The Latest Recommendations in the Prophylaxis and Treatment of Bleeding from Esophagogastric Varices

 

Ivan Grgov¹, Daniela Benedeto Stojanov^2,3, Biljana Radovanović Dinić^2,3, Milica Grgov ⁴,
Saša Grgov⁵, Tomislav Tasić⁶

¹General Hospital Leskovac, Department of General Surgery with Traumatology, Leskovac, Serbia
²University Clinical Center Niš, Clinic of Gastroenterology and Hepatology, Niš, Serbia
³University of Niš, Faculty of Medicine, Niš, Serbia
⁴ University Clinical Center Niš, Clinic of Pulmonology, Niš, Serbia
⁵Primary Healthcare Center VIP Medical, Leskovac, Serbia
⁶General Hospital Leskovac, Department of Gastroenterology and Hepatology, Leskovac, Serbia

 

  SUMMARY

 

Introduction/Aim. Esophagogastric varices develop in 50-60% of patients with liver cirrhosis, and 30% of them have one episode of variceal hemorrhage within two years of variceal diagnosis. The aim of the paper was to present the latest attitudes in the treatment of esophagogastric varices.
Literature review. Prevention of first bleeding from esophageal varices (EV) involves the use of non-selective beta blockers (NSBB) or carvedilol, while in case of their intolerance or contraindications for their use, endoscopic band ligation (EBL) should be performed. In acute variceal bleeding, endoscopy should be performed, preferably within 12 hours of the presentation of the bleeding, and EBL should be applied. In case of refractory hemorrhage (about 20%), repeated endoscopy and hemostasis or balloon tamponade, self-expanding metal stent (SEMS), transjugular intrahepatic portosystemic shunt (TIPS) and surgical therapy are required. Bleeding from gastric varices (GV) is less common than bleeding from EV but is significantly more severe with higher mortality and more frequent treatment failure. The therapy of choice is the application of cyanoacrylate (CYA), which can be applied under endoscopic ultrasonography (EUS) control. In the trial is the administration of coil injections with or without CYA. In the secondary prophylaxis of bleeding from EV, NSBB should be used in combination with EBL. In the secondary prophylaxis of bleeding from cardiofundal varices, the approach is individual.
Conclusion. The therapy of choice for the primary prevention of bleeding from EV is NSBB, while the combined therapy (NSBB and EBL) is for the secondary prophylaxis of bleeding. CYA is the therapy of choice for GI bleeding. Refractory variceal hemorrhage requires the application of many therapeutic modalities.

 Keywords: esophagogastric varices, prophylaxis, treatment

  

Corresponding author:

Ivan Grgov 

e-mail: grgovivan@gmail.com