C., Kuo, B.I., et al.: Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial. Hepatology, 1995, 21(6), p.1517–1522.
49. Djurdjevic, D., Janosevic, S., Dapcevic, B., et al.: Combined ligation and sclerotherapy versus ligation alone for eradication of bleeding esophageal varices: a randomized and prospective trial. Endoscopy, 1999, 31(4), p.286–290.
50. Drastich, P., Špičák, J.: Ligace v léčbě krvácejících jícnových varixů. Bulletin HPB Chirurgie, 1998, roč. 6, č. 2-3, s. 22–24.
51. Moitinho, E., Escorsell, A., Bandi, J.C., et al.: Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology, 1999, 117(3), p.626-631.
52. Vangeli, M., Patch, D., Burroughs, A.K.: Salvage tips for uncontrolled variceal bleeding. J Hepatol, 2002, 37(5), p.703–704.
53. Monescillo, A., Martínez-Lagares, F., Ruiz-del-Arbol, L., et al.: Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology, 2004, 40(4), p.793–801.
54. García-Pagán, J.C., Caca, K., Bureau, C., et al.: Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med, 2010, 362(25), p.2370–2379.
55. Guerrini, G.P., Pleguezuelo, M., Maimone, S., et al.: Impact of tips preliver transplantation for the outcome posttransplantation. Am J Transplant, 2009, 9(1), p.192–200.
56. Abraldes, J.G., Villanueva, C., Bañares, R., et al.: Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol, 2008, 48(2), p.229–236.
57. Colomo, A., Hernandez-Gea, V., Madoz, P., et al.: Hemodynamic changes and transfusion strategies in cirrhotic patients with acute variceal bleeding (abstract). Hepatology, 2009, 50(4 Suppl):403A.
58. Working group for portal hypertension at the Czech Society of Hepatology, Czech Medical Association of J. E. Purkyně: Coordinator Brůha, R., Group members: Drastich, P., Fejfar, T., Hůlek, P., Lata, J., Mareček, Z., Petrtýl, J., Procházka, V., Špičák, J., Tozzi, I., Vaňásek,T., Zdeněk, P.: Guidelines on the diagnosis and treatment of bleeding into the digestive tract cause by portal hypertension. Gastroenterologie a hepatologie, 2011, roč. 65, č. 3, s. 141–142.
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