Treatment of variceal bleeding:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1999
|
| Schriftenreihe: | Gastrointestinal endoscopy clinics of North America
9,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | VIII S., S. 167 - 358 Ill., graph. Darst. |
Internformat
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| 245 | 1 | 0 | |a Treatment of variceal bleeding |c Christopher J. Gostout, guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 1999 | |
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| 490 | 1 | |a Gastrointestinal endoscopy clinics of North America |v 9,2 | |
| 650 | 2 | |a Hémorragie gastro-intestinale - Thérapeutique | |
| 650 | 2 | |a Varices oesophagiennes et gastriques - Thérapeutique | |
| 650 | 4 | |a Esophageal and Gastric Varices |x therapy | |
| 650 | 4 | |a Gastrointestinal Hemorrhage |x therapy | |
| 650 | 4 | |a Gastrointestinal hemorrhage |x Treatment | |
| 650 | 4 | |a Varicose veins |x Hemorrhage |x Treatment | |
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Datensatz im Suchindex
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| adam_text | TREATMENT OF VARICEAL BLEEDING
CONTENTS
Foreword xi
Charles J. Lightdale
Preface xiii
Christopher J. Gostout
Pathophysiology of Variceal Bleeding 167
Lewis R. Roberts and Patrick S. Kamath
A review of the pathophysiology of variceal bleeding, with a dis¬
cussion of the pathogenesis of portal hypertension, formation of
varices, and bleeding from varices. Portal hypertension results from
increases in portal flow and portal vascular resistance. The factors
increasing portal blood flow are primarily humoral. Resistance to
portal flow has fixed and variable components. Elevated portal
pressure leads to variceal formation. Variceal bleeding is depen¬
dent on portal pressure, variceal size, and variceal wall thickness.
Patient Assessment and Resuscitation 175
Christopher J. Gostout
The patient with acute variceal bleeding requires prompt attention
and is best served by an organized approach to assessment and
resuscitation. Knowledge of the differential diagnosis for acute
bleeding from portal hypertension is essential. Special attention is
needed during resuscitation regarding endotracheal intubation,
intravenous resuscitation, and management of coagulopathy and
thrombocytopenia. Carefully selected patients may be triaged into
outpatient, overnight observation, routine inpatient, and intensive
care settings.
GASTROINTESTINAL ENDOSCOPY
CLINICS OF NORTH AMERICA
VOLUME 9 • NUMBER 2 • APRIL 1999 V
Endoscopic Management of the Acute Variceal
Bleeding Event 189
Brian L. Bleau
An examination of the published literature with regard to back¬
ground and endoscopic management. Methods that are reviewed
include laser, polymer injection, sclerotherapy, ligation and novel
new methods. Sclerotherapy is compared to other non endoscopic
management. Ligation and sclerotherapy are compared for effec¬
tiveness and complications. Information on endoscopic therapy of
gastric varices is also reviewed.
Variceal Ligation with Bands and Clips 207
Nuzhat A. Ahmad and Gregory G. Ginsberg
While endoscopic sclerotherapy is effective for management of
variceal bleeding, significant local and systemic side effects pro¬
moted the development of alternative endoscopic therapies. Endo¬
scopic band ligation has emerged as a technique with equal or
greater efficacy and fewer local and systemic complications. New
multibanded ligation systems have enhanced the speed and effi¬
ciency of endoscopic variceal ligation therapy and eliminated the
need for an esophageal overtube. Endoscopic hemostatic clipping
is another means of achieving directed, mechanical endoscopic
hemostasis that has a limited role in variceal bleeding.
Injection Therapy for Variceal Bleeding 231
Muhammad A. Memon and Whitney F. Jones
The role of injection therapies in the management of esophageal
and gastric varices are reviewed. Available radiographic, pharma
cologic and alternative endoscopic methods are compared and
contrasted with sclerotherapy. Recent studies regarding a combina¬
tion of endoscopic band ligation and low volume sclerotherapy to
achieve best eradication of esophageal varices are reviewed.
Long Term Endoscopic Management of
Variceal Bleeding 253
Karen L. Woods and Waqar A. Qureshi
Recurrent hemorrhage from esophageal varices is a major source
of morbidity and mortality in patients with portal hypertension.
Esophageal sclerotherapy (EST) and more recently esophageal
band ligation (EVL) can obliterate varices in 3 6 treatment sessions.
Multiple band ligators make the use of overtubes unnecessary and
make the procedure faster and more tolerable for the patient. EVL
has several advantages, including fewer complications, fewer treat¬
ment sessions to obliteration, lower rebleeding rates, and lower
mortality as compared to EST; the other advantages of EVL make
vi CONTENTS
it the treatment of choice for bleeding varices and long term man¬
agement. The recommendations and rational for long term EST
and EVL are presented and combination therapy and EUS guided
EVL are discussed.
Endoscopic Ultrasound in the Evaluation of
Portal Hypertension 271
Larry S. Miller
There is no question that EUS has a role in the imaging of gastric
varices. EUS can be used to accurately differentiate thickened folds
or submucosal lesions from varices. Its use in the evaluation of
perigastric varices has progressed from the days in which EUS
scopes were used, but were not as sensitive as endoscopy, to the
current use of EUS probes, which very accurately measure the
radius and the wall thickness (WT) of esophageal varices. These
probes can locate varices not seen at endoscopy and can be used
to calculate the variceal WT. EUS has been used to predict which
patients will respond to therapy and which will not and it can
be used to assess the results of therapeutic intervention. EUS of
periesophageal varices may also be used to predict which patients
will and will not respond to therapy. Although the use of EUS
imaging in the evaluation of varices is still in its infancy, it holds
great promise for the future.
