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New Developments in Managing Variceal Bleeding

Mostafa Ibrahim1, Ibrahim Mostafa2, Jacques Devière3

  • 1Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt.

Gastroenterology
|February 27, 2018
PubMed

Insights

Acute variceal bleeding (AVB) in liver cirrhosis remains life-threatening. New endoscopic therapies, like coil-glue injection and hemostatic powders, show promise as bridge treatments for AVB patients.

Area of Science:

  • Gastroenterology and Hepatology
  • Internal Medicine
  • Endoscopic Interventions

Background:

  • Liver cirrhosis represents the advanced stage of chronic liver disease, marked by fibrosis and regenerative nodules.
  • Complications of cirrhosis include portal hypertension, ascites, and hepatic encephalopathy.
  • Acute variceal bleeding (AVB) is a critical complication with significant mortality.

Purpose of the Study:

  • To review the current standard of care for acute variceal bleeding in liver cirrhosis.
  • To explore novel endoscopic modalities for managing AVB and related gastric varices.
  • To assess the role of new therapies as bridge treatments until definitive management.

Main Methods:

  • Review of current treatment guidelines for acute variceal bleeding.
  • Discussion of emerging endoscopic techniques, including coil-glue injection and hemostatic powder application.
  • Analysis of the potential of these new modalities in managing bleeding or non-bleeding gastric varices.

Main Results:

  • The standard care for AVB involves vasoactive drugs, antibiotics, and endoscopic therapy.
  • Emerging techniques like coil-glue injection and hemostatic powders offer promising alternatives or adjuncts.
  • Hemostatic powders can be applied with minimal expertise as an early intervention.

Conclusions:

  • Acute variceal bleeding in liver cirrhosis necessitates prompt and effective management.
  • Novel endoscopic interventions provide valuable options for managing gastric varices and AVB.
  • These new modalities can serve as crucial bridge therapies, improving patient outcomes.

Keywords:
Hemostatic PowderPortal HypertensionVariceal Bleeding

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