Reyes DAA

Idioma: Español
Referencias bibliográficas: 41
Paginas: 50-55
Archivo PDF: 44.00 Kb.

RESUMEN

En el sangrado secundario a várices esofágicas los betabloqueadores no selectivos (propanolol o nalodol) continúan siendo la base de la profilaxis primaria, pero cada vez se populariza más el uso profiláctico de las ligaduras endoscópicas. El sangrado variceal agudo ha perdido su carácter de catástrofe irreversible gracias a los métodos actuales de control. El método preferido para el sangrado por várices esofágicas es la ligadura endoscópica y para las várices gástricas, la obliteración con cianoacrilato. La terapia farmacológica con octreótido o con terlipresina parece ser efectiva, fundamentalmente si no se cuenta con disponibilidad inmediata de tratamiento endoscópico. El TIPS (transjugular intrahepatic portosystemic shunt) es una alternativa como procedimiento de rescate en caso de falla del tratamiento médico y endoscópico. El papel de la ligadura endoscópica en la profilaxis secundaria es ahora indisputable, especialmente en comparación con la escleroterapia. La farmacoterapia con drogas que reducen la hipertensión portal es una alternativa al tratamiento endoscópico. Es necesario uniformar la técnica y los criterios de la erradicación endoscópica para disminuir la gran variabilidad que presentan algunos estudios reportados en la literatura.

REFERENCIAS (EN ESTE ARTÍCULO)

1. de Franchis R. Updating consensus in portal hypertension: report of Baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2000; 33: 846-52.

2. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices: a prospective multi-center study. N Engl J Med 1988; 319: 983-9.

3. Bendsten F, Skovgaard KR, Sorensen TI, Matzen P. Agreement among multiple observers on endoscopic diagnosis of esophageal varices before bleeding. Hepatology 1990; 11: 341-7.

4. Idezuki Y. General rules for recording endoscopic findings of esophagogastric varices (1991). Japanese Society for Portal Hypertension. World J Surg 1995; 19: 420-2.

5. Ichikawa S, Okamura S, Tujigami K, et al. Quantitative analysis of red color sign in the endoscopic evaluation of esophageal varices. Endoscopy 2001; 33: 747-53.

6. Miller ES, Kim JK, Gandehok J, et al. A new device for measuring esophageal variceal pressure. Gastrointest Endosc 2002; 56: 284-91

7. Irisawa A, Shibikawa G, Obara K, et al. Collateral vessels around the esophageal wall in patients with portal hypertension: comparison of EUS imaging and microscopic findings at autopsy. Gastrointest Endosc 2002; 56: 249-53.

8. Konishi Y, Nakamura T, Kida H, et al. Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointest Endosc 2002; 55: 197-203.

9. Lebrec D, Hillon P, Muñoz C, et al. The effect of propanolol on portal hypertension in patients with cirrhosis: a hemodynamic study. Hepatology 1982; 2: 523-27.

10. Thuluvath PJ, Krishnan A. Primary prophylaxis of variceal bleeding. Gastrointest Endosc 2003; 58: 558-67.

11. Mercado M, Orozco H, Plata-Muñoz J. Hipertensión portal. Guía basada en la evidencia. Rev Gastroenterol Mex 2004; 69: 102-8.

12. Garcia-Pagan JC, Villanueva C, Vila MC, Albillos A, Genesca J, et al. Isosorbide mononitrate in the prevention of first variceal bleed in patients who cannot recive beta-blockers. Gastroenterology 2001; 121: 908-14.

13. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal hemorrhage. Ann Intern Med 1995; 123: 280-7.

14. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001; 33: 802-7.

15. Lui HF, Stanley AJ, Forrest EH, et al. Primary prophylaxis of variceal hemorrahage: a randomized controlled trial comparing band ligation, propanolol, and isosorbide mononitrate. Gastroenterology 2002; 123: 735-44.

16. Gross M, Schiemann U, Muhlhofer A, Zoller WG. Meta-analysis: efficacy of therapeutic regimens in ongoing variceal bleeding. Endoscopy 2001; 33: 737-46.

