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

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...

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Detalles Bibliográficos
Autores: Escorsell i Mañosa, M. Àngels, Bosch i Genover, Jaume
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2011
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/57283
Acceso en línea:https://hdl.handle.net/2445/57283
Access Level:acceso abierto
Palabra clave:Varices esofàgiques
Cirrosi hepàtica
Terapèutica
Esophageal varices
Hepatic cirrhosis
Therapeutics
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spelling Self-expandable metal stents in the treatment of acute esophageal variceal bleedingEscorsell i Mañosa, M. ÀngelsBosch i Genover, JaumeVarices esofàgiquesCirrosi hepàticaTerapèuticaEsophageal varicesHepatic cirrhosisTherapeuticsAcute 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.Hindawi Publishing Corporation2011info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/57283Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: http://dx.doi.org/10.1155/2011/910986Gastroenterology Research and Practice, 2011, vol. 2011, num. (2011)http://dx.doi.org/10.1155/2011/910986cc-by (c) Escorsell i Mañosa, M. Àngels et al., 2011http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/572832026-05-27T06:46:51Z
dc.title.none.fl_str_mv Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
title Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
spellingShingle Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
Escorsell i Mañosa, M. Àngels
Varices esofàgiques
Cirrosi hepàtica
Terapèutica
Esophageal varices
Hepatic cirrhosis
Therapeutics
title_short Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
title_full Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
title_fullStr Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
title_full_unstemmed Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
title_sort Self-expandable metal stents in the treatment of acute esophageal variceal bleeding
dc.creator.none.fl_str_mv Escorsell i Mañosa, M. Àngels
Bosch i Genover, Jaume
author Escorsell i Mañosa, M. Àngels
author_facet Escorsell i Mañosa, M. Àngels
Bosch i Genover, Jaume
author_role author
author2 Bosch i Genover, Jaume
author2_role author
dc.subject.none.fl_str_mv Varices esofàgiques
Cirrosi hepàtica
Terapèutica
Esophageal varices
Hepatic cirrhosis
Therapeutics
topic Varices esofàgiques
Cirrosi hepàtica
Terapèutica
Esophageal varices
Hepatic cirrhosis
Therapeutics
description 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.
publishDate 2011
dc.date.none.fl_str_mv 2011
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/57283
url https://hdl.handle.net/2445/57283
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: http://dx.doi.org/10.1155/2011/910986
Gastroenterology Research and Practice, 2011, vol. 2011, num. (2011)
http://dx.doi.org/10.1155/2011/910986
dc.rights.none.fl_str_mv cc-by (c) Escorsell i Mañosa, M. Àngels et al., 2011
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Escorsell i Mañosa, M. Àngels et al., 2011
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Hindawi Publishing Corporation
publisher.none.fl_str_mv Hindawi Publishing Corporation
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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