Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding

  title={Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding},
  author={Gin-Ho Lo and Daw Shyong Perng and Chi-Yang Chang and Chi‐Ming Tai and Huay-Min Wang and Hui-Chen Lin},
  journal={Journal of Gastroenterology and Hepatology},
Endoscopic therapy combined with vasoconstrictor was generally recommended to treat acute variceal bleeding. However, up to 30% of patients may still encounter treatment failure. 

The Use of Vasoconstrictors in Acute Variceal Bleeding: How Long Is Enough?

  • G. Lo
  • Medicine
    Clinical endoscopy
  • 2019
If variceal bleeding is successfully controlled by endoscopic Variceal ligation, the combination of vasoconstrictors can be reduced to less than 1 day.

Current Management Strategies for Acute Esophageal Variceal Hemorrhage

A strategy in which patients are stratified by Child class, the main predictor of outcomes, is proposed, based on a review of recent evidence.

Experience of Vasoactive Therapy from Esophageal Variceal Bleeding in Patients with Hepatic Cyrrosis and Syndrome of Portal Hypertension

The presented clinical experience of the use of synthetic somatostatin analogues in complex therapy at acute esophageal variceal bleeding allows recommending their wide use in the practice of urgent surgical clinics.

Effects of Proton Pump Inhibitor on Gastroesophageal Varices of Cirrhosis: A Randomized Controlled Trial

PPI does not appear to reduce variceal bleeding and adverse events in patients with cirrhosis after endoscopic therapy, and the average hospitalization expense of Patients in the PPI group was higher than that of patients in the non-PPI group.

Short-course vasoconstrictors are adequate for esophageal variceal bleeding after endoscopic variceal ligation: A systematic review and meta-analysis

Subgroup analysis suggested EVL with short-course vasoconstrictors is highly efficacious for esophageal variceal bleeding compared to standard combination, and clinical heterogeneity was found for the rebleeding rate for the subgroup during sensitivity analysis.

Necessity of vasoconstrictors for esophageal variceal bleeding after endoscopic ligation: A systematic review and meta-analysis

In patients with acute esophageal variceal bleeding after EVL, 5-day and 6-week mortality rates were similar regardless of vasoconstrictor use, and considering the controversial 5- day rebleeding rate, short course of vasodilator use based on current evidence may be reasonable.

Safe use of proton pump inhibitors in patients with cirrhosis

This work aims to develop practical guidance on the safe use of PPIs in patients with cirrhosis, and to investigate the role of EMT in the development and use of these drugs.

Use of Proton Pump Inhibitors in the Management of Gastroesophageal Varices

The best available evidence supports the use of short-course (10 days) PPI post–endoscopic variceal ligation to reduce ulcer size if ulcer healing is a concern and practices such as high-dose infusion and prolonged use should be discouraged until evidence of benefit becomes available.

Endoscopic Therapy for Variceal Bleeding: from Patient Preparation to Available Techniques and Rescue Therapies

The global management of patients with VB should include volume resuscitation, blood transfusion, and prevention of complications such as renal failure+/-sepsis+/-liver encephalopathy, as they drive the prognosis.

Acid suppression in patients treated with endoscopic therapy for the management of gastroesophageal varices: a systematic review and meta-analysis

The subgroup analyses showed that acid suppression could significantly decrease the incidence of bleeding in patients undergoing prophylactic EVL, rather than in patients undergoing therapeutic EVL.



Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding: A prospective randomized trial

It is demonstrated that the addition of sclerotherapy significantly improves the efficacy of SMT alone for the treatment of acute variceal bleeding, although it also increases the rate of complications.

Endoscopic Variceal Ligation Plus Nadolol and Sucralfate Compared With Ligation Alone for the Prevention of Variceal Rebleeding: A Prospective, Randomized Trial

The combination of ligation, nadolol, and sucralfate (triple therapy) proved more effective than banding ligation alone in terms of prevention of variceal recurrence and upper gastrointestinal rebleeding as well asvariceal reble bleeding.

Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: A meta‐analysis

In patients with AVB, pharmacologic agents improve the efficacy of endoscopic therapy to achieve initial control of bleeding and 5‐day hemostasis, yet fail to affect mortality.

Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

Banding ligation and sclerotherapy were comparable in the arresting of oozing varices, whereas ligation was superior to scler Therapy in the control of spurting varices.

Management of Acute Esophageal Variceal Hemorrhage

  • G. Lo
  • Medicine
    The Kaohsiung journal of medical sciences
  • 2010

Terlipressin vs. Octreotide in Bleeding Esophageal Varices as an Adjuvant Therapy With Endoscopic Band Ligation: A Randomized Double-Blind Placebo-Controlled Trial

The efficacy of terlipressin was not inferior to octreotide as an adjuvant therapy for the control of esophageal variceal bleed and in-hospital survival and high pulse, low hemoglobin, prothrombin time, blood in nasogastric aspiration, and portosystemic encephalopathy (PSE) were predictors of prolonged hospital stay.

Longer treatment with vasoactive drugs to prevent early variceal rebleeding in cirrhosis

  • R. de Franchis
  • Medicine
    European journal of gastroenterology & hepatology
  • 1998
Tterlipressin administration, in conjunction with sclerotherapy, can significantly reduce the likelihood of rebleeding compared with sclerosis alone and further supports its potential use in the longer-term treatment of BOV.