Acute Variceal Bleeding Is It Only the Success of Hemostasis That Guarantees the Positive Outcome?

Nikolay Tsonev; D. Vundeva; K. Toncheva; Dimitar  Zvezdov; I. Petrov; D. Dimitrova; D. Petrova

doi:10.3889/oamjms.2022.8106

Authors

Nikolay Tsonev Department of Gastroenterology, Clinic of Internal Diseases, 2nd MHAT, Sofia, Bulgaria
D. Vundeva Department of Gastroenterology, Clinic of Internal Diseases, 2nd MHAT, Sofia, Bulgaria
K. Toncheva Department of Gastroenterology, Clinic of Internal Diseases, 2nd MHAT, Sofia, Bulgaria
Dimitar Zvezdov Department of Gastroenterology, Clinic of Internal Diseases, 2nd MHAT, Sofia, Bulgaria
I. Petrov Department of Gastroenterology, Clinic of Internal Diseases, 2nd MHAT, Sofia, Bulgaria
D. Dimitrova Department of Gastroenterology, Clinic of Internal Diseases, 2nd MHAT, Sofia, Bulgaria
D. Petrova Department of Gastroenterology, Clinic of Internal Diseases, 2nd MHAT, Sofia, Bulgaria

DOI:

https://doi.org/10.3889/oamjms.2022.8106

Keywords:

Acute variceal bleeding, Vasoactive drugs, Endoscopic band ligation, MELD, Child-Pugh, Baveno VI recommendations

Abstract

Acute variceal bleeding remains with a high mortality rate (around 15%). Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and antibiotic therapy. Effective resuscitation (blood transfusions, volume replacement) is essential to prevent complications. In case of failure - transjugular intrahepatic portosystemic shunt (TIPS) with appropriate indications and limitations related to the prognosis of the individual patient. Balloon tamponade or specially designed coated esophageal stents can be used as a bridge to definitive therapy in unstable patients. Early TIPS should be the first choice in patients at high risk of treatment failure (Child-Pugh B with active bleeding or Child-Pugh C < 14). This article discusses the latest advances in variceal bleeding management in line with current recommendations of the Baveno VI Consensus Conference.

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