Avgerinos A
2nd Department of Gastroenterology, Evangelismos Hospital, Athens University, Greece.
Digestion. 1998;59 Suppl 1:1-22. doi: 10.1159/000051408.
Various treatment strategies have been used to control variceal bleeding, including drugs, esophageal tamponade, endoscopic sclerotherapy (ES), endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt and emergency surgery. None of these procedures are ideal and treatment frequently requires a combination of techniques. Sclerotherapy is one of the most widely used methods to control variceal bleeding; however, success is largely dependent on an experienced endoscopist. Vasoactive drugs act by decreasing pressure and blood flow in the gastroesophageal collaterals and they offer the advantage of being administered by inexperienced personnel. Drugs currently used in the treatment of variceal hemorrhage include vasopressin, terlipressin, somatostatin and octreotide. In the clinical studies to date, somatostatin was more effective than vasopressin and as effective as terlipressin in the control of bleeding esophageal varices (BEV), with an improved safety profile. In contrast, octreotide has shown conflicting results and more data are required to support the drug in this indication. More recently the ABOVE (Acute Bleeding Esophageal Variceal Episodes) study has provided further evidence that early administration of vasoactive drugs such as somatostatin is significantly more effective than placebo in the overall control of acute BEV episodes in cirrhotic patients undergoing ES. Therefore, the administration of a vasoactive drug as early as possible before emergency sclerotherapy is recommended for the effective management of BEV.
已经采用了多种治疗策略来控制静脉曲张出血，包括药物治疗、食管压迫、内镜下硬化剂治疗（ES）、内镜下静脉曲张结扎术、经颈静脉肝内门体分流术和急诊手术。这些方法都不理想，治疗通常需要多种技术联合使用。硬化剂治疗是控制静脉曲张出血最常用的方法之一；然而，其成功率很大程度上取决于经验丰富的内镜医师。血管活性药物通过降低胃食管侧支循环的压力和血流量起作用，其优点是可由经验不足的人员给药。目前用于治疗静脉曲张出血的药物包括血管加压素、特利加压素、生长抑素和奥曲肽。在迄今为止的临床研究中，生长抑素在控制食管静脉曲张出血（BEV）方面比血管加压素更有效，与特利加压素效果相当，且安全性更高。相比之下，奥曲肽的结果存在争议，需要更多数据来支持该药用于这一适应症。最近，ABOVE（急性食管静脉曲张出血发作）研究进一步证明，在接受ES的肝硬化患者中，早期给予生长抑素等血管活性药物在总体控制急性BEV发作方面比安慰剂显著更有效。因此，建议在急诊硬化剂治疗前尽早给予血管活性药物，以有效管理BEV。
