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Variceal Upper GI Bleeding

  • Jianhua Andy Tau
  • Waqar A. QureshiEmail author
Chapter
  • 730 Downloads

Abstract

Variceal hemorrhage is one the most harrowing situations encountered by GI fellows in training. It will be encountered frequently and emergently. Management of acute variceal hemorrhage demands sound endoscopic technique, prompt resuscitation, and medical therapy with antibiotics and somatostatin analogues. Despite advances in techniques and algorithms, the mortality rate and re-bleeding rate associated with variceal hemorrhage remain high. The Child-Pugh class, size of the varix, and endoscopic presence of high-risk stigmata determine the choice between non-selective beta blocker (NSBB) and endoscopic variceal ligation in the primary prevention of esophageal hemorrhage, while secondary prevention requires both. Proper dosing and tolerance of NSBB is challenging but can preclude further endoscopic surveillance. Gastric varices are defined by their location. They are less common, but more challenging. Glue injection and TIPS are currently the prominent tools used in both acute hemorrhage and secondary prevention, while primary prevention is typically avoided.

Keywords

Variceal hemorrhage Varices Non-selective beta blocker (NSBB) Endoscopic variceal ligation (EVL) Glue injection TIPS 

Supplementary material

Video 3.1

Control of active bleeding from esophageal varices (MP4 39079 kb)

Video 3.2

Obliteration of gastric varices using cyanoacrylate glue (MP4 52891 kb)

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Medicine, Section of Gastroenterology and HepatologyBaylor College of MedicineHoustonUSA

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