RT Book, Section
A1 Grace, Norman D.
A1 Minor, Melissa A.
A2 Greenberger, Norton J.
A2 Blumberg, Richard S.
A2 Burakoff, Robert
SR Print(0)
ID 1119990995
T1 Portal Hypertension & Esophageal Variceal Hemorrhage
T2 CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071837729
LK accessmedicine.mhmedical.com/content.aspx?aid=1119990995
RD 2024/04/19
AB ESSENTIAL  CONCEPTSEither  nonselective  β-blockers  or  esophageal  variceal  ligation  can  be  first-line  treatment  for  primary  prophylaxis  of  variceal  hemorrhage  in  patients  with  medium  to  large  esophageal  and  high-risk  small  varices.Endoscopic  variceal  ligation  (EVL)  is  an  alternative  to  pharmacologic  therapy  for  patients  intolerant  to  β-blockers.Management  of  acute  variceal  hemorrhage  includes  resuscitation,  antibiotic  prophylaxis,  use  of  vasoactive  agents,  and  endoscopic  treatment  with  band  ligation.  Early  transjugular  intrahepatic  portosystemic  shunt  (TIPS)  should  be  considered  for  high-risk  patients.Balloon  tamponade  can  be  used  as  a  bridge  to  TIPS  or  surgical  shunt  therapy.The  combination  of  a  nonselective  β-blocker  and  esophageal  variceal  ligation  is  first-line  treatment  for  prevention  of  recurrent  variceal  hemorrhage.Hepatic  venous  pressure  gradient  (HVPG)  measurements  have  prognostic  and  therapeutic  value.TIPS,  surgical  shunt  procedures,  or  liver  transplantation  are  treatment  options  for  patients  who  do  not  respond  to  medical  therapy.Gastric  varices  that  are  contiguous  with  esophageal  varices  can  be  treated  as  esophageal  varices;  those  below  the  gastroesophageal  junction  are  best  treated  with  endoscopic  injection  of  glue.TIPS  is  the  preferred  rescue  procedure  for  uncontrolled  variceal  bleeding  and  can  be  first-line  therapy  for  high-risk  patients.Portal  hypertensive  gastropathy  (PHG)  is  usually  mild  and  stops  spontaneously.Chronic  bleeding  from  PHG  is  treated  with  β-blockers  or  TIPS  based  on  the  severity  of  hemorrhage.