How is gastric variceal bleeding treated? Gastric varices are generally not amenable to EBL or sclerotherapy (except those that extend from the esophagus to the lesser curvature; GOV1 varices). Cyanoacrylate glue injection is an alternative endoscopic technique for gastric varices. Balloon-occluded retrograde transvenous obliteration or balloon-occluded anterograde transvenous obliteration are alternative radiologic procedures increasingly used …
What are the techniques available for rescue therapy in variceal bleeding ? Balloon tamponade is typically employed if EBL cannot be attempted because of patient instability, or if rebleeding occurs immediately after EBL. Transjugular intrahepatic portosystemic shunts (TIPSs) are indicated in the setting of rebleeding after EBL or for initial management of gastric variceal bleeding. …
What endoscopic therapy is available to control variceal bleeding? Variceal endoscopic band ligation (EBL) and sclerotherapy are the main methods for endoscopic control of variceal bleeding, and control bleeding in approximately 90% of cases. EBL is the preferred method based on lower rebleeding (26% vs. 44%), mortality (24% vs. 31%) and complication rates (11% vs. …
What is the nonendoscopic management of variceal bleeding? If a variceal etiologic factor is suspected, octreotide bolus (50 mcg) with subsequent infusion (50 mcg/h) should be initiated to decrease portal pressures and ongoing bleeding. Antibiotics (typically a fluoroquinolone or ceftriaxone if there is a high local prevalence of quinolone-resistant organisms) should be given for 7 …
What are the endoscopic techniques for managing nonvariceal UGI bleeding? There are a number of endoscopic modalities available for the treatment of nonvariceal UGI bleeding. Epinephrine therapy is not effective as monotherapy but can be a helpful adjuvant in combination with other modalities. In general, the choice of therapy depends on the type and location …
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What is the nonendoscopic management of peptic ulcer bleeding? IV proton pump inhibitor (PPI) bolus and infusion preendoscopy decreases the number of patients with high-risk stigmata at endoscopy and the need for endoscopic treatment, although it has not been shown to decrease related outcomes, including rebleeding, need for surgery, and mortality. Preendoscopy IV PPI is …
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What can help differentiate between an upper and a lower source of bleeding? Feature Upper GI Bleeding Lower GI Bleeding Anatomy Esophagus to ligament of Treitz (duodenum) Below ligament of Treitz (jejunum to rectum) Common Causes Peptic ulcers, esophageal varices, gastritis, Mallory-Weiss tear Diverticulosis, hemorrhoids, colon cancer, IBD, angiodysplasia Color of Blood Dark red, black …
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