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НЕВРОЛОГИ, НЕЙРОХІРУРГИ, ЛІКАРІ ЗАГАЛЬНОЇ ПРАКТИКИ, СІМЕЙНІ ЛІКАРІ

КАРДІОЛОГИ, СІМЕЙНІ ЛІКАРІ, РЕВМАТОЛОГИ, НЕВРОЛОГИ, ЕНДОКРИНОЛОГИ

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ТРАВМАТОЛОГИ

ОНКОЛОГИ, (ОНКО-ГЕМАТОЛОГИ, ХІМІОТЕРАПЕВТИ, МАМОЛОГИ, ОНКО-ХІРУРГИ)

ЕНДОКРИНОЛОГИ, СІМЕЙНІ ЛІКАРІ, ПЕДІАТРИ, КАРДІОЛОГИ ТА ІНШІ СПЕЦІАЛІСТИ

ПЕДІАТРИ ТА СІМЕЙНІ ЛІКАРІ

АНЕСТЕЗІОЛОГИ, ХІРУРГИ

"Emergency medicine" Том 18, №5, 2022

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Endoscopic therapy of gastric variceal bleeding

Authors: Чуклін С.М. (1), Чуклін С.С. (2), Дутка Я.Р. (1)
(1) — Львівський національний медичний університет імені Данила Галицького, м. Львів, Україна
(2) — Медичний центр Святої Параскеви, м. Львів, Україна

Categories: Medicine of emergency

Sections: Specialist manual

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Summary

Кровотеча з варикозно розширених вен стравоходу та шлунка є найнебезпечнішим для життя ускладненням цирозу печінки та портальної гіпертензії. Кровотеча з варикозно розширених вен шлунка часто є серйознішою та може призвести до смерті. Для її зупинки спочатку проводиться ендоскопічне лікування. Зараз міжнародні консенсусні рекомендації щодо лікування кровотечі з варикозу шлунка відрізняються залежно від ендоскопічної класифікації. Варикозне розширення вен шлунка має іншу фізіологію та клінічні характеристики порівняно з варикозним розширенням вен стравоходу. Існує мало інформації про способи гемостазу при кровотечі зі шлункових вариксів. Незважаючи на те, що кілька нещодавніх розробок щодо препаратів і методів поліпшили результати при цій патології, консенсус щодо оптимального лікування не досягнутий. У цій статті розглядаються сучасні можливості ендоскопічного втручання при варикозній кровотечі зі шлунка за літературними даними з бази MedLine.

Bleeding from esophageal and gastric varices is the most life-threatening complication of liver cirrhosis and portal hypertension. Gastric variceal bleeding is often more serious and can be fatal. Endoscopic treatment is initially performed to stop variceal hemorrhage. Currently, international consensus guidelines for the treatment of gastric variceal bleeding vary depending on the endoscopic classification. Gastric varices have different physiology and clinical characteristics compared to esophageal varices. There is little information about the management of gastric variceal bleeding. Although several recent developments in the agents and the techniques have improved the outcome in this pathology, no consensus has been reached on the optimum treatment. This article reviews the current endoscopic treatment modalities used in gastric variceal bleeding according to the literature from MedLine.


