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Asociación Mexicana de Gastroenterología

2007, Número 1

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Rev Gastroenterol Mex 2007; 72 (1)


Ligadura endoscópica de várices en el tratamiento de la hipertensión portal

García-Pagán JC, Bellot GP, Bosch GJ

Idioma: Español
Referencias bibliográficas: 46
Paginas: 52-61
Archivo PDF: 62.32 Kb.


RESUMEN

La ligadura endoscópica (LEV) ha mostrado tener una mayor eficacia y menor número de efectos secundarios adversos que la escleroterapia en el tratamiento de las várices esofágicas. La introducción de dispositivos multibandas que permiten la colocación de 5-10 bandas en una sola sesión, ha logrado simplificar la realización de la técnica, evitando el uso de sobretubo y las complicaciones inherentes a ello. Las sesiones de LEV son realizadas cada dos semanas hasta conseguir la erradicación de las várices, lo cual se consigue en alrededor de 90% de los pacientes tras 2-4 sesiones. De acuerdo con la evidencia actual, los betabloqueantes no selectivos son la primera elección terapéutica en la profilaxis primaria de la hemorragia por várices esofágicas, mientras que la LEV debería reservarse para los pacientes con intolerancia o contraindicaciones para los betabloqueantes. El tratamiento combinado con betabloqueantes y 5-mononitrato de isosorbide, junto con la LEV es probablemente una buena opción terapéutica para la profilaxis secundaria de la hemorragia por várices. La eficacia de la LEV puede estar incrementada si se combina con betabloqueantes. Los pacientes que tienen contraindicaciones para el tratamiento con betabloqueantes o presentan una hemorragia mientras reciben tratamiento profiláctico con ellos, deben ser tratados con ligadura endoscópica. La LEV en combinación con el tratamiento farmacológico vasoactivo es el tratamiento de elección de la hemorragia aguda por várices esofágicas; sin embargo, se puede realizar escleroterapia de las várices si la realización de la LEV es técnicamente difícil.


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