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Management of acute variceal bleeding: updated APASL guidelines.
Cosmas Rinaldi Adithya Lesmana1,2,3, Akash Shukla4,5, Ashish Kumar6
1Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia. medicaldr2001id@yahoo.com.
Hepatology International
|August 31, 2025
Summary
Acute variceal bleeding (AVB) management has advanced significantly. New APASL guidelines offer updated strategies for portal hypertension complications, improving patient outcomes.
Area of Science:
- Hepatology and Gastroenterology
- Clinical Medicine
- Interventional Radiology
Background:
- Acute variceal bleeding (AVB) is a severe complication of portal hypertension (PHT) with high mortality.
- Recent advancements in management strategies have improved patient outcomes.
- The APASL Portal Hypertension Working Party convened experts to update AVB guidelines.
Purpose of the Study:
- To update the APASL (Asia-Pacific Association for the Study of the Liver) guidelines for AVB management.
- To incorporate recent evidence and emerging trends in AVB treatment.
Main Methods:
- A panel of experts from the Asia-Pacific region reviewed current literature and identified key developments.
- A structured process was used to discuss advances and controversial areas in AVB management.
- Previous APASL AVB guidelines were updated based on expert consensus and latest evidence.
Main Results:
- Updated guidelines emphasize safe transportation, defined time frames for bleeding episodes, and outcome reporting.
- Recommendations cover optimizing early intervention, pharmacotherapy, endoscopic therapies, and salvage modalities like TIPS.
- Guidelines address AVB in special populations, necessary skill sets, and research priorities.
Conclusions:
- The updated APASL guidelines provide a contemporary framework for managing AVB in patients with and without cirrhosis.
- These guidelines aim to improve patient outcomes through evidence-based, optimized treatment strategies.
Keywords:
CTP scoreCirrhosisEHPVOElla-Denis StentEndoscopyGastrointestinal hemorrhageHepatic encephalopathyMELD scoreNon-cirrhotic portal fibrosisPortal hypertensionShunt surgeryTIPSVaricesVasoactive drugsMore Related Videos
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