digestive disorders
Esophageal Varices
Treatment of Esophageal Varices
Fluids given by vein (intravenously) and sometimes a blood transfusion Endoscopic treatments to stop the bleeding Intravenousoctreotide Sometimes antibiotics Sometimes a portosystemic shunting procedure People with variceal bleeding usually need fluids given intravenously to replace their blood loss. If they have lost a lot of blood, they may need a Overview of Blood Transfusion . During endoscopy, doctors can do treatments to stop the bleeding. Most often, doctors apply bands around the varices to close them off (a procedure called endoscopic banding). Sometimes they inject the varices with substances that seal them closed (a procedure called injection sclerotherapy). At the same time, doctors may give the medicationoctreotideorvasopressinintravenously to help stop the bleeding. If bleeding continues despite these treatments, doctors may do a procedure called portosystemic shunting. This procedure connects the portal vein or one of its branches to a vein in the general circulation and reroutes most of the blood that normally goes to the liver so that it bypasses the liver. This bypass (called a shunt) lowers pressure in the portal vein so that bleeding is easier to control. There are various types of portosystemic shunt procedures. In one type, called transjugular intrahepatic portosystemic shunting (TIPS), doctors, using x-rays for guidance, insert a catheter with a needle into a vein in the neck and thread it to veins in the liver. The catheter is used to create a passage (shunt) that connects the portal vein (or one of its branches) directly with one of the hepatic veins. Less commonly, portosystemic shunts are created surgically. If the person's life is in immediate danger from severe bleeding while waiting for the shunt procedure, doctors may place a tube with balloons down the person's esophagus. They inflate the balloons to squeeze (compress) the varices, which controls the bleeding. This tube is only a temporary measure. Expandable metal esophageal stents may be used to compress the varices to control the bleeding. People who have cirrhosis and bleeding are at risk of bacterial infection and are given an antibiotic. Even after successful treatment, esophageal varices can bleed again, particularly if the person's liver disease remains active. Doctors may give medications such as beta-blockers to help control portal hypertension, but people who continue to have problems may need Liver Transplantation . 