Keywords

варикозно розширені вени шлунка; огляд; класифікація; ендоскопія; лікування

gastric varices; review; classification; endoscopy; treatment


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Bibliography

  1. Garcia-Tsao G., Abraldes J.G., Berzigotti A., Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American association for the study of liver diseases. Hepatology. 2017. Vol. 65. P. 310-335. 
  2. Ryan B.M., Stockbrugger R.W., Ryan J.M. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004. Vol. 126. P. 1175-1189. 
  3. Tripathi D., Stanley A.J., Hayes P.C. et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015. Vol. 64. P. 1680-1704. 
  4. Irani S., Kowdley K., Kozarek R. Gastric varices: an updated review of management. J. Clin. Gastroenterol. 2011. Vol. 45. P. 133-148.
  5. Triantafyllou M., Stanley A.J. Update on gastric varices. World J. Gastrointest. Endosc. 2014. Vol. 6. P. 168-175. 
  6. Teng W., Chen W.T., Ho Y.P. et al. Predictors of mortality within 6 weeks after treatment of gastric variceal bleeding in cirrhotic patients. Medicine (Baltimore). 2014. Vol. 93. e321. 
  7. Choi J.K., Choi J.S., Hyun J.H. Endoscopic finding of UGI in 15 pancreatic cancer patients. J. Korean Med. Assoc. 1983. Vol. 26. Р. 37.
  8. Hosking S.W., Johnson A.G. Gastric varices: A proposed classification leading to management. Br. J. Surg. 1988. Vol. 75. P. 195-196. 
  9. Mathur S.K., Dalvi A.N., Someshwar V. et al. Endoscopic and radiological appraisal of gastric varices. Br. J. Surg. 1990. Vol. 77. P. 432-4355. 
  10. Hashizume M., Kitano S., Yamaga H. et al. Endoscopic classification of gastric varices. Gastrointest. Endosc. 1990. Vol. 36. P. 276-280. 
  11. Sarin S.K., Lahoti D., Saxena S.P. et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992. Vol. 16. P. 1343-1349.
  12. Henry Z., Patel K., Patton H., Saad W. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review. Clin. Gastroenterol. Hepatol. 2021. Vol. 9. P. 1098-1107.e1. 
  13. Arakawa M., Masuzaki T., Okuda K. Pathomorphology of esophageal and gastric varices. Semin. Liver Dis. 2002. Vol. 22. P. 73-82.
  14. Iwase H., Maeda O., Shimada M. et al. Endoscopic ablation with cyanoacrylate glue for isolated gastric variceal bleeding. Gastroint. Endosc. 2001. Vol. 53. P. 585-592. 
  15. de Franchis R., Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol. 2015. Vol. 63. P. 743-752. 
  16. Cheung J., Soo I., Bastiampillai R. et al. Urgent vs. non-urgent endoscopy in stable acute variceal bleeding. Am. J. Gastroenterol. 2009. Vol. 104. P. 1125-1129. 
  17. Hsu Y.C., Chung C.S., Tseng C.H. et al. Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage. J. Gastroenterol. Hepatol. 2009. Vol. 24. P. 1294-1299.
  18. Chen P.H., Chen W.C., Hou M.C. et al. Delayed endoscopy increases re-bleeding and mortality in patients with hematemesis and active esophageal variceal bleeding: a cohort study. J. Hepatol. 2012. Vol. 57. P. 1207-1213. 
  19. Trudeau W., Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest. Endosc. 1986. Vol. 32. P. 264-268. 
  20. Ali S.M., Wu S., Xu H. et al. A prospective study of endoscopic injection sclerotherapy and endoscopic variceal ligation in the treatment of esophageal varices. J. Laparoendosc. Adv. Surg. Tech. A. 2017. Vol. 27. P. 333-341. 
  21. Sarin S.K. Long-term follow-up of gastric variceal sclerotherapy: An eleven-year experience. Gastrointest. Endosc. 1997. Vol. 46. P. 8-14. 
  22. Stray N., Jacobsen C.D., Rosseland A. Injection sclerotherapy of bleeding oesophageal and gastric varices using a flexible endoscope. Acta Med. Scand. 1982. Vol. 211. P. 125-129. 
  23. Sarin S.K., Mishra S.R. Endoscopic therapy for gastric varices. Clin. Liver Dis. 2010. Vol. 14. P. 263-279. 
  24. Soehendra N., Nam C.V., Grimm H., Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy. 1986. Vol. 18. P. 25-26. 
