The role of endoscopic therapy in the treatment of bleeding varices

Sabine Bohnacker, Sreeram Parupudi, Nib Soehendra

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The role of endoscopy in bleeding varices is both diagnostic and therapeutic. While sclerotherapy of oesophageal varices remains an established modality, ligation has, in view of its higher safety margin, turned out to be superior in recent years. The excellent initial results of ligation are, however, tainted by a higher recurrence rate in the long term. Since the endpoint of treatment is the achievement and maintenance of variceal eradication, the addition of low-dose sclerotherapy following initial eradication by ligation seems to be the optimal method to combine the best of both techniques. In the management of life-threatening bleeding from oesophageal varices and gastric varices, cyanoacrylate remains the only promising non-surgical option. Primary endoscopic prophylaxis is still under evaluation. It is only justified in high-risk patients with large varices bearing red colour signs and in the presence of an intolerance of or contra-indication to propranolol. When indicated, ligation seems to be preferable, and the addition of low-dose sclerotherapy after initial variceal eradication may maintain the benefits accrued in such high-risk patients. The present review examines the available evidence regarding the above issues in the recent literature.

Original languageEnglish (US)
Pages (from-to)477-494
Number of pages18
JournalBailliere's Best Practice and Research in Clinical Gastroenterology
Volume14
Issue number3
DOIs
StatePublished - Jun 2000
Externally publishedYes

Fingerprint

Varicose Veins
Sclerotherapy
Ligation
Esophageal and Gastric Varices
Hemorrhage
Cyanoacrylates
Therapeutics
Propranolol
Endoscopy
Color
Maintenance
Safety
Recurrence

Keywords

  • Bleeding
  • Endoscopy
  • Therapy
  • Varices

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The role of endoscopic therapy in the treatment of bleeding varices. / Bohnacker, Sabine; Parupudi, Sreeram; Soehendra, Nib.

In: Bailliere's Best Practice and Research in Clinical Gastroenterology, Vol. 14, No. 3, 06.2000, p. 477-494.

Research output: Contribution to journalArticle

@article{e52e27dcceae472db7793265bc9e0f76,
title = "The role of endoscopic therapy in the treatment of bleeding varices",
abstract = "The role of endoscopy in bleeding varices is both diagnostic and therapeutic. While sclerotherapy of oesophageal varices remains an established modality, ligation has, in view of its higher safety margin, turned out to be superior in recent years. The excellent initial results of ligation are, however, tainted by a higher recurrence rate in the long term. Since the endpoint of treatment is the achievement and maintenance of variceal eradication, the addition of low-dose sclerotherapy following initial eradication by ligation seems to be the optimal method to combine the best of both techniques. In the management of life-threatening bleeding from oesophageal varices and gastric varices, cyanoacrylate remains the only promising non-surgical option. Primary endoscopic prophylaxis is still under evaluation. It is only justified in high-risk patients with large varices bearing red colour signs and in the presence of an intolerance of or contra-indication to propranolol. When indicated, ligation seems to be preferable, and the addition of low-dose sclerotherapy after initial variceal eradication may maintain the benefits accrued in such high-risk patients. The present review examines the available evidence regarding the above issues in the recent literature.",
keywords = "Bleeding, Endoscopy, Therapy, Varices",
author = "Sabine Bohnacker and Sreeram Parupudi and Nib Soehendra",
year = "2000",
month = "6",
doi = "10.1053/bega.2000.0092",
language = "English (US)",
volume = "14",
pages = "477--494",
journal = "Bailliere's Best Practice and Research in Clinical Gastroenterology",
issn = "1521-6918",
publisher = "Bailliere Tindall Ltd",
number = "3",

}

TY - JOUR

T1 - The role of endoscopic therapy in the treatment of bleeding varices

AU - Bohnacker, Sabine

AU - Parupudi, Sreeram

AU - Soehendra, Nib

PY - 2000/6

Y1 - 2000/6

N2 - The role of endoscopy in bleeding varices is both diagnostic and therapeutic. While sclerotherapy of oesophageal varices remains an established modality, ligation has, in view of its higher safety margin, turned out to be superior in recent years. The excellent initial results of ligation are, however, tainted by a higher recurrence rate in the long term. Since the endpoint of treatment is the achievement and maintenance of variceal eradication, the addition of low-dose sclerotherapy following initial eradication by ligation seems to be the optimal method to combine the best of both techniques. In the management of life-threatening bleeding from oesophageal varices and gastric varices, cyanoacrylate remains the only promising non-surgical option. Primary endoscopic prophylaxis is still under evaluation. It is only justified in high-risk patients with large varices bearing red colour signs and in the presence of an intolerance of or contra-indication to propranolol. When indicated, ligation seems to be preferable, and the addition of low-dose sclerotherapy after initial variceal eradication may maintain the benefits accrued in such high-risk patients. The present review examines the available evidence regarding the above issues in the recent literature.

AB - The role of endoscopy in bleeding varices is both diagnostic and therapeutic. While sclerotherapy of oesophageal varices remains an established modality, ligation has, in view of its higher safety margin, turned out to be superior in recent years. The excellent initial results of ligation are, however, tainted by a higher recurrence rate in the long term. Since the endpoint of treatment is the achievement and maintenance of variceal eradication, the addition of low-dose sclerotherapy following initial eradication by ligation seems to be the optimal method to combine the best of both techniques. In the management of life-threatening bleeding from oesophageal varices and gastric varices, cyanoacrylate remains the only promising non-surgical option. Primary endoscopic prophylaxis is still under evaluation. It is only justified in high-risk patients with large varices bearing red colour signs and in the presence of an intolerance of or contra-indication to propranolol. When indicated, ligation seems to be preferable, and the addition of low-dose sclerotherapy after initial variceal eradication may maintain the benefits accrued in such high-risk patients. The present review examines the available evidence regarding the above issues in the recent literature.

KW - Bleeding

KW - Endoscopy

KW - Therapy

KW - Varices

UR - http://www.scopus.com/inward/record.url?scp=0033869804&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033869804&partnerID=8YFLogxK

U2 - 10.1053/bega.2000.0092

DO - 10.1053/bega.2000.0092

M3 - Article

C2 - 10952810

AN - SCOPUS:0033869804

VL - 14

SP - 477

EP - 494

JO - Bailliere's Best Practice and Research in Clinical Gastroenterology

JF - Bailliere's Best Practice and Research in Clinical Gastroenterology

SN - 1521-6918

IS - 3

ER -