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Prevention of Recurrent Bleeding: Sclerotherapy

  • Karl-Joseph Paquet

Abstract

To understand the etiology of acute variceal hemorrhage and the rationale for the success of endoscopic injection sclerotherapy, it is necessary to study the anatomy of esophageal varices and the pathophysiology of portal hypertension. Unfortunately, neither is fully comprehended. Nevertheless, it has become increasingly accepted that esophageal varices usually bleed from the lower 5 cm of the esophagus [1–3], and that the hemorrhage is caused by rupture or disruption of a varix rather than erosion from within the esophageal lumen [3–6]. Although most authors find it difficult to predict which individual patient is likely to bleed, there is an accepted higher risk of hemorrhage in those with large esophageal varices [4,7], and in those with high portal pressure [4,8]. Therefore, our group has introduced a classification of esophageal varices (Fig. 39.1). We found that varices of degree IV have a high risk of bleeding. In this category teleangiectasias (varices on top of varices), signaling an impending danger of bleeding, can be seen endoscopically in more than 50% of the patients. On the other hand, some patients with large varices, particularly those with a congenital or iatrogenic prehepatic block, may never bleed. While it has been shown that the threshold pressure for variceal bleeding is approximately 22 mmHg [8] it is 12 mmHg for the development of varices in alcoholic cirrhosis [4].

Keywords

Esophageal Varix Variceal Bleeding Gastric Varix Recurrent Bleeding Injection Sclerotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Japan 1991

Authors and Affiliations

  • Karl-Joseph Paquet
    • 1
  1. 1.Department of SurgeryHeinz Kalk Hospital ClinicBad KissingenGermany

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