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Management of Esophageal Variceal Bleeding

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Gastrointestinal Bleeding

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Abstract

Variceal bleeding is a fatal complication of portal hypertension, which can be secondary to cirrhosis or various disorders that lead to increased portal pressures in a patient with preserved hepatic function. Current guideline recommendations base prophylaxis on the size of the varices and their likelihood of bleeding based on their endoscopic appearance and the severity of liver disease. Non-selective beta blockers are the mainstay of medical primary prophylaxis. In active variceal bleeding, medications are given to decrease portal pressures and endoscopy is performed with variceal band ligation to stop bleeding. For secondary prophylaxis, a combination of beta blockers and variceal band ligation is used to prevent re-bleeding. If acute variceal bleeding treated by endoscopy with band ligation fails to control bleeding, interventional radiology can be performed for a transjugular intrahepatic portosystemic shunt procedure or a surgical consultation should be called for evaluation for portacaval shunting to decompress the portal system.

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Authors and Affiliations

  1. Stony Brook University Hospital, 101 Nicolls Road, HSC Building, Room 17-060, Stony Brook, NY, 11794-8173, USA

    Demetrios Tzimas M.D. & Juan Carlos Bucobo M.D.

  2. Stony Brook University Hospital, 101 Nicolls Road, HSC T18-040, Stony Brook, NY, 11794, USA

    Dana Telem M.D.

Authors
  1. Demetrios Tzimas M.D.
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  2. Juan Carlos Bucobo M.D.
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  3. Dana Telem M.D.
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Correspondence to Demetrios Tzimas M.D. .

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Editors and Affiliations

  1. Department of Surgery, Stony Brook Medicine, Stony Brook, New York, USA

    Aurora D. Pryor

  2. Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA

    Theodore N. Pappas

  3. Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA

    M. Stanley Branch

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Tzimas, D., Bucobo, J.C., Telem, D. (2016). Management of Esophageal Variceal Bleeding. In: Pryor, A., Pappas, T., Branch, M. (eds) Gastrointestinal Bleeding. Springer, Cham. https://doi.org/10.1007/978-3-319-40646-6_3

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  • DOI: https://doi.org/10.1007/978-3-319-40646-6_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40644-2

  • Online ISBN: 978-3-319-40646-6

  • eBook Packages: MedicineMedicine (R0)

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