Endoprosthetics for bleeding esophageal varices |
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| Institution: | 1. Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy;2. Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy;3. Department of Biomedical Technology, Czech Technical University in Prague, Kladno, Czech Republic;1. Division of Gastroenterology and Hepatology, The McGill University Health Center, Montreal, Quebec, Canada;2. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA;3. Johns Hopkins Carey Business School, Baltimore, Maryland, USA;4. Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA;5. Gastroenterology, Humanitas Clinical and Research Hospital, IRCCS, Rozanno, Italy;6. King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia;1. Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Yangpu District, Shanghai, China;2. Department of Gastroenterology, Shanghai First People''s Hospital, Shanghai, China;3. Department of Gastroenterology, Xijing Hospital Affiliated to Fourth Military Medical University, Xi''an, China;4. Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Jiading District, Shanghai, China |
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| Abstract: | Refractory esophageal hemorrhage and early rebleeding following endoscopic therapy remain challenging conditions to treat and are associated with a high mortality. Techniques such as balloon tamponade (BT) and transjugular intrahepatic portosystemic shunt (TIPS) are highly effective at controlling refractory bleeding, but they can be associated with a high rate of complications and, in the case of TIPS, may not be immediately available outside specialist centers. Recently, removable self-expanding metal stents (SEMSs) have been introduced in clinical practice for the management of esophageal variceal bleeding. SEMSs control bleeding by tamponade of varices in the distal esophagus and can remain in situ for a number of days, thus preventing early rebleeding. The use of SEMSs does not require the transfer of the patient to a specialist center, and unlike TIPS, it is not associated with deterioration in liver function. The use of SEMSs has been described in small series of patients with refractory bleeding. These series report high rates of hemostasis with low complication rates, suggesting that SEMSs may have an important role in the management of refractory bleeding either as an alternative to BT or where TIPS is contraindicated. SEMSs may also have a role in treating complications of therapy for bleeding esophageal varices, such as postbanding ulceration and BT-induced esophageal tears. The aim of this review is to summarize the published data on the efficacy of SEMSs and suggest future studies that may clarify its role in the management of esophageal variceal hemorrhage. |
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| Keywords: | Portal hypertension TIPS Esophageal stent Tamponade |
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