Acute Variceal Bleeding

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Endoscopic Banding Ligation (EBL) vs Injection Sclerotherapy • Sclerotherapy can be used in patients in whom EBL is not feasible Lo G et al. Hepatology 1997 Villanueva et al. J Hepatol 2006 Garcia-Pagan et al. Nat Clin Pract Gastroenterol Hepatol 2005
Endoscopic Banding Ligation (EBL) vs Cyanoacrylate Obturation • Conflicting data from 1 small prospective case series & 2 small randomized studies – Ljubicic et al reported no significant difference in terms of acute OV bleeding control, re-bleeding rate, and mortality – Santos et al reported more minor complications, OV recurrence, and a trend towards more re-bleeding in Cyanoacrylate group Cipolletta L et al. Dig Liver Dis 2009 Ljubicic N et al. Hepatogastroenterology 2011 Santos M et al. Eur J Gastroenterol Hepatol 2011
Page 1 and 2: Updates in Management of Acute Vari
Page 3 and 4: The Problem • Gastroesophageal Va
Page 5 and 6: Varices Oesophageal Duodenal Gastri
Page 7 and 8: Initial Assessment & Resuscitation
Page 9 and 10: Blood Volume Resuscitation • Main
Page 11 and 12: Management of Coagulopathy • FFP
Page 13 and 14: Vasoactive Drugs • Somatostatin &
Page 15 and 16: Vasoactive Drugs as 1 st line thera
Page 17 and 18: Endoscopic Variceal Ligation (EVL)
Page 19 and 20: Timing of Endoscopy • OGD within
Page 21 and 22: Endoscopic Therapy + Pharmacologica
Page 23: Endoscopic Banding Ligation (EBL) v
Page 27 and 28: Gastric Varices (GV) • Present in
Page 29: Cyanoacrylate Obturation • Tissue
Page 32 and 33: Transjugular Intrahepatic Portosyst
Page 34: EUS guided Cyanoacrylate Injection
Page 37 and 38: EUS guided Cyanoacrylate Injection
Page 39 and 40: Rescue / Alternative Therapy • TI
Page 41 and 42: Early Use of TIPS in Variceal Bleed
Page 43 and 44: Balloon Tamponade • Sengstaken-Bl
Page 45 and 46: Balloon-Occluded Retrograde Transve

Acute Variceal Bleeding

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