Albillos Agustín, Tejedor Marta
Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, CIBERehd, IRYCIS, University of Alcalá, Ctra. Colmenar km. 9.100, Madrid 28034, Spain.
Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Ctra. Colmenar km 9.100, Madrid 28034, Spain.
Clin Liver Dis. 2014 May;18(2):359-70. doi: 10.1016/j.cld.2014.01.007. Epub 2014 Feb 25.
Combination therapy with beta-blockers and endoscopic band ligation (EBL) is the standard prophylaxis of esophageal variceal rebleeding in cirrhosis. Beta-blockers are the backbone of combination therapy, since their benefit extend to other complications of portal hypertension. EBL carries the risk of post-banding ulcer bleeding, which explains why overall rebleeding is reduced when beta-blockers are added to EBL, and not when EBL is added to beta-blockers. TIPS is the rescue treatment, but it could be considered as first choice in patients that first bleed while on beta-blockers, those with contraindications to beta-blockers or with refractory ascites, and those with fundal varices.
β受体阻滞剂与内镜下套扎术（EBL）联合治疗是肝硬化食管静脉曲张再出血的标准预防方法。β受体阻滞剂是联合治疗的基础，因为其益处还扩展到门静脉高压的其他并发症。EBL存在套扎术后溃疡出血的风险，这就解释了为何在EBL基础上加用β受体阻滞剂时总体再出血会减少，而在β受体阻滞剂基础上加用EBL时则不然。经颈静脉肝内门体分流术（TIPS）是挽救治疗，但对于在服用β受体阻滞剂时首次出血的患者、有β受体阻滞剂禁忌证或难治性腹水的患者以及有胃底静脉曲张的患者，可将其视为首选治疗方法。
