Back to Basics: Management of Esophageal Variceal Bleeding

Mon, 12/24/2018 - 5:02am
Editor: 
Alexis Pelletier-Bui, MD
Catherine Ginty, MD
Management of Esophageal Variceal Bleeding
 
Author:  Sydney Tabaac, MD
 
Drugs
  • Vasoactive Drugs
    • Octreotide: decrease splanchnic blood flow
    • Vasopressin: reduces portal pressure; increases systemic vasoconstriction - associated w MI & small bowel necrosis
    • B-blocker (propranolol): used as prophylaxis in long-term management
  • Antibiotics
    • 3rd generation cephalosporin (CTX): mortality benefit, decrease risk of infection, renal failure and rebleed
Interventions
  • Endoscopic: banding ligation (better outcomes; preferred treatment) or sclerotherapy (50% rebleed)
  • Balloon tamponade: Sengstagen-Blakemore tube (bridging measure to endoscopic therapy)
  • Variceal decompression: TIPS, esophageal transection or portacaval shunt

Reference:

Zetterman R.  The clinical management of esophageal varices.  Jan 20, 2012.  Accessed https://www.medscape.com/viewarticle/756964_4 on November 11, 2018.