Singh S, Chandan S, Vinayek R, Aswath G, Facciorusso A, Maida M. Comprehensive approach to esophageal variceal bleeding: From prevention to treatment. World J Gastroenterol 2024; 30(43): 4602-4608 [DOI: 10.3748/wjg.v30.i43.4602]
Corresponding Author of This Article
Marcello Maida, MD, Professor, Department of Medicine and Surgery, University of Enna ‘Kore’, Piazza dell'Università, Enna 94100, Sicilia, Italy. marcello.maida@unikore.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 21, 2024; 30(43): 4602-4608 Published online Nov 21, 2024. doi: 10.3748/wjg.v30.i43.4602
Comprehensive approach to esophageal variceal bleeding: From prevention to treatment
Sahib Singh, Saurabh Chandan, Rakesh Vinayek, Ganesh Aswath, Antonio Facciorusso, Marcello Maida
Sahib Singh, Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
Saurabh Chandan, Center for Interventional Endoscopy, Advent Health, Orlando, FL 32803, United States
Rakesh Vinayek, Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
Ganesh Aswath, Division of Gastroenterology and Hepatology, State University of New York Upstate Medical University, Syracuse, NY 13210, United States
Antonio Facciorusso, Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia 71122, Italy
Marcello Maida, Department of Medicine and Surgery, University of Enna ‘Kore’, Enna 94100, Sicilia, Italy
Author contributions: Singh S, Chandan S, Vinayek R, Aswath G, Facciorusso A and Maida M contributed to this paper; Facciorusso A and Maida M designed the overall concept and outline of the manuscript; Singh S contributed to the discussion and design of the manuscript; Singh S, Chandan S, Vinayek R, Aswath G, Facciorusso A and Maida M contributed to the writing, and editing the manuscript, illustrations, and review of literature.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marcello Maida, MD, Professor, Department of Medicine and Surgery, University of Enna ‘Kore’, Piazza dell'Università, Enna 94100, Sicilia, Italy. marcello.maida@unikore.it
Received: September 15, 2024 Revised: October 2, 2024 Accepted: October 18, 2024 Published online: November 21, 2024 Processing time: 45 Days and 20.2 Hours
Abstract
Esophageal variceal bleeding is a severe complication often associated with portal hypertension, commonly due to liver cirrhosis. Prevention and treatment of this condition are critical for patient outcomes. Preventive strategies focus on reducing portal hypertension to prevent varices from developing or enlarging. Primary prophylaxis involves the use of non-selective beta-blockers, such as propranolol or nadolol, which lower portal pressure by decreasing cardiac output and thereby reducing blood flow to the varices. Endoscopic variceal ligation (EVL) may also be employed as primary prophylaxis to prevent initial bleeding episodes. Once bleeding occurs, immediate treatment is essential. Initial management includes hemodynamic stabilization followed by pharmacological therapy with vasoactive drugs such as octreotide or terlipressin to control bleeding. Endoscopic intervention is the cornerstone of treatment, with techniques such as EVL or sclerotherapy applied to directly manage the bleeding varices. In cases where bleeding is refractory to endoscopic treatment, transjugular intrahepatic portosystemic shunt may be considered to effectively reduce portal pressure. Long-term management after an acute bleeding episode involves secondary prophylaxis using beta-blockers and repeated EVL sessions to prevent rebleeding, complemented by monitoring and managing liver function to address the underlying disease. In light of new scientific evidence, including the findings of the study by Peng et al, this editorial aims to review available strategies for the prevention and treatment of esophageal varices.
Core Tip: Despite the advancements in prophylaxis and treatment of esophageal variceal bleeding, the rebleeding rates and mortality remain high. Among the prediction tools for assessing the risk of variceal bleeding, imaging modalities such as computed tomography and endoscopy are commonly used, with the upcoming field of radiomics showing promising results.
