Optimal treatment in acute variceal bleeding

Abstract

SUMMARY
Different treatment strategies have been used to control
variceal haemorrhage including drugs, oesophageal tambonade,
endoscopie sclerotherapy or ligation, TIPS, and
surgery. Optimal therapy should stop bleeding and prevent
early rebleeding. The initial resuscitation of patients is as
important as the other specific measures to promote haemostasis.
Balloon tambonade is a highly effective treatment
to achieve a temporary control of bleeding but it carries a
very high risk of complications. Pharmacologie treatment
has the theoretical advantage of allowing specific therapy
without requiring any complicated equipment and experienced
personnel. Drugs currently used in the treatment include
vasopressin, terlipressin and somatostatin or its analogues
octreotide and vapreotide. In clinical studies somatostatin
was more effective than vasopressin and as effective
as terlipressin but with improved safety profile. Endoscopie
treatments (sclerotherapy and ligation) are highly
effective in achieving haemostasis but they are largely
depended on the experience of the endoscopist. The association
of endoscopie with pharmacologie therapy (preferably
somatostatin), used as soon as the diagnosis is suspected
(before the endoscopy) and continued for five days, currently
appears to be the best approach to treatment. TIPS
is indicated in patients in whom bleeding cannot be controlled
or recurs after two sessions of endoscopie treatment.
Keywords: Portal hypertension, bleeding oesophageal varices,
cirrhosis, sclerotherapy, lipation, vasoactive drugs.