Clin Endosc.  2019 Jan;52(1):36-39. 10.5946/ce.2018.084.

The Use of Vasoconstrictors in Acute Variceal Bleeding: How Long Is Enough?

Affiliations
  • 1Division of Gastroenterology, Department of Medical Research, E-DA Hospital, Kaohsiung, Taiwan. ghlo@kimo.com

Abstract

Vasoconstrictors are often used as the first line therapy for acute esophageal variceal hemorrhage. They might also be used for a few days after endoscopic therapy to prevent early rebleeding. International guidelines recommend the use of vasoconstrictor therapy when acute esophageal variceal hemorrhage is suspected and continuation of the therapy until 3 to 5 days after endoscopic treatment. However, the duration of use of vasoconstrictors after endoscopic therapy is not clear. This review shows that if variceal bleeding is successfully controlled by endoscopic variceal ligation, the combination of vasoconstrictors can be reduced to less than 1 day.

Keyword

Acute variceal bleeding; Sclerotherapy; Vasoconstrictors; Banding ligation

MeSH Terms

Esophageal and Gastric Varices*
Hemorrhage
Ligation
Sclerotherapy
Vasoconstrictor Agents*
Vasoconstrictor Agents

Reference

1. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology. 1981; 80:800–809.
Article
2. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007; 46:922–938.
Article
3. Lo GH, Chen WC, Chen MH, et al. The characteristics and the prognosis for patients presenting with actively bleeding esophageal varices at endoscopy. Gastrointest Endosc. 2004; 60:714–720.
Article
4. Laine L, Planas R, Nevens F, Banares R, Patch D, Bosch J. Treatment of the acute bleeding episode. In : de Franchis R, editor. Portal hypertension IV - proceedings of the 4th Baveno International Consensus Workshop. Oxford: Blackwell Publishing;2006. p. 714–720.
5. Besson I, Ingrand P, Person B, et al. Sclerotherapy with or without octreotide for acute variceal bleeding. N Engl J Med. 1995; 333:555–560.
Article
6. Primignani M, Andreoni B, Carpinelli L, et al. Sclerotherapy plus octreotide versus sclerotherapy alone in the prevention of early rebleeding from esophageal varices: a randomized, double-blind, placebo-controlled, multicenter trial. New Italian Endoscopic Club. Hepatology. 1995; 21:1322–1327.
7. Sung JJ, Chung SC, Yung MY, et al. Prospective randomised study of effect of octreotide on rebleeding from oesophageal varices after endoscopic ligation. Lancet. 1995; 346:1666–1669.
Article
8. de Franchis R, Primignani M. Endoscopic treatments for portal hypertension. Semin Liver Dis. 1999; 19:439–455.
Article
9. Bañares R, Albillos A, Rincón D, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology. 2002; 35:609–615.
Article
10. Tripathi D, Stanley AJ, Hayes PC, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015; 64:1680–1704.
Article
11. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017; 65:310–335.
Article
12. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med. 1995; 123:280–287.
13. Lo GH, Lai KH, Cheng JS, et al. Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices. Hepatology. 1997; 25:1101–1104.
Article
14. Lo GH. Do we need vasoconstrictors up to 5 days after successful hemostasis by ligation of bleeding varices? Hepatology. 2017; 66:1009.
Article
15. Avgerinos A, Nevens F, Raptis S, Fevery J. Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial. Lancet. 1997; 350:1495–1499.
Article
16. Zuberi BF, Baloch Q. Comparison of endoscopic variceal sclerotherapy alone and in combination with octreotide in controlling acute variceal hemorrhage and early rebleeding in patients with low-risk cirrhosis. Am J Gastroenterol. 2000; 95:768–771.
Article
17. Calès P, Masliah C, Bernard B, et al. Early administration of vapreotide for variceal bleeding in patients with cirrhosis. N Engl J Med. 2001; 344:23–28.
Article
18. Shah HA, Mumtaz K, Jafri W, et al. Sclerotherapy plus octreotide versus sclerotherapy alone in the management of gastro-oesophageal variceal hemorrhage. J Ayub Med Coll Abbottabad. 2005; 17:10–14.
19. Paquet KJ, Feussner H. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial. Hepatology. 1985; 5:580–583.
Article
20. Villanueva C, Piqueras M, Aracil C, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol. 2006; 45:560–567.
Article
21. Abid S, Jafri W, Hamid S, et al. Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebo-controlled trial. Am J Gastroenterol. 2009; 104:617–623.
Article
22. Azam Z, Hamid S, Jafri W, et al. Short course adjuvant terlipressin in acute variceal bleeding: a randomized double blind dummy controlled trial. J Hepatol. 2012; 56:819–824.
Article
23. Seo YS, Park SY, Kim MY, et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology. 2014; 60:954–963.
Article
24. Lo GH, Perng DS, Chang CY, Tai CM, Wang HM, Lin HC. Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding. J Gastroenterol Hepatol. 2013; 28:684–689.
Article
25. Salim A, Amin MJ, Javed M, et al. Terlipressin administered only prior to endoscopic therapy in the management of bleeding esophageal varices does not increase the risk of re-bleeding compared to standard 3-5 days regime. Annals of Punjab Medical College. 2017; 11:78–82.
26. Lo GH. Lack of difference among vasoconstrictors: similar effectiveness or similar ineffectiveness? Hepatology. 2015; 62:653.
Article
27. de Franchis R. Longer treatment with vasoactive drugs to prevent early variceal rebleeding in cirrhosis. Eur J Gastroenterol Hepatol. 1998; 10:1041–1044.
Article
28. Lo GH, Lai KH, Cheng JS, et al. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology. 2000; 32:461–465.
Article
29. Moitinho E, Escorsell A, Bandi JC, et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999; 117:626–631.
Article
30. García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010; 362:2370–2379.
Article
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