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2011-10-15

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cc-by (c) Escorsell i Mañosa, M. Àngels et al., 2011
Please use this identifier to cite or link to this item: https://hdl.handle.net/2445/57283

Self-expandable metal stents in the treatment of acute esophageal variceal bleeding

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http://dx.doi.org/10.1155/2011/910986

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.

Subject

Varices esofàgiques, Cirrosi hepàtica, Terapèutica

Subject (English)

Esophageal varices, Hepatic cirrhosis, Therapeutics

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Articles publicats en revistes (Medicina)

Citation

ESCORSELL I MAÑOSA, M. Àngels and BOSCH I GENOVER, Jaume. Self-expandable metal stents in the treatment of acute esophageal variceal bleeding. Gastroenterology Research and Practice. 2011. Vol. 2011, num. (2011). ISSN 1687-6121. [consulted: 15 of August of 2026]. Available at: https://hdl.handle.net/2445/57283

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