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Title: Self-expandable metal stents in the treatment of acute esophageal variceal bleeding.
Author: Escorsell i Mañosa, M. Àngels
Bosch i Genover, Jaume
Keywords: Varices esofàgiques
Cirrosi hepàtica
Esophageal varices
Hepatic cirrhosis
Issue Date: 15-Oct-2011
Publisher: Hindawi Publishing Corporation
Abstract: Acute variceal bleeding (AVB) is a life-threatening complication in patients with cirrhosis. Hemostatic therapy of AVB includes early administration of vasoactive drugs that should be combined with endoscopic therapy, preferably banding ligation. However, failure to control bleeding or early rebleed within 5 days still occurs in 15-20% of patients with AVB. In these cases, a second endoscopic therapy may be attempted (mild bleeding in a hemodynamically stable patient) or we can use a balloon tamponade as a bridge to definitive derivative treatment (i.e., a transjugular intrahepatic portosystemic shunt). Esophageal balloon tamponade provides initial control in up to 80% of AVB, but it carries a high risk of major complications, especially in cases of long duration of tamponade (>24 h) and when tubes are inserted by inexperienced staff. Preliminary reports suggest that self-expandable covered esophageal metallic stents effectively control refractory AVB (i.e., ongoing bleeding despite pharmacological and endoscopic therapy or massive bleeding precluding endoscopic therapy) with a low incidence of complications. Thus, covered self-expanding metal stents may represent an alternative to the Sengstaken-Blakemore balloon for the temporary control of bleeding in treatment failures. Further studies are required to determine the role of this new device in AVB.
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It is part of: Gastroenterology Research and Practice, 2011, vol. 2011, num. (2011)
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ISSN: 1687-6121
Appears in Collections:Articles publicats en revistes (Medicina)

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