The current knowledge about the therapeutic use of endoscopic sclerotherapy and endoscopic tissue adhesives in variceal bleeding

被引:48
作者
Al-Khazraji, Ahmed [1 ]
Curry, Michael P. [1 ]
机构
[1] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Transplant Liver Ctr, Dept Gastroenterol & Hepatol, 330 Brookline Ave, Boston, MA 02215 USA
关键词
Sclerotherapy; tissue adhesive; variceal bleeding; glue; thrombin; sclerotherapy complications; GASTRIC FUNDAL VARICES; INJECTION SCLEROTHERAPY; ESOPHAGEAL-VARICES; TRANSVENOUS OBLITERATION; CYANOACRYLATE INJECTION; STOMAL VARICES; FOLLOW-UP; MANAGEMENT; RISK; TIPS;
D O I
10.1080/17474124.2019.1652092
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Introduction: The most recent guidelines vary in their approach to the management of variceal bleeding especially with the use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA). This review highlights their clinical use for variceal bleeding from different guidelines perspectives. Areas covered: A comprehensive literature review of three major guidelines including the American Association for the Study of Liver Diseases (AASLD) 2017, United Kingdom (UK) guidelines 2015 and Baveno VI Consensus workshop guidelines in 2015 on the use of ES and ETA in variceal bleeding. Expert opinion: While endoscopic band ligation (EBL) completely replaced endoscopic sclerotherapy (ES) for esophageal varices. There is a valuable use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA) especially for patients with gastroesophageal varices (GOV2) and isolated gastric varices (IGV2). The current standard of care heading toward portosystemic shunting with Trans-jugular-Intrahepatic Portosystemic Shunt (TIPS) and balloon retrograde transvenous obliteration (BRTO). However, recent advancement in endoscopic ultrasound (EUS) allowing direct injection of sclerosant and tissue adhesive into the varix bringing promising results in achieving hemostasis and lowering the risk of complications. Also, ES and ETA have great clinical value in achieving hemostasis for isolated (ectopic) varices and stomal varices.
引用
收藏
页码:893 / 897
页数:5
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