  25. Hong C.H., Kim H.J., Park J.H. et al. Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration. J. Gastroenterol. Hepatol. 2009. Vol. 24. P. 372-378. 
  26. ASGE Technology Committee, Bhat Y.M., Banerjee S. et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest. Endosc. 2013. Vol. 78. P. 209-215.
  27. Caldwell S. Gastric varices: is there a role for endoscopic cyanoacrylates, or are we entering the BRTO era. Am. J. Gastroenterol. 2012. Vol. 107. P. 1784-1790. 
  28. Sarin S.K., Jain A.K., Jain M., Gupta R. A randomized controlled trial of cyanoacrylate vs alcohol injection in patients with isolated fundic varices. Am. J. Gastroenterol. 2002. Vol. 97. P. 1010-1015.
  29. Lim Y.S. Practical approach to endoscopic management for bleeding gastric varices. Korean J. Radiol. 2012. 13. Suppl. 1. S40-44.
  30. Ríos Castellanos E., Seron P., Gisbert J.P., Bonfill Cosp X. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst. Rev. 2015. N 5. CD010180. 
  31. Karstensen J.G., Ebigbo A., Bhat P. et al. Endoscopic treatment of variceal upper gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline. Endosc. Int. Open. 2020. Vol. 8. E990-997. 
  32. Franco M.C., Gomes G.F., Nakao F.S. et al. Efficacy and safety of endoscopic prophylactic treatment with undiluted cyanoacrylate for gastric varices. World J. Gastrointest. Endosc. 2014. Vol. 6. P. 254-259.
  33. Guo Y.W., Miao H.B., Wen Z.F. et al. Procedure-related complications in gastric variceal obturation with tissue glue. World J. Gastroenterol. 2017. Vol. 23. P. 7746-7755. 
  34. Mohan B.P., Chandan S., Khan S.R. et al. Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis. Endoscopy. 2020. Vol. 52. P. 259-267. 
  35. Seo Y.S. Prevention and management of gastroesophageal varices. Clin. Mol. Hepatol. 2018. Vol. 24. P. 20-42. 
  36. Cheng L.F., Wang Z.Q., Li C.Z. et al. Low incidence of complications from endoscopic gastric variceal obturation with butyl cyanoacrylate. Clin. Gastroenterol. Hepatol. 2010. Vol. 8. P. 760-766. 
  37. Wani Z.A., Bhat R.A., Bhadoria A.S. et al. Gastric varices: classification, endoscopic and ultrasonographic management. J. Res. Med. Sci. 2015. Vol. 20. P. 1200-1207. 
  38. Guo Y.W., Miao H.B., Wen Z.F. et al. Procedure related complications in gastric variceal obturation with tissue glue. World J. Gastroenterol. 2017. Vol. 23. P. 7746-7755. 
  39. Paik C.N., Kim S.W., Lee I.S. et al. The therapeutic effect of cyanoacrylate on gastric variceal bleeding and factors related to clinical outcome. J. Clin. Gastroenterol. 2008. Vol. 42. P. 916-922.
  40. Jun C.H., Kim K.R., Yoon J.H. et al. Clinical outcomes of gastric variceal obliteration using N-butyl-2-cyanoacrylate in patients with acute gastric variceal hemorrhage. Korean J. Intern. Med. 2014. Vol. 29. P. 437-444.
  41. Liu C., Ma L., Wang J., Tseng Y. et al. Prophylactic use of antibiotics in endoscopic injection of tissue adhesive for the elective treatment of gastric varices: a randomized controlled study. J. Gastroenterol. Hepatol. 2019. Vol. 34. P. 1486-1491. 
  42. Chirapongsathorn S., Manatsathit W., Farrell A., Suksama A. Safety and efficacy of endoscopic cyanoacrylate injection in the management of gastric varices: A systematic review and meta-analysis. JGH Open. 2021. Vol. 5. P. 1047-1055. 
  43. McAvoy N.C., Plevris J.N., Hayes P.C. Human thrombin for the treatment of gastric and ectopic varices. World J. Gastroenterol. 2012. Vol. 18. P. 5912-5917. 
  44. Jhajharia A., Wanjari S.J., Ashdhir P. et al. Role and safety of human thrombin injection for the treatment of bleeding gastric varices. Indian J. Gastroenterol. 2018. Vol. 37. P. 321-325. 
  45. Yang W.L., Tripathi D., Therapondos G. et al. Endoscopic use of human thrombin in bleeding gastric varices. Am. J. Gastroenterol. 2002. Vol. 97. P. 1381-1385. 
