Abstract
About one quarter of cirrhotic patients with esophageal varices will experience a variceal bleed within 2 years of diagnosis. Despite the progress in the management of variceal bleeding achieved during the last decades, bleeding cirrhotic patients have a 6 weeks mortality ranging between 10 and 20 %. Current treatment with a combination of vasoactive drugs and endoscopic band ligation can control bleeding in over 90 % of patients. The patients in whom bleeding control fails or who rebleed shortly after an initial successful hemostasis have a very high mortality. For these reasons, several studies have been carried out to identify those patients at high risk for a first variceal hemorrhage, in order to select them for prophylactic therapy, and those at high risk of failure of bleeding control, in order to decide the early adoption of a more aggressive form of therapy. The NIEC score is presently the most reliable among the various methods proposed to predict the first variceal hemorrhage. Patients at risk of failure of first-line therapies can be identified by evaluating clinical and endoscopic variables at admission and by monitoring the early evolution of the clinical situation.
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Abbreviations
- HVPG:
-
Hepatic vein pressure gradient
- NIEC:
-
North Italian Endoscopic Club
- TIPS:
-
Transjugular intrahepatic portosystemic shunt
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de Franchis, R. (2014). Assessing the Risk of Bleeding. In: de Franchis, R., Dell’Era, A. (eds) Variceal Hemorrhage. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0002-2_4
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