Ösophagusvarizenblutung: medikamentöse, endoskopische, interventionelle Therapie

Michael Praktiknjo; Jonel Trebicka

doi:10.1055/a-1939-5505

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie, Table of Contents

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2022; 9(04): 301-312
DOI: 10.1055/a-1939-5505

CME-Fortbildung

Ösophagusvarizenblutung: medikamentöse, endoskopische, interventionelle Therapie

Michael Praktiknjo

,

Jonel Trebicka

Abstract

Die Varizenblutung ist durch ihre hohe Letalität eine der gefürchtetsten Komplikationen in der Gastroenterologie/Hepatologie. Das Management ist komplex und beinhaltet ein rasches und präzises Vorgehen bereits beim Eintreffen des Patienten. Dieser Beitrag beschreibt die State-of-the-Art-Therapie inklusive medikamentöser, endoskopischer und interventioneller Optionen sowie die aktuellen Empfehlungen zur Primär- und Sekundärprophylaxe.

Full Text

References

Literatur
1 Götz M, Anders M, Biecker E. et al. [S2k Guideline Gastrointestinal Bleeding – Guideline of the German Society of Gastroenterology DGVS]. Z Gastroenterol 2017; 55: 883-936
2 Baradarian R, Ramdhaney S, Chapalamadugu R. et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol 2004; 99: 619-622
3 Gattas DJ, Dan A, Myburgh J. et al. Fluid resuscitation with 6% hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy. Intensive Care Med 2013; 39: 558-568
4 Martínez J, Hernández-Gea V, Rodríguez-de-Santiago E. et al. Bacterial infections in patients with acute variceal bleeding in the era of antibiotic prophylaxis. J Hepatol 2021; 75: 342-350
5 de Franchis R. Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743-752
6 de Franchis R, Bosch J, Garcia-Tsao G. et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol 2021;
7 Villanueva C, Colomo A, Bosch A. et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11-21
8 Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147-156
9 Wells M, Chande N, Adams P. et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012; 35: 1267-1278
10 Sharma P, Agrawal A, Sharma BC. et al. Prophylaxis of hepatic encephalopathy in acute variceal bleed: a randomized controlled trial of lactulose versus no lactulose. J Gastroenterol Hepatol 2011; 26: 996-1003
11 Maharshi S, Sharma BC, Srivastava S. et al. Randomised controlled trial of lactulose versus rifaximin for prophylaxis of hepatic encephalopathy in patients with acute variceal bleed. Gut 2015; 64: 1341-1342
12 Trebicka J, Gu W, Ibáñez-Samaniego L. et al. Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS. J Hepatol 2020; 73: 1082-1091
13 Escorsell À, Pavel O, Cárdenas A. et al. Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial. Hepatology 2016; 63: 1957-1967
14 Nicoară-Farcău O, Han G, Rudler M. et al. Effects of early placement of transjugular portosystemic shunts in patients with high-risk acute variceal bleeding: a meta-analysis of individual patient data. Gastroenterology 2021; 160: 193-205.e10
15 Hernández-Gea V, Procopet B, Giráldez Á. et al. Preemptive-TIPS improves outcome in high-risk variceal bleeding: an observational study. Hepatology 2019; 69: 282-293
16 Schepis F, Vizzutti F, Garcia-Tsao G. et al. Under-dilated TIPS associate with efficacy and reduced encephalopathy in a prospective, non-randomized study of patients with cirrhosis. Clin Gastroenterol Hepatol 2018; 16: 1153-1162.e7
17 Praktiknjo M, Abu-Omar J, Chang J. et al. Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation. JHEP Rep 2021; 3: 100264
18 Sarwar A, Zhou L, Novack V. et al. Hospital volume and mortality after transjugular intrahepatic portosystemic shunt creation in the United States. Hepatology 2018; 67: 690-699
19 Villanueva C, Albillos A, Genescà J. et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, doubleblind, placebo-controlled, multicentre trial. Lancet 2019; 393: 1597-1608