Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-10

10_Patel Challenges in Variceal Bleeding

Pdf Summary

Dr. Kal Patel's presentation, "Challenges in Variceal Bleeding," highlights the complexities in managing gastric and refractory esophageal varices, particularly in patients with liver cirrhosis. Gastric varices, which develop in about 20% of cirrhosis patients, are especially prevalent in those with alcohol-related liver disease, due to portal hypertension and the dilation of submucosal gastric veins.<br /><br />The presentation outlines the need to understand the vascular anatomy, including GOV1, IGV1, and GOV2, and the phases of variceal bleeding for effective management. A crucial focus is on endoscopic and interventional radiology techniques, such as cyanoacrylate injections and EUS-guided coil embolization, which are preferred treatments due to their high immediate hemostasis rates. However, challenges such as high rebleed rates, especially in the presence of a shunt, necessitate a tailored approach.<br /><br />For bleeding varices, the AGA Clinical Practice Guidance assists in choosing treatment modalities based on shunt presence, which significantly influences outcomes. Endoscopic therapy with cyanoacrylate is recommended, although it poses embolization risks, and its success can be impacted by existing shunts. Alternative approaches like TIPS and RTO can improve conditions like ascites and encephalopathy in these scenarios.<br /><br />For refractory esophageal variceal bleeding, Dr. Patel discusses traditional interventions like balloon tamponade and newer options like esophageal metal stents, though the latter's availability can be limited. Overall, effective management of varices involves a multidisciplinary approach, engaging hepatologists, radiologists, and surgeons to optimize patient outcomes and address complications like high re-bleed rates.<br /><br />The presentation underscores the importance of personalized treatment plans, considering both acute interventions and long-term prophylactic strategies, to manage and mitigate the risks associated with variceal bleeding.

Keywords

variceal bleeding

gastric varices

esophageal varices

liver cirrhosis

portal hypertension

cyanoacrylate injections

EUS-guided coil embolization

AGA Clinical Practice Guidance

TIPS

multidisciplinary approach