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Old 11-10-2012
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GIT Esophageal varices, prophylactic banding?

Hey guys, do we need to perform band ligation on esophageal varices before they bleed?do we need to do survelliance endoscopy looking for them?or is propranolol enough?
Thanks I am confused and I cant find the answer!
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Old 11-10-2012
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Condroid fisher ...

If u bleed we band...For prophylaxis -----Propranalol..
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Old 11-10-2012
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if the patient has grade 3 varices on screening endoscope, would u still prefer beta blocker or elective banding..??????
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Old 11-10-2012
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Quote:
Originally Posted by anomali View Post
if the patient has grade 3 varices on screening endoscope, would u still prefer beta blocker or elective banding..??????
I think its a controversy....
Usually USMLE will not ask controversial questions....


Early beta-blocker therapy may slow the rate of growth of small esophageal varices.

Endoscopic variceal ligation (EVL) eradicates esophageal varices has been shown to be as effective as the use of beta-blockers.

Which one to choose is not come as recommentation

It is recommended that prophylactic EVL be reserved for patients who cannot tolerate or have contraindications to beta-blocker use, or in those who do not show a reduction in hepatic vein pressure gradient (HVPG) of > 20% or 12 mm Hg.


Quote:
Treatment for variceal hemorrhage as a complication of portal hypertension is divided into two main categories: (1) primary prophylaxis and (2) prevention of re-bleeding once there has been an initial variceal hemorrhage. Primary prophylaxis requires routine screening by endoscopy of all patients with cirrhosis. Once varices that are at increased risk for bleeding are identified, primary prophylaxis can be achieved either through nonselective beta blockade or by variceal band ligation. Numerous placebo-controlled clinical trials of either propranolol or nadolol have been reported in the literature. The most rigorous studies were those that only included patients with significantly enlarged varices or with hepatic vein pressure gradients >12 mmHg. Patients treated with beta blockers have a lower risk of variceal hemorrhage than those treated with placebo over 1 and 2 years of follow-up. There is also a decrease in mortality related to variceal hemorrhage. Unfortunately, overall survival was improved in only one study. Further studies have demonstrated that the degree of reduction of portal pressure is a significant feature to determine success of therapy. Therefore, it has been suggested that repeat measurements of hepatic vein pressure gradients may be used to guide pharmacologic therapy; however, this may be cost-prohibitive. Several studies have evaluated variceal band ligation and variceal sclerotherapy as methods for providing primary prophylaxis.

Endoscopic variceal ligation (EVL) has achieved a level of success and comfort with most gastroenterologists who see patients with these complications of portal hypertension. Thus, in patients with cirrhosis who are screened for portal hypertension and are found to have large varices, it is recommended that they receive either beta blockade or primary prophylaxis with EVL.

The approach to patients once they have had a variceal bleed is first to treat the acute bleed, which can be life-threatening, and then to prevent further bleeding. Prevention of further bleeding is usually accomplished with repeated variceal band ligation until varices are obliterated. Treatment of acute bleeding requires both fluid and blood-product replacement as well as prevention of subsequent bleeding with EVL.
Harrison.

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Old 11-10-2012
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According to UW:

Every new patient with new cirrhosis should receive endoscopy, if we find varicies we give propranolol prophylaxis

After the patient bleeds, we should do endoscopic treatment. If the patient is acutely bleeding, sclerotherapy is the best measure. If we are doing elective endoscopic treatment, banding the best measure.
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Old 11-23-2014
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Quote:
Originally Posted by Leili View Post
Hey guys, do we need to perform band ligation on esophageal varices before they bleed?do we need to do survelliance endoscopy looking for them?or is propranolol enough?
Thanks I am confused and I cant find the answer!

for prevention According to UW.

beta Blocker ; prevents progression & decrease morbidity & mortality
if Contraindication to BB , E Band ligation can be done for prevention

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