  46. Ramesh J., Limdi J.K., Sharma V., Makin A.J. The use of thrombin injections in the management of bleeding gastric varices: A single-center experience. Gastrointest. Endosc. 2008. Vol. 68. P. 877-882. 
  47. Frost J.W., Hebbar S. EUS-guided thrombin injection for management of gastric fundal varices. Endosc. Int. Open. 2018. Vol. 6. E664-668.
  48. Gillespie S.L., McAvoy N.C., Yung D.E. et al. Thrombin Is an Effective and Safe Therapy in the Management of Bleeding Gastric Varices. A Real-World Experience. J. Clin. Med. 2021. Vol. 10. Р. 785.
  49. Lo G.H., Lin C.W., Tai C.M. et al. A prospective, randomized trial of thrombin versus cyanoacrylate injection in the control of acute gastric variceal hemorrhage. Endoscopy. 2020. Vol. 52. P. 548-555. 
  50. Bhurwal A., Makar M., Patel A. et al. Safety and Efficacy of Thrombin for Bleeding Gastric Varices: A Systematic Review and Meta-Analysis. Dig. Dis. Sci. 2022. Vol. 67. P. 953-963. 
  51. de Franchis R. Evolving consensus in portal hypertension: report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J. Hepatol. 2005. Vol. 43. P. 167-176. 
  52. Van Stiegmann G. Update of endoscopic band ligation therapy for treatment of esophageal varices. Endoscopy. 2003. Vol. 35. S 5-8. 
  53. Lee T.H., Shih L.N. Clinical experience of endoscopic banding ligation for bleeding gastric varices. Hepatogastroenterology. 2008. Vol. 55. P. 766-769. 
  54. Tan P., Hou M., Lin H. et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology. 2006. Vol. 43. P. 690-697.
  55. Mansour L., El-Kalla F., El-Bassat H. et al. Randomized controlled trial of scleroligation versus band ligation alone for eradication of gastroesophageal varices. Gastrointest. Endosc. 2017. Vol. 86. P. 307-315. 
  56. Qiao W., Ren Y., Bai Y. et al. Cyanoacrylate injection versus band ligation in the endoscopic management of acute gastric variceal bleeding: meta-analysis of randomized, controlled studies based on the PRISMA statement. Medicine (Baltimore). 2015. Vol. 94. e1725. 
  57. Sung J.J., Luo D., Wu J.C. et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy. 2011. Vol. 43. P. 291-295.
  58. Holster I.L., Poley J.W., Kuipers E.J., Tjwa E.T. Controlling gastric variceal bleeding with endoscopically applied hemostatic powder (HemosprayTM). J. Hepatol. 2012. Vol. 57. P. 1397-1398. 
  59. Ibrahim M., El-Mikkawy A., Mostafa I., Devière J. Endoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: a prospective pilot study. Gastrointest. Endosc. 2013. Vol. 78. P. 769-773.
  60. Ibrahim M., El-Mikkawy A., Abdel Hamid M. et al. Early application of haemostatic powder added to standard management for oesophagogastric variceal bleeding: a randomised trial. Gut. 2019. Vol. 68. P. 844-853. 
  61. Maruyama H., Okugawa H., Yoshizumi H. et al. Hemodynamic features of gastrorenal shunt: a Doppler study in cirrhotic patients with gastric fundal varices. Acad. Radiol. 2008. Vol. 15. P. 1148-1154.
  62. Kim M.Y., Um S.H., Baik S.K. et al. Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data. Clin. Mol. Hepatol. 2013. Vol. 19. P. 36-44. 
  63. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J. Hepatol. 2018. Vol. 69. P. 406-460. 
  64. Park S.W., Seo Y.S., Lee H.A. et al. Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation. Can. J. Gastroenterol. Hepatol. 2016. 2016. 2198163. 
  65. Toubia N., Sanyal A.J. Portal hypertension and variceal hemorrhage. Med. Clin. North Am. 2008. Vol. 92. P. 551-574. 
  66. Lo G.H., Lin C.W., Perng D.S. et al. A retrospective comparative study of histoacryl injection and banding ligation in the treatment of acute type 1 gastric variceal hemorrhage. Scand. J. Gastroenterol. 2013. Vol. 48. P. 1198-1204. 
  67. Luo X., Hernández-Gea V. Update on the management of gastric varices. Liver Int. 2022. Vol. 42. P. 1250-1258. 
  68. Maydeo A., Patil G. How to Approach a Patient With Gastric Varices. Gatroenterology. 2022. Vol. 162. P. 689-695. 

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