Prevention and Management of Gastroesophageal Variceal Hemorrhage / 대한소화기내시경학회지

ABSTRACT

Gastroesophageal variceal hemorrhage involving increased portal pressure is the most common fatal complication of liver cirrhosis. Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. Although acute variceal hemorrhage-related mortality has decreased significantly over the last decade, it still is at least 20% at 6 weeks after variceal bleeding even with optimal management. In patients with medium and large varices that have not bled but have a high risk of hemorrhage, nonselective beta-blockers or endoscopic variceal ligation may be recommended for the prevention of first variceal hemorrhage. Acute variceal hemorrhage requires intravascular volume support and blood transfusions with vasoconstrictive agents and prophylactic antibiotics. Endoscopic variceal ligation and nonselective beta-blockers are standard secondary prophylaxis therapies for variceal bleeding. Patients whose hepatic venous pressure gradient decreases to <12 mmHg or at least 20% from baseline levels after treatment with nonselective beta-blockers can reduce the probability of recurrent variceal hemorrhage. In gastric fundal varices, endoscopic variceal obturation using cyanoacrylate is preferred. For failures of medical therapy, a transjugular intrahepatic portosystemic shunt or surgically created shunts are salvage procedures.