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Endoscopy and the Liver Patient

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Liver Disorders

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Abstract

Portal hypertension due to liver disease can result in several endoscopic findings in the GI tract, all of which are similar in that they do not cause symptoms except for GI bleeding, which can sometimes be acute and severe. Endoscopic screening for esophageal varices is recommended and primary prophylaxis is indicated with either nonselective beta-blocker (NSBB) or endoscopic banding for select cirrhotics depending on the severity of underlying liver disease and endoscopic features of the varices. Acute esophageal variceal bleeding can be life-threatening and requires inpatient management with resuscitation with judicious use of IV fluids and blood transfusions, vasoactive drugs such as somatostatin, antibiotics, and endoscopic evaluation and/or therapy within 12 h of presentation. Secondary prophylaxis after bleeding is controlled includes both NSBB and endoscopic therapy. Refractory bleeding may require temporizing measures such as a covered esophageal stent or balloon tamponade as a bridge to definitive therapy, usually transhepatic portosystemic shunt (TIPS). Gastric variceal bleeding is more difficult to control endoscopically but tissue adhesives such as cyanoacrylate have an emerging role; TIPS is still often required. Portal hypertensive gastropathy/colopathy may cause chronic GI blood loss and rarely requires treatment but NSBB and endoscopic ablation along with iron supplementation are usually effective.

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  1. Division of Gastroenterology, Gastroenterology and Hepatology – Froedtert, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Abdul H. Khan M.D.

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  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Kia Saeian

  2. Division of Gastroenterology and Hepatology, Medicine Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Reza Shaker

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Khan, A.H. (2017). Endoscopy and the Liver Patient. In: Saeian, K., Shaker, R. (eds) Liver Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-30103-7_34

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