17. Cales P, Masliah C, Bernard B, et al. Early administration of vapreotide for variceal bleeding in patients with cirrhosis. French Club for the Study of Portal Hypertension. N Engl J Med 2001; 344: 23-28.

18. Soehendra N, Nam VC, Grimm H, et al. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy 1986; 18: 25-26.

19. Kind R, Guglielmi A, Rodella L, et al. Bucrylate treatment of bleeding gastric varices: 12 years experience. Endoscopy 2000; 52: 168-74.

20. Huang YH, Yeh HZ, Chen GH, et al. Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoarylate (Histoacryl) injection: long term efficacy and safety. Gastrointest Endosc 2000; 52: 160-67.

21. Iwase H, Maeda O, Shimada M, et al. Endoscopic ablation with cyanoacrylate glue for insolated gastric variceal bleeding. Gastrointest Endosc 2001; 53: 585-92.

22. Seewald S, Sriram PV, Naga M, et al. Cyanoacrylate glue in gastric variceal bleeding. Endoscopy 2002; 34: 926-32.

23. Soehendra N, Grimm H, Maydeo A, et al. Endoscopic obliteration of fundal varices. Can J Gastroenterol 1990; 4: 643-6.

24. Lo GH, Lai KH, Cheng JS, et al. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology 2001; 33: 1060-4.

25. Sarin SK. Long term follow-up of gastric variceal sclerotherapy: an eleven-year experience. Gastrointest Endosc 1997; 46: 8-14.

26. Lee MS, Cho JY, Cheon YK, et al. Use of detachable snares and elastic bands for endoscopic control of bleeding from large gastric varices. Gastrointest Endosc 2002; 56: 83-8.

27. Nguyen AJ, Baron TH, Bugart LJ, et al. 2-Octyl-cyanoacrylate (Dermabond), a new glue for variceal injection therapy: results of a preliminary animal study. Gastrointest Endosc 2002; 55: 572-5.

28. Heneghan MA, Byrne A, Harrison PM. An open pilot study of the effects of a human fibrin glue for endoscopic treatment of patients with acute bleeding from gastric varices. Gastrointest Endosc 2002; 56: 422-6.

29. Papatheodoritis GV, Goulis J, Leandro G, et al. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis. Hepatology 1999; 30: 612-22.

30. Burroughs AK, Vangeli M. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy: randomized trials for secondary prophylaxis of variceal bleeding: an updated meta-analysis. Scand J Gastroenterol 2002; 14: 249-52.

31. Azoulay D, Castaing D, Majno P, et al. Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis. J Hepatol 2001; 35: 590-7.

32. El-Serag HB, Everhard JE. Improved survival after variceal hemorrhage over an 11 year period in the Department of Veterans Affairs. Am J Gastroenterol 2000; 95: 3566-73.

33. Gournay J, Masliah C, Martin T, Perrin D, Galmiche J. Isosorbide mononitrate and propanolol compared with propanolol for the prevention of variceal rebleeding. Hepatology 2000; 31: 1239-45.

34. de la Peña J, Rivero M, Sanchez E, et al. Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial. Gastrointest Endosc 1999; 49: 417-23.

35. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding: a meta-analysis. Ann Intern Med 1995; 123: 280-7.

36. Patch D, Sabin CA, Goulis J, et al. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology 2002; 123: 1013-9.

37. Villanueva C, Minana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med 2001; 345: 647-55.

38. Lo GH, Chen WC, Chen MH, et al. Banding ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding. Gastroenterology 2002; 123: 728-34.

39. Rubenstein J, Inadomi J. Secondary Prophilaxis of Varicel Bleeding: Should we shoot rubber bands or push pills? Evidence-Based Gastroenterology 2003; 4: 61-2.

40. Orozco H, Mercado MA, Chan C, et al. A comparative study of the elective treatment of variceal hemorrhage with beta-blockers, transendoscopic sclerotherapy and surgery: a prospective, controlled and randomized trial during 10 years. Ann Surg 2000; 232: 216-9.

41. Seewald S, Mendoza G, Seitz U, Salem O, Soehendra N. Variceal bleeding and portal hypertension. Endoscopy 2003; 35: 136-44.