ASGE Adult and Pediatric Gastroenterology and Endoscopy Board Preparatory and Review Course | 2022-Ryou Diagnosis, Etiologies and Management of Esophageal

Ryou Diagnosis, Etiologies and Management of Esophageal

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The document is a summary of a presentation on the diagnosis, etiologies, and management of esophageal and gastric varices in patients with portal hypertension. Portal hypertension is defined as an elevated hepatic venous pressure greater than 5 mm Hg and is most commonly caused by cirrhosis. The presentation discusses the pathogenesis, manifestations, and treatment of portal hypertension, as well as the management of esophageal and gastric varices.<br /><br />For the diagnosis of esophageal varices, esophagogastroduodenoscopy (EGD) is the gold standard. Screening for esophageal varices is recommended in all patients with cirrhosis, and repeat EGD may be performed at the time of decompensating events. Primary prophylaxis for variceal bleeding in patients with small or large varices includes non-selective beta blockers (NSBBs) or endoscopic variceal ligation (EVL). In cases of acute esophageal variceal bleeding, the immediate goals of therapy are to control bleeding, prevent early recurrence, restore hemodynamic stability, maximize tissue oxygenation, and minimize complications. Treatment options include blood transfusions, antibiotics, vasoactive medications, and endoscopic therapies such as EVL or sclerotherapy. Transjugular intrahepatic portosystemic shunt (TIPS) may be considered in select patients.<br /><br />The presentation also covers the management of gastric varices, which account for 10-20% of all variceal bleeding. Limited data is available for primary and secondary prophylaxis of gastric variceal bleeding. Endoscopic injection therapy with cyanoacrylate or endoscopic ultrasound-guided injection therapy may be used for acute bleeding. Secondary prophylaxis options include cyanoacrylate injection or TIPS.<br /><br />The presentation concludes with a challenge question involving a patient with cirrhosis and acute esophageal variceal bleeding. The correct next step in management is to place a Sengstaken-Blakemore tube and expedite transfer for TIPS.<br /><br />Overall, the presentation provides an overview of the diagnosis, etiologies, and management of esophageal and gastric varices in the setting of portal hypertension.

Keywords

esophageal varices

gastric varices

portal hypertension

cirrhosis

esophagogastroduodenoscopy

endoscopic variceal ligation

non-selective beta blockers

acute variceal bleeding

transjugular intrahepatic portosystemic shunt

cyanoacrylate injection