Clinical Endoscopy

Focused Review Series: Endoscopic Hemostasis: An Overview of Principles and Recent Applications

Endoscopic Therapy and Radiologic Intervention of Acute Gastroesophageal Variceal Bleeding: Jeong Eun Song, Byung Seok Kim; Clin Endosc 2019;52(5):407-415. Published online September 30, 2019; DOI: https://doi.org/10.5946/ce.2019.178

Acute gastroesophageal variceal hemorrhage is a dreaded complication in patients with liver cirrhosis. Endoscopic therapy and radiologic intervention for gastroesophageal bleeding have rapidly developed in the recent decades. Endoscopic treatment is initially performed to stop variceal hemorrhage. For the treatment of esophageal variceal bleeding, endoscopic variceal ligation (EVL) is considered the endoscopic treatment of choice. In cases of gastric variceal hemorrhage, the type of gastric varices (GVs) is important in deciding the strategy of endoscopic treatment. Endoscopic variceal obturation (EVO) is recommended for fundal variceal bleeding. For the management of gastroesophageal varix type 1 bleeding, both EVO and EVL are available treatment options; however, EVO is preferred over EVL. If endoscopic management fails to control variceal hemorrhage, radiologic interventional modalities could be considered. Transjugular intrahepatic portosystemic shunt is a good option for rescue treatment in refractory variceal bleeding. In cases of refractory hemorrhage of GVs in patients with a gastrorenal shunt, balloon-occluded retrograde transvenous obliteration could be considered as a salvage treatment.

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Commentary

Endoscopic Ultrasound Real-Time Elastography in Liver Disease: Jeong Eun Song, Dong Wook Lee, Eun Young Kim; Clin Endosc 2018;51(2):118-119. Published online March 30, 2018; DOI: https://doi.org/10.5946/ce.2018.049

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