Kezer Camille A, Gupta Neil
Loyola University Stritch School of Medicine, Maywood, IL, USA.
Division of Gastroenterology and Nutrition, Loyola University Medical Center, 2160 S. First Ave., Building 54, Room 167, Maywood, IL, 60153, USA.
Curr Gastroenterol Rep. 2018 Jun 9;20(7):31. doi: 10.1007/s11894-018-0637-6.
This article aims to review current therapeutic endoscopic treatments available for the management of gastrointestinal bleeding related to cirrhosis.
Endoscopic band ligation is an effective treatment for primary prophylaxis, acute bleeding, and secondary prophylaxis of esophageal varices as well as for acute bleeding and secondary prophylaxis of select gastric varices. Sclerotherapy is a treatment option for acute bleeding and secondary prophylaxis of esophageal varices when band ligation is technically difficult. Cyanoacrylate glue injection is an effective treatment for acute bleeding of gastric and ectopic varices. Argon plasma coagulation is first-line and radiofrequency ablation is second-line treatment for chronic bleeding secondary to gastric antral vascular ectasia. There are a variety of endoscopic treatment modalities for cirrhosis-related gastrointestinal bleeding, and the appropriate therapy depends on the location of the bleed, history or presence of acute bleeding, and risk factors for intervention-related adverse events.
本文旨在综述目前可用于治疗肝硬化相关胃肠道出血的内镜治疗方法。
内镜下套扎术是食管静脉曲张一级预防、急性出血和二级预防以及部分胃静脉曲张急性出血和二级预防的有效治疗方法。当套扎术在技术上存在困难时,硬化疗法是食管静脉曲张急性出血和二级预防的一种治疗选择。氰基丙烯酸酯胶注射是胃静脉曲张和异位静脉曲张急性出血的有效治疗方法。氩离子凝固术是胃窦血管扩张症继发慢性出血的一线治疗方法,射频消融是二线治疗方法。对于肝硬化相关胃肠道出血有多种内镜治疗方式,合适的治疗方法取决于出血部位、急性出血病史或是否存在急性出血以及干预相关不良事件的危险因素。