Review Article
Role of Self-Expandable Metal Stents in Acute Variceal Bleeding
Table 2
Rescue therapies for refractory esophageal variceal bleeding.
| Modality | Candidate | Efficacy in controlling bleeding | Complications | Limitation |
| BT | Refractory esophageal bleeding as bridge to definitive therapy. | More than 80% but tube should be removed within 24 hours. | Potentially lethal complications including esophageal perforation aspiration and pneumonia. | Limited efficacy and high complication rate in in-experienced hands. Temporary measure |
| Surgery | Acute variceal bleeding unresponsive to medical and endoscopic therapy. | Heterogeneous group but generally very effective. | Hepatic encephalopathy. Liver decompensation. | Requires expertise with exception of modified Sugiura procedure. |
| TIPS |
Acute variceal bleeding unresponsive to medical and endoscopic therapy. |
More than 90%. | Hepatic encephalopathy. | Limited availability |
Liver decompensation. | Occlusion and stenosis. | Not suitable or contraindicated in many patients. |
| SEMSs |
Refractory esophageal bleeding as bridge to definitive therapy. |
70–100% and stent can be left in place for as long as 2 weeks. | Minor esophageal ulcer. | Temporary measures |
Migration. | Require a repeat endoscopy for removal. |
Compression of left main bronchus. | |
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