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Definitive therapy for variceal bleeding: a personal view.

L F Rikkers1

  • 1Department of Surgery, University of Nebraska Medical Center, Omaha.

American Journal of Surgery
|July 1, 1990
PubMed
Summary

Variceal hemorrhage treatment has advanced significantly, offering diverse options like shunts, devascularization, sclerotherapy, and transplantation. The University of Nebraska

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Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Innovation
  • Transplantation Medicine

Background:

  • Variceal hemorrhage management has evolved over 50 years.
  • Early treatments focused on nonselective shunts.
  • Current options include selective shunts, devascularization, sclerotherapy, and transplantation.

Purpose of the Study:

  • To outline the current therapeutic strategies for variceal hemorrhage.
  • To describe patient stratification based on transplantation candidacy.
  • To detail the University of Nebraska's approach to managing variceal bleeding.

Main Methods:

  • Patient stratification based on liver disease severity and transplantation eligibility.
  • Prioritization of liver transplantation for advanced or symptomatic disease.
  • Sequential treatment with endoscopic sclerotherapy and distal splenorenal shunt (DSRS) for non-transplant candidates or future candidates.

Main Results:

  • Selective shunts, particularly DSRS, demonstrate a lower frequency of encephalopathy compared to nonselective shunts.
  • Endoscopic sclerotherapy is a primary therapy for non-transplant candidates.
  • A multidisciplinary approach is crucial for optimizing outcomes in variceal bleeding.

Conclusions:

  • Modern variceal hemorrhage therapy involves a range of procedures tailored to patient subgroups.
  • Distal splenorenal shunt is preferred over nonselective shunts due to reduced encephalopathy.
  • Liver transplantation is a definitive option for select patients with advanced liver disease.

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