Comprehensive approach to esophageal variceal bleeding:From prevention to treatment  

作　　者：Sahib Singh Saurabh Chandan Rakesh Vinayek Ganesh Aswath Antonio Facciorusso Marcello Maida 

机构地区：[1]Department of Internal Medicine,Sinai Hospital,Baltimore,MD 21215,United States [2]Center for Interventional Endoscopy,Advent Health,Orlando,FL 32803,United States [3]Department of Gastroenterology,Sinai Hospital of Baltimore,Baltimore,MD 21215,United States [4]Division of Gastroenterology and Hepatology,State University of New York Upstate Medical University,Syracuse,NY 13210,United States [5]Gastroenterology Unit,Department of Medical and Surgical Sciences,University of Foggia,Foggia 71122,Italy [6]Department of Medicine and Surgery,University of Enna‘Kore’,Enna 94100,Sicilia,Italy

出　　处：《World Journal of Gastroenterology》2024年第43期4602-4608,共7页世界胃肠病学杂志（英文）

摘　　要：Esophageal variceal bleeding is a severe complication often associated with portal hypertension,commonly due to liver cirrhosis.Prevention and treatment of this condition are critical for patient outcomes.Preventive strategies focus on reducing portal hypertension to prevent varices from developing or enlarging.Primary prophylaxis involves the use of non-selective beta-blockers,such as propranolol or nadolol,which lower portal pressure by decreasing cardiac output and thereby reducing blood flow to the varices.Endoscopic variceal ligation(EVL)may also be employed as primary prophylaxis to prevent initial bleeding episodes.Once bleeding occurs,immediate treatment is essential.Initial management includes hemodynamic stabilization followed by pharmacological therapy with vasoactive drugs such as octreotide or terlipressin to control bleeding.Endoscopic intervention is the cornerstone of treatment,with techniques such as EVL or sclerotherapy applied to directly manage the bleeding varices.In cases where bleeding is refractory to endoscopic treatment,transjugular intrahepatic portosystemic shunt may be considered to effectively reduce portal pressure.Long-term management after an acute bleeding episode involves secondary prophylaxis using betablockers and repeated EVL sessions to prevent rebleeding,complemented by monitoring and managing liver function to address the underlying disease.In light of new scientific evidence,including the findings of the study by Peng et al,this editorial aims to review available strategies for the prevention and treatment of esophageal varices.

关 键 词：Esophageal varices Portal hypertension CIRRHOSIS BLEEDING PREVENTION TREATMENT 

分 类 号：R571[医药卫生—消化系统]