Prevention and Management of Gastroesophageal Variceal Hemorrhage

Korean J Gastrointest Endosc > Volume 40(2); 2010 > Article

Korean Journal of Gastrointestinal Endoscopy 2010;40(2): 71-83.

위식도정맥류 출혈의 예방과 치료

정승원ㆍ조주영ㆍ신성재*ㆍ김문영^†ㆍ이병석^‡ㆍ이태희^§ㆍ장재영ㆍ서연석^∥ㆍ전훈재^∥ㆍ최석렬^¶

순천향대학교 의과대학 내과학교실, *아주대학교 의과대학 내과학교실, ^†연세대학교 원주의과대학 내과학교실, ^‡충남대학교 의과대학 내과학교실, ^§건양대학교 의과대학 내과학교실, ^∥고려대학교 의과대학 내과학교실, ^¶동아대학교 의과대학 내과학교실

Prevention and Management of Gastroesophageal Variceal Hemorrhage

Soung Won Jeong, M.D., Joo Young Cho, M.D., Sung Jae Shin, M.D.*, Moon Young Kim, M.D.^†, Byung Seok Lee, M.D.^‡, Tae Hee Lee, M.D.^§, Jae Young Jang, M.D., Yeon Seok Seo, M.D.^∥, Hoon Jai Chu

Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, *Ajou University College of Medicine, Suwon, ^†Yonsei University Wonju College of Medicine, Wonju, ^‡Chungnam National University College of Medicine, Daejeon, ^§Konyang University College of Medicine, Daejeon, ^∥Korea University College of Medicine, Seoul, ^¶Dong-A University College of Medicine, Busan, Korea

Abstract

Gastroesophageal variceal hemorrhage involving increased portal pressure is the most common fatal complication of liver cirrhosis. Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. Although acute variceal hemorrhage-related mortality has decreased significantly over the last decade, it still is at least 20% at 6 weeks after variceal bleeding even with optimal management. In patients with medium and large varices that have not bled but have a high risk of hemorrhage, nonselective Ղ-blockers or endoscopic variceal ligation may be recommended for the prevention of first variceal hemorrhage. Acute variceal hemorrhage requires intravascular volume support and blood transfusions with vasoconstrictive agents and prophylactic antibiotics. Endoscopic variceal ligation and nonselective Ղ-blockers are standard secondary prophylaxis therapies for variceal bleeding. Patients whose hepatic venous pressure gradient decreases to ＜12 mmHg or at least 20% from baseline levels after treatment with nonselective Ղ-blockers can reduce the probability of recurrent variceal hemorrhage. In gastric fundal varices, endoscopic variceal obturation using cyanoacrylate is preferred. For failures of medical therapy, a transjugular intrahepatic portosystemic shunt or surgically created shunts are salvage procedures. (Korean J Gastrointest Endosc 2010;40:71-83)

Key Words: Gastroesophageal varices, Nonselective Ղ-blocker, Endoscopic variceal ligation