Has sclerotherapy altered the management of patients with variceal bleeding?

Article Abstract:

Sclerotherapy, injection of a hardening agent through the esophagus, has changed the method of treating patients with bleeding from esophageal varices, which are enlarged, swollen and tortuous veins at the lower end of the esophagus. Esophageal varices result from portal hypertension (increased blood pressure in the portal vein of the liver), which may be due blood flow obstruction within the liver due to cirrhosis. Sclerotherapy is the treatment of choice today for most patients who have active bleeding from esophageal varices. This form of treatment should be performed, if possible, in a specialized center. Diagnosis of bleeding esophageal varices should be confirmed by endoscopy, (visualization of the interior of the esophagus using an illuminated optic instrument). Sclerotherapy should be performed immediately, with surgical procedures (such as shunts of the portal vein and transection of the esophagus) used only when sclerotherapy fails (in about 5 to 10 percent of patients). The best long-term management following an episode of bleeding may depend on the underlying cause of the portal hypertension; in Western countries this is frequently liver cirrhosis. Treatment options include repeated injection sclerotherapy and liver transplant, medical management, portal system shunt surgery and drug therapy, which is highly controversial. Liver transplant should be considered for any patient who has had variceal bleeding, as this is the only therapy that cures the underlying liver disease and portal hypertension. Since use of sclerotherapy does not interfere with subsequent liver transplant, this therapy is recommended. Long-term sclerotherapy should not be continued if varices are not able to be eliminated; early surgery should then be performed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Liver cirrhosis, Esophageal varices, Portal hypertension

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Management of variceal hemorrhage in the potential liver transplant candidate

Article Abstract:

The increased frequency of liver transplantation raises new issues concerning the management of bleeding tortuous and dilated veins (variceal hemorrhage) in the esophagus (the gullet) in patients who may or will undergo liver transplantation. Transplants were performed in 37 of 53 cases referred to liver transplant centers. Twenty-two of the 53 patients referred for transplantation had a history of variceal hemorrhage. Sclerotherapy (injecting material to harden and close-off a fragile blood vessel) was required in nine patients and the surgical creation of a portacaval shunt (a connection between the systemic venous system and the digestive or portal venous system) was required in four patients. Variceal hemorrhage contributed to the deaths of three of six patients who died before transplantation could be performed. Sclerotherapy has become the most common invasive treatment for patients suffering from esophageal variceal hemorrhage. If sclerotherapy is unsuccessful in stopping or controlling variceal hemorrhage, the decision must be made whether to proceed with urgent liver transplantation or the surgical creation of a portacaval shunt. Factors influencing this choice include the ability to stabilize an acutely bleeding patient, the ability of the liver to function, the general clinical status of the patient, and the availability of a liver transplant center.

Health aspects, Management, Surgery, Varicose veins, Endoscopy, Portacaval anastomosis, Portal vein bypass

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Syndrome of multiple bowel perforations in liver transplant recipients

Article Abstract:

Patients who currently undergo liver transplant surgery experience longer survival as a result of improvements in anesthesia techniques and critical care. However, there is still a relatively high incidence of postoperative complications. An analysis of 500 liver transplant patients identified 12 patients who developed a syndrome of multiple bowel (intestine) perforations following liver transplant. These perforations were not due to injury during surgery. All bowel perforations occurred in very young children, ranging in age from two weeks to five years. These children represent 7 percent of the 500 children who underwent liver transplant at the University of Nebraska Medical Center from 1985 to 1990. A study was undertaken to identify the possible cause of the syndrome and describe the course of the affected patients. Patients had at least three perforations, typically pinpoint perforations in normal-appearing intestine. The children underwent many exploratory operations and specific operative procedures. At average follow-up of 34.9 months, all patients are alive. The cause of this syndrome remains unclear; it appears to have multiple causes, but may be related to high-dose steroid therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Intestines

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