Updated strategies in the management of acute variceal haemorrhage

Edelson Jerome; Basso Jessica E.; Rockey Don C.

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Updated strategies in the management of acute variceal haemorrhage

机译：急性瓦氏血管出血管理中的更新策略

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Purpose of review This article reviews the most recent studies regarding the management of acute esophageal variceal haemorrhage. Recent findings New randomized control trials and meta-analyses confirmed the role of early transjugular intrahepatic portosystemic shunt (TIPS) in the management of acute variceal haemorrhage in Child-Pugh C (10-13) and B patients with active bleeding. A recent randomized controlled trial focused on the duration of vasoactive therapy showed no difference between 2 and 5 days of octreotide. A randomized trial showed decreased use of blood products for the correction of coagulopathy using a thromboelastography-guided approach (vs. conventional parameters) as well as decreased bleeding rates when compared with standard of care. A meta-analysis found that for rescue of variceal bleeding, self-expanding metallic stents were more efficacious and safer than balloon tamponade. In addition, studies showed that Child-Pugh C patients and those with hepatic vein pressure gradient more than 20 were at the highest risk of treatment failure, while model for end-stage liver disease was highly predictive of in-hospital mortality. In patients with severe coagulopathy and uncontrolled bleeding, TEG-based transfusion strategies are recommended. Antibiotics should be used for all cirrhotic patients presenting with upper gastrointestinal bleeding, but should be tailored in accordance to local resistance patterns. Early TIPS for high-risk patients has been shown to have a significant survival benefit. Certain aspects of the management of variceal bleeding remain poorly studied such as the role of early TIPS in Child-B patients as well as strategies for rescue therapy in patients who are not TIPS candidates, and require further investigation.

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《Current opinion in gastroenterology》 |2021年第3期|共6页
作者
Edelson Jerome; Basso Jessica E.; Rockey Don C.;
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作者单位

Brooke Army Med Ctr Dept Gastroenterol &

Hepatol Ft Sam Houston TX 78234 USA;

Brooke Army Med Ctr Dept Gastroenterol &

Hepatol Ft Sam Houston TX 78234 USA;

Med Univ South Carolina Digest Dis Res Ctr Charleston SC 29425 USA;

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正文语种 eng
中图分类消化系及腹部疾病;
关键词
balloon tamponade; endoscopic variceal ligation; self-expanding metallic stents; transjugular intrahepatic portosystemic shunt;

机译：气球铺位;内窥镜静脉结扎;自膨胀金属支架;讲库内存的静脉内部系统;

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机译：急性静脉曲张破裂出血的治疗历史回顾与回顾
2. Historical overview and review of current day treatment in the management of acute variceal haemorrhage [J] . Rajoriya Neil, Tripathi Dhiraj World journal of gastroenterology : . 2014,第21期

机译：急性静脉曲张破裂出血的治疗历史回顾与回顾
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机译：综述：内窥镜检查管理算法：氰基丙烯酸酯胶注和自扩金属支架在急性静脉曲张破裂出血中的作用
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Updated strategies in the management of acute variceal haemorrhage

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