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- Title
Self-Expandable Metal Stents in the Treatment of Acute Esophageal Variceal Bleeding.
- Authors
Escorsell, Àngels; Bosch, Jaime
- 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 ormassive 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.
- Subjects
ESOPHAGEAL varices; ESOPHAGEAL surgery; SURGICAL stents; METALS in surgery; HEMORRHAGE; HEMOSTASIS; CIRRHOSIS of the liver; ENDOSCOPIC surgery; SURGICAL complication risk factors; PATIENTS; THERAPEUTICS
- Publication
Gastroenterology Research & Practice, 2011, Vol 2011, p1
- ISSN
1687-6121
- Publication type
Article
- DOI
10.1155/2011/910986