Back to Basics: Management of Esophageal Variceal Bleeding
Mon, 12/24/2018 - 5:02am
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.