Background: Acute variceal bleeding (AVB) is a life-threatening complication of liver cirrhosis
or less commonly splenic vein thrombosis. Pharmacological and endoscopic interventions
are cornerstones in the management of variceal bleeding but may fail in 10 – 15 %
of patients. Rescue therapy with balloon tamponade (BT) or transjugular intrahepatic
portosystemic shunt (TIPS) may be required to control refractory acute variceal bleeding
effectively but with some limitations. The self-expanding metal stent (SEMS) is a
covered, removable tool that can be deployed in the lower esophagus under endoscopic
guidance as a rescue therapy to achieve hemostasis for refractory AVB.
Aims: To evaluate the technical feasibility, efficacy, and safety of SEMS as a rescue therapy
for AVB.
Methods: In this review article, we have performed an extensive literature search summarizing
case reports and case series describing SEMS as a rescue therapy for AVB. Indications,
features, technique, deployment, success rate, limitations, and complications are
discussed.
Results: At present, 103 cases have been described in the literature. Studies have reported
97.08 % technical success rates in deployment of SEMS. Most of the stents were intact
for 4 – 14 days with no major complications reported. Stent extraction had a success
rate of 100 %. Successful hemostasis was achieved in 96 % of cases with only 3.12 %
found to have rebleeding after placement of SEMS. Stent migration, which was the most
common complication, was observed in 21 % of patients.
Conclusion: SEMS is a safe and effective alternative approach as a rescue therapy for refractory
AVB.
