Overview
Bleeding esophageal varices (BEV) are dilated veins in the esophagus due to portal hypertension, often leading to significant upper gastrointestinal bleeding 1.Diagnosis
Endoscopic visualization of varices grade I-IV 1.
Laboratory tests: Elevated INR, low platelet count, and signs of liver dysfunction 1.
Imaging: Contrast-enhanced CT or MRI may help assess underlying liver disease and portal vein anatomy 1.Management
First-line treatments:
- Non-selective beta-blockers (e.g., propranolol) to reduce portal pressure 1.
- Transjugular intrahepatic portosystemic shunt (TIPS) for refractory bleeding or recurrent variceal bleeding 1.
Acute bleeding control:
- Vasoconstrictors (e.g., somatostatin, octreotide) to control acute bleeding episodes 1.
- Endoscopic band ligation or sclerotherapy for immediate hemostasis 1.Special Populations
Comorbidities: Management strategies for patients with iatrogenic hepatic artery lesions may involve endovascular interventions like Trans-catheter Arterial Embolization (TAE) when addressing complications 1.Key Recommendations
Use non-selective beta-blockers prophylactically in patients with high-risk varices to prevent first variceal hemorrhage (Evidence: Moderate) 1.
Employ endoscopic band ligation or sclerotherapy as primary interventions for acute variceal bleeding (Evidence: Moderate) 1.
Consider Transjugular Intrahepatic Portosystemic Shunt (TIPS) for patients with recurrent bleeding or those refractory to endoscopic therapy (Evidence: Moderate) 1.
For iatrogenic hepatic arterial lesions complicating BEV management, endovascular procedures like TAE are effective and minimally invasive alternatives to surgery (Evidence: Strong) 1.References
1 Basile A, Lupattelli T, Giulietti G, Massa Saluzzo C, Mundo E, Carbonatto P et al.. Interventional treatment of iatrogenic lesions and hepatic arteries. La Radiologia medica 2005. link