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Esophageal Varices

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by McCarthy AA
 

Treatment

Several treatments can help lower the risk of vessel rupture or stop bleeding if it starts. Treatment options include the following:

Drug Therapy

Drugs may be given to lower blood pressure in the veins to decrease the risk of bleeding or help slow bleeding.

Endoscopic Band Ligation

During endoscopic band ligation, a rubber band is tied around bulging veins to prevent ruptures or stop bleeding.

Balloon Tamponade

This procedure involves the passage of a balloon through the nose to help compress the bleeding varices.

Sclerotherapy

During sclerotherapy, drugs intended to slow bleeding are injected into the bleeding vein and sometimes into the surrounding area. The drugs cause clots to form and harden the vein to stop bleeding.

Transjugular Intrahepatic Portosystemic Shunting (TIPS)

TIPS involves threading a catheter from a neck vein to the liver. A stent, a small tube designed to keep veins open, is bound to the catheter and inserted into the liver. It will increase blood flow through the portal vein and relieve blood pressure in the esophageal varices. This procedure can control bleeding in most cases.

Distal Splenorenal Shunt (DSRS)

DSRS is a surgical procedure that connects the main vein in the spleen to the left kidney vein. The procedure is done to lower blood pressure in the swollen vessels and to limit bleeding.

Esophageal Transection

This procedure is reserved for patients who fail to respond to drug or endoscopic treatment and are not considered good candidates for a shunting procedure.

Liver Transplant

Liver transplantation is the only way to completely cure esophageal varices.
If you are diagnosed with esophageal varices, follow your doctor's instructions.
If you are diagnosed with esophageal varices, follow your doctor's instructions.
 

RESOURCES

American College of Gastroenterology
http://www.gi.org

American Gastroenterological Association
http://www.gastro.org

 

CANADIAN RESOURCES

The Canadian Association of Gastroenterology
http://www.cag-acg.org

Canadian Liver Foundation
http://www.liver.ca

 

References


Berry PA, Wendon JA. The management of severe alcoholic liver disease and variceal bleeding in the intensive care unit. Curr Opin Crit Care . 2006;12:171-7.


Bhasin DK, Siyad I. Variceal bleeding and portal hypertension: new lights on old horizon. Endoscopy . 2004;36(2):120-129.


D’Amico G. The role of vasoactive drugs in the treatment of oesophageal varices. Expert Opinion Pharmacotherapy . 2004;5(2):349-360.


Garcia-Tsao G, Sanyal AJ. Prevention and management of gastroesophageal varicies and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102(9):2086-2102.


Gastroesophageal varices. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 13, 2013. Accessed July 10, 2013.


Kamath PS. Esophageal variceal bleeding: primary prophylaxis. Clin Gastroenterol Hepatol. 2005;3(1):90-93.


Lubel JS, Angus PW. Modern management of portal hypertension. Intern Med J . 2005;35(1):45-9.


Villanueva C, Piqueras M, Aracil C, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol.2006;45:560-7

 

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