Comprehensive approach to esophageal variceal bleeding: From prevention to treatment
Sahib Singh,
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Saurabh Chandan,
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Rakesh Vinayek
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et al.
World Journal of Gastroenterology,
Journal Year:
2024,
Volume and Issue:
30(43), P. 4602 - 4608
Published: Oct. 31, 2024
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
hypertension
prevent
varices
from
developing
or
enlarging.
Primary
prophylaxis
involves
the
use
non-selective
beta-blockers,
such
as
propranolol
nadolol,
which
lower
pressure
by
decreasing
cardiac
output
thereby
blood
flow
varices.
Endoscopic
ligation
(EVL)
may
also
be
employed
primary
initial
episodes.
Once
occurs,
immediate
essential.
Initial
management
includes
hemodynamic
stabilization
followed
pharmacological
therapy
vasoactive
drugs
octreotide
terlipressin
control
bleeding.
intervention
cornerstone
treatment,
techniques
EVL
sclerotherapy
applied
directly
manage
In
cases
where
refractory
endoscopic
transjugular
intrahepatic
portosystemic
shunt
considered
effectively
reduce
pressure.
Long-term
after
an
acute
episode
secondary
using
beta-blockers
repeated
sessions
rebleeding,
complemented
monitoring
managing
function
address
underlying
disease.
light
new
scientific
evidence,
including
findings
study
Peng
et
al
,
editorial
aims
review
available
prevention
esophageal
Language: Английский
TIPS and hepatic encephalopathy in patients with cirrhosis
Pauline Bozon-Rivière,
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Marika Rudler,
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Nicolas Weiss
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et al.
Metabolic Brain Disease,
Journal Year:
2025,
Volume and Issue:
40(2)
Published: Feb. 4, 2025
Language: Английский
Which patients benefit the most? An update on transjugular intrahepatic portosystemic shunt
World Journal of Hepatology,
Journal Year:
2025,
Volume and Issue:
17(2)
Published: Feb. 20, 2025
This
is
a
narrative
review
in
which
the
advances
technical
aspects,
main
indications,
limitations
and
clinical
results
of
transjugular
intrahepatic
portosystemic
shunt
(TIPS)
portal
hypertension
(PH)
are
addressed.
With
emergence
coated
prosthesis,
better
patency,
lower
incidence
hepatic
encephalopathy
(HE)
survival
when
compared
to
TIPS
with
conventional
prosthesis
demonstrated.
The
indications
for
refractory
ascites,
acute
variceal
bleeding
unresponsive
pharmacological/
endoscopic
therapy
and,
lastly,
patients
considered
at
high
risk
rebleeding
preemptive
(pTIPS).
Absolute
contraindications
use
severe
uncontrolled
HE,
systemic
infection
or
sepsis,
congestive
heart
failure,
pulmonary
arterial
hypertension,
biliary
obstruction.
control
hemorrhage
due
rupture
can
reach
up
90%-100%
cases,
55%
ascites.
Despite
evidences
regarding
pTIPS
rebleeding,
less
than
20%
eligible
treated.
may
also
decrease
future
decompensation
cirrhosis
increase
selected
patients.
In
conclusion,
an
essential
treatment
PH,
but
often
neglected.
It
important
hepatologist
form
multidisciplinary
team,
role
radiologist
experience
interventional
procedures
prominent.
Language: Английский