Pharmacologic Intervention During the Acute
Bleeding Episode 287
Alexandre Nader and Norman D. Grace
The risk of recurrent variceal bleeding after an acute episode of
bleeding has been controlled in significant with rebleeding rates
as high as 80% between one and two years. Pharmacologic therapy
has a definite role in the prevention of recurrent variceal bleeding
and should be started as soon as the acute bleeding event has
been controlled. Serial hemodynamic measurements are critical for
success. Non selective beta blocker therapy is a reasonable first
line approach followed by the addition of a long acting nitrate
for patients not achieving a 20 /!) reduction in the hepatic venous
pressure gradient. Most patients will require combination pharma
cotherapy or combined endoscopic therapy with pharmacotherapy.
Pharmacological Prevention of Rebleeding 301
Alexandre Nader and Norman D. Grace
Pharmacologic therapy used during acute variceal bleeding may
control the bleeding episode, minimized transfusion requirements,
and prevent early rebleeding. Several options for pharmacologic
therapy exist in this setting and include: vasopressin in combina¬
tion with nitroglycerin, terlipressin, somatostatin, and octreotide.
CONTENTS vii
Metoclopramide and domperidone may also be useful but require
additional study. At present, octreotide, administered intrave¬
nously as soon as variceal bleeding is suspected, is favored.
Interventional Radiology for the Control and
Prevention Bleeding 311
Michael A. McKusick
Percutaneous treatment of patients with variceal hemorrhage be¬
gan with transhepatic variceal embolization. These procedures
proved to be ineffective as the absolute portal pressure remained
elevated and varices recanalized with subsequent rebleeding.
Transjugular intrahepatic portosystemic shunts (TIPS) promised
the ability to effectively decompress the portal system without the
need for general anesthesia. Initial enthusiasm for the procedure
has waned as intrahepatic shunt durability proved to be less than
adequate. Although it remains a powerful tool, TIPS is not a first
line treatment for patients with variceal bleeding.
The Timing and Role of Non Transplant Surgery in
Management of Variceal Bleeding 331
J. Michael Henderson
Non transplant surgery for variceal bleeding includes surgical
shunts and devascularization procedures. The indication for such
operation are good risk (Childs A/B) patients who have failed
endoscopic therapy. Undecided is the issue of TIPS versus surgi¬
cal shunt.
Liver Transplantation for Variceal Hemorrhage 347
Hugo E. Vargas and Jorge Rakela
Orthotopic liver transplantation should be considered as a treat¬
ment for end stage liver disease, which provides resolution to all
its complications, including portal hypertensive related bleeding.
In the 1990s, variceal bleeding should be controlled primarily with
endoscopy and, if this approach fails, with selective surgical shunt¬
ing in those patients who have good hepatic function and with
TIPS in those patients whose hepatic function is marginal and need
bridging treatment until transplantation. Decompression of the
portal system with either of these approaches allows for liver trans¬
plantation with challenges that can be overcome by experienced
surgical teams.
Index 355
Subscription Information Inside back cover
viii contents
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| spelling | Treatment of variceal bleeding Christopher J. Gostout, guest ed. Philadelphia [u.a.] Saunders 1999 VIII S., S. 167 - 358 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Gastrointestinal endoscopy clinics of North America 9,2 Hémorragie gastro-intestinale - Thérapeutique Varices oesophagiennes et gastriques - Thérapeutique Esophageal and Gastric Varices therapy Gastrointestinal Hemorrhage therapy Gastrointestinal hemorrhage Treatment Varicose veins Hemorrhage Treatment Ösophagusvarizenblutung (DE-588)4172448-3 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Ösophagusvarizenblutung (DE-588)4172448-3 s DE-604 Gostout, Christopher J. Sonstige oth Gastrointestinal endoscopy clinics of North America 9,2 (DE-604)BV005455484 9,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008573563&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Treatment of variceal bleeding Gastrointestinal endoscopy clinics of North America Hémorragie gastro-intestinale - Thérapeutique Varices oesophagiennes et gastriques - Thérapeutique Esophageal and Gastric Varices therapy Gastrointestinal Hemorrhage therapy Gastrointestinal hemorrhage Treatment Varicose veins Hemorrhage Treatment Ösophagusvarizenblutung (DE-588)4172448-3 gnd |
| subject_GND | (DE-588)4172448-3 (DE-588)4143413-4 |
| title | Treatment of variceal bleeding |
| title_auth | Treatment of variceal bleeding |
| title_exact_search | Treatment of variceal bleeding |
| title_full | Treatment of variceal bleeding Christopher J. Gostout, guest ed. |
| title_fullStr | Treatment of variceal bleeding Christopher J. Gostout, guest ed. |
| title_full_unstemmed | Treatment of variceal bleeding Christopher J. Gostout, guest ed. |
| title_short | Treatment of variceal bleeding |
| title_sort | treatment of variceal bleeding |
| topic | Hémorragie gastro-intestinale - Thérapeutique Varices oesophagiennes et gastriques - Thérapeutique Esophageal and Gastric Varices therapy Gastrointestinal Hemorrhage therapy Gastrointestinal hemorrhage Treatment Varicose veins Hemorrhage Treatment Ösophagusvarizenblutung (DE-588)4172448-3 gnd |
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