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Year : 2016  |  Volume : 4  |  Issue : 3  |  Page : 15-23

Management of portal hypertensive bleeding

Professor and Head, Department of Gastroenterology

Correspondence Address:
B Vishwanath Tantry
Professor and Head, Department of Gastroenterology, Kasturba Medical College, Mangalore 575001

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2666-1802.258518

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Bleeding gastro-oesophageal varices is a major complication of cirrhosis and carries a high mortality. Major cause of death is the severity of the underlying disease. Patient with suspected variceal haemorrhage should undergo prompt resuscitation and early endoscopy. A combination of vasoactive drugs and endoscopic therapy gives the best results. Endoscopic variceal ligation is the endoscopic therapy of choice for oesophageal varices. For gastric varices, glue injection with 2% cyanoacrylate is the most cost effective therapy. In uncontrollable haemorrhage from oesophageal varices, emergency covered stent placement in oesophagus may be life saving. Use of covered TIPS should be considered in medical failure for both oesophageal and gastric varices. Balloon occluded retrograde transvenous obliteration is an emerging therapy for gastric varices. Re-bleeding is best prevented by a combination of beta blockers and endoscopic variceal ligation.

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