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Table of Contents
Vol. 85, No. 3, 2012
Issue release date: May 2012
Section title: Original Paper
Digestion 2012;85:185–191
(DOI:10.1159/000335081)

Acute Management of Refractory Variceal Bleeding in Liver Cirrhosis by Self-Expanding Metal Stents

Dechêne A.a · El Fouly A.H.a, c · Bechmann L.P.a · Jochum C.a · Saner F.H.b · Gerken G.a · Canbay A.a
Departments of aGastroenterology and Hepatology and bGeneral, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany; cDivision of Tropical Medicine, Ain Shams University, Cairo, Egypt

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 08, 2011
Accepted: November 15, 2011
Published online: January 20, 2012
Issue release date: May 2012

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 3

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: http://www.karger.com/DIG

Abstract

Background and Aims: Current treatment strategies of variceal bleeding (VB) include banding and sclerotherapy. However, up to 10% of bleeding events remain refractory to standard therapy with high mortality. With this study, we aimed to evaluate the implantation of self-expanding metal stents (SEMS) for the management of therapy-refractory variceal bleeding. Patients and Methods: Eight cirrhotic patients who presented to our unit with a total of 9 refractory bleeding events were treated by SEMS placement. Results: Stenting resulted in immediate hemostasis in all cases without recurrent bleeding with SEMS in situ. After stabilization, 1 patient was treated by transjugular intrahepatic portosystemic shunt (TIPS) and after the second bleeding episode by TIPS dilation. One patient underwent orthotopic liver transplantation (OLT). The remaining patients were treated with standard drug regimens to reduce portal pressure. The SEMS were removed after a median of 11 days. No acute hemorrhage was noted on stent retrieval. While no early rebleeding occurred in the patients after TIPS implant, TIPS dilation or OLT, 3 out of 5 patients on conservative treatment experienced recurrence of VB within 9 days after SEMS removal. Conclusions: SEMS placement sufficiently stops hemorrhage in refractory VB. Due to the high rebleeding rate after conservative treatment alone following SEMS removal, this procedure may be utilized as a mere bridging method. Additional interventional and/or surgical methods to effectively reduce portal pressure (i.e. TIPS, OLT) should be considered. Further studies to evaluate the optimum treatment algorithm of refractory esophageal VB are warranted.

© 2012 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 08, 2011
Accepted: November 15, 2011
Published online: January 20, 2012
Issue release date: May 2012

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 3

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: http://www.karger.com/DIG


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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