ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Clinical Case-Based Learning (Day Two) | March 2024-Management of Variceal Bleeding in Cirrhosis

Pdf Summary

The management of variceal bleeding in cirrhosis involves understanding the etiologies of chronic liver disease, such as alcohol, NAFLD, and viral hepatitis. Portal hypertension plays a crucial role in the development of esophageal varices, with risk factors including the severity of liver disease and the presence of red wale signs. Screening for varices through EGD is recommended at different intervals based on the patient's condition. Treatment options for varices include non-selective beta-blockers, variceal band ligation, and early TIPS in certain cases.<br /><br />In cases of variceal hemorrhage, immediate resuscitation, stabilization, and control of bleeding are necessary. Pharmacologic therapies like octreotide and terlipressin, along with antibiotics, are used to manage bleeding. Endoscopic interventions like variceal ligation and sclerotherapy are performed to prevent rebleeding. In refractory cases, emergency procedures like balloon tamponade or TIPS may be necessary.<br /><br />Management also involves considering complications like hepatic encephalopathy, monitoring for rebleeding risk, and providing secondary prophylaxis through a combination of interventions. Additional considerations include discontinuing PPIs, thiamine for alcohol use disorder, and electrolyte repletion. Overall, a comprehensive approach involving multi-modal therapies and close monitoring is crucial in the effective management of variceal bleeding in cirrhosis.

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Sumeet Tewani, MD, FASGE

Keywords

variceal bleeding

cirrhosis

chronic liver disease

alcohol

NAFLD

viral hepatitis

portal hypertension

esophageal varices

variceal band ligation

TIPS procedure