International Journal of Hepatology / 2012 / Article / Tab 2

Review Article

Role of Self-Expandable Metal Stents in Acute Variceal Bleeding

Table 2

Rescue therapies for refractory esophageal variceal bleeding.

ModalityCandidateEfficacy in controlling bleedingComplicationsLimitation

BTRefractory 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

SurgeryAcute 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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