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current endoscopic
management
Dr. B K Jalan, MD
Esophageal
Gastric
usual cause is portal hypertension
due to
Cirrhosis of liver
portal thrombosis
others
Variceal bleed - general
outlook
In about 80% of patients, variceal
bleeding stops spontaneously.
mortality is high, often > 50%.
Mortality depends primarily on severity
of the associated liver disease rather
than on the bleeding itself.
Surviving patients are at high risk of
further variceal bleeding typically 50
to 75% have recurrence within 1 to 2
yr.
Endoscopic sclerotherapy
v successful in controlling acute esophageal
variceal bleeding in up to 90% of patients.
v Hemorrhagic control should be obtained with 1-
2 sessions.
Patients continuing to bleed after 2
sessions should be considered for
alternative methods to control their
bleeding.
v sclerosants:
– sodium tetradecyl sulfate
– sodium morrhuate
Endoscopic sclerotherapy
v Serious complications to sclerotherapy have
been reported in 15-20% of patients, with an
associated mortality rate of 2%.
v Complications of sclerotherapy may include
– mucosal ulceration,
– bleeding,
– oesophageal perforation,
– mediastinitis, and
– pulmonary complications.
– Long-term complications, such as esophageal
stricture formation, may also occur.
Bleeding esophageal varix
and sclerosant/ glue
lick to edit Master text styles
econd level injection
● Third level
● Fourth level
● Fifth level
Glue injection
Banding
Glue injection of bleeding
gastric varix
Mr. Sarma 74 yrs
Presented with
repeated
hematemesis,
precipitated by blood
05 12 transfusions
18 12
2009 2009
22 12 06 01
2009 2010
Prognosis of variceal
bleeding
The natural course of the disease
causing portal hypertension
Prevention of
Is early endoscopy necessary ?
● Out of the hours procedure
Injection
Thermal
● Heater probe
● Bipolar probe
● Nd: YAG laser
● Argon Plasma Coagulation
Mechanical
● Hemoclips
Injection temponade
1:10000 to 1:20000 adrenalin solution
injected round the bleeding site to
produce local compression
How likely?
therapy
10
Endotherapy / surgery ??
Follow up treatment