Notes on Endoscopic Management of Bleeding Varices
If esophageal varices are not treated, the chances of recurrent bleeding is more than 75%.
2. In resuscitation of bleeding varices maintain CVP between 2-5 cm of water.
3. Do not give sedatives in resuscitation of bleeding varices.
4.Sclerotherapy is better than medical managament as it has
a) Low incidence of rebleed
b) Increased long term survival
c) Less morbidity
Balloon Tube control
Done in cases of failure of endoscopic management in patients with exsanguinating bleed.
4 lumen minnesota tube
Gastric ballon maximum volume is 250 ml
Esophageal ballon can be inflated till 40 mm Hg
Remove tube after 6-12 hrs and maximum permissible time is 24 hours.
Bleeding Varices
If bleeding reoccurs after removal of tube, ask an experienced personnel to check if it was properly placed or
re introduce it .
Repeat endoscopy
1.Esophageal varices seen in 40% patients with cirrhosis and 60% of those with cirrhosis and ascites.
2. If initial evaluation shows no varices, in cirrhotics esophgeal varices develop at a rate of 5%/year.
3. 25% of patients with newly discovered varices will bleed in 2 years.
4.Best clinical predictor of bleeding is the size of the varices.
5. All patients with large varices (diameter greater than 5 mm) should be considered for prophylactic therapy (“primary prophylaxis”) to prevent variceal bleeding
6. Beta blockers are cheaper and more convenient to use and may potentially reduce the risk of bleeding from gastric varices and portal hypertensive gastropathy. Band ligation is the only option for patients with high-risk varices who have contraindications to beta blockers or who have not responded to or are intolerant of beta blockers. Combined use of propranolol and endoscopic variceal ligation to prevent primary prophylaxis is not currently recommende