Application of Endoscopy in Improving Survival of Cirrhotic Patients with Acute Variceal Hemorrhage英文文献资料.docVIP

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Application of Endoscopy in Improving Survival of Cirrhotic Patients with Acute Variceal Hemorrhage英文文献资料.doc

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Application of Endoscopy in Improving Survival of Cirrhotic Patients with Acute Variceal Hemorrhage英文文献资料

SAGE-HindawiAccesstoResearch InternationalJournalofHepatology Volume2011,ArticleID893973,8pages doi:10.4061/2011/893973 ReviewArticle ApplicationofEndoscopyinImprovingSurvivalof CirrhoticPatientswithAcuteVaricealHemorrhage Yao-ChunHsu, Chen-ShuanChung, 1 2andHsiu-PoWang 3,4 1 2 3 4 DivisionofGastroenterologyandHepatology,DepartmentofInternalMedicine,E-DaHospital/I-ShouUniversity, Kaohsiung824,Taiwan DivisionofGastroenterologyandHepatology,DepartmentofInternalMedicine,FarEasternMemorialHospital, NewTaipei220,Taiwan DepartmentofInternalMedicine,NationalTaiwanUniversityCollegeofMedicine,NationalTaiwanUniversityHospital, Taipei100,Taiwan DepartmentofInternalMedicine,NationalTaiwanUniversityHospital,7,Chung-ShanSouthRoad,Taipei100,Taiwan CorrespondenceshouldbeaddressedtoHsiu-PoWang,wanghp@.tw Received15March2011;Accepted12May2011 AcademicEditor:DeepakAmarapurkar Copyright?2011Yao-ChunHsuetal.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense, whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited. Playingacentralroleinthemodernmultidisciplinarymanagementofacutegastroesophagealvaricealhemorrhage,endoscopyis essentialtostratifypatientatrisk,controlactivehemorrhage,andprevent?rstaswellasrecurrentbleeding.Beforeendoscopic procedure,antibioticprophylaxisalongwithvasoactivemedicationisnowroutinepractice.Intravenouserythromycine?ectively cleansesstomachandmayimprovethequalityofendoscopy.Thetimingofendoscopyshouldbeonanurgentbasisasdelayfor morethan15hoursafterpresentationisassociatedwithmortality.Activevaricealbleedingonendoscopyinapatientwithhepatic decompensationheraldspoorprognosisandmandatesconsiderationofaggressivestrategywithearlyportosystemicshunting. Bandligationhasbecomethepreferredmodalitytocontrolandpreventbleedingfromesophagealvarices,althoughoccasionally sclerotherapymaystillbeusedtoachievehemostasis.Additionofpharmacotherapywithnonselectivebetablockadetoendoscopic