علاج نزيف الدوالي المريئية الحاد في تشمع الكبد مع معايير الخطورة العالية (تشايلد-بيو B/C أو ارتفاع HVPG)

References

DOI: 10.1007/s12072-025-10894-4

• Pre-emptive TIPS with PTFE covered stents within 72 h (ideally < 24 h) reduces re-bleeding and improves survival in carefully selected patients who met any of the following criteria: Child–Pugh class C < 14 points or Child–Pugh class B > 7 with active bleeding at initial endoscopy or HVPG > 16 mmHg at the time of hemorrhage.
• Combination of a vasoactive drug and endoscopic therapy is the first-line therapy for acute variceal bleed.
• Vasoactive treatment should be started at the earliest, preferably within 30 minutes of index bleed.
• Band ligation with multi-band ligator is the preferred modality of therapy for esophageal variceal bleed.
• For patients with cirrhosis with AVB, a broad-spectrum antibiotic like ceftriaxone (1-2 gram daily) is recommended for 5 days before endoscopic therapy.
• Control of AVB is defined as the cessation of bleeding with hemodynamic stability (systolic blood pressure > 90 mmHg and MAP ≥ 60 mmHg) for at least 48 h post-therapy.