Secondary Prophylaxis for Esophageal Variceal Bleeding

作者：Albillos Agustin^*; Tejedor Marta

来源：Clinics in Liver Disease, 2014, 18(2): 359-+.

DOI：10.1016/j.cld.2014.01.007

• Secondary prophylaxis
• Variceal rebleeding
• beta-blockers
• Endoscopic band ligation
• Hemodynamic responders
• Transjugular intrahepatic portosystemic shunt (TIPS)

A combination of drug treatment with beta-blockers and endoscopic therapy with band ligation is the standard first-line option for secondary prophylaxis of variceal bleeding in cirrhosis. Transjugular intrahepatic portosystemic shunt is the recommended treatment when combination therapy fails. %26lt;br%26gt;beta-Blockers are the backbone of combination therapy, because their benefit goes beyond their portal-pressure-lowering effect and their efficacy extends to complications of portal hypertension other than bleeding. The added value of endoscopic band ligation is rather marginal. %26lt;br%26gt;In the setting of rebleeding prevention, there is a lack of robust criteria to stratify patients according to their rebleeding risk, because some patients are likely to respond to beta-blockers or endoscopic band ligation, whereas others present a high risk of rebleeding despite being on combination therapy. %26lt;br%26gt;Hepatic venous pressure gradient monitoring can identify responders to beta-blockers (%26quot;hemodynamic responders%26quot;), who have a very low rebleeding rate while treated only with beta-blockers. %26lt;br%26gt;Bleeders who could benefit more from a transjugular intrahepatic portosystemic shunt than from combination therapy include patients who first bleed while on beta-blockers, those with contraindications to beta-blockers or with refractory ascites, and patients with fundal varices.

• 出版日期2014-5