Hi guys, Welcome to the Advanced Video Search Engine, and you are watching GASTRIC VARICEAL BLEED: HISTOACRYL GLUE AND TIPSS. That video is uploaded by monzahmed at 2024-03-20T13:10:50-07:00. We are promoting this video only for entertainment and educational purpose only. So, I hope you like & enjoy it. [j397boWYFow]
| Name | GASTRIC VARICEAL BLEED: HISTOACRYL GLUE AND TIPSS |
| Video Uploader | Video From monzahmed |
| Upload Date | This Video Uploaded At 20-03-2024 20:10:50 |
| Video Discription | This is a slightly unusual case of a 50 year old ex-publican who was admitted with a 24 hour history of haematemesis and melaena. He was a heavy user of alcohol and this was his first presentation. He was obese (BMI over 40) and had sleep apnoea. Variceal bleeding was suspected (secondary to Alcohol related Liver Disease (ArLD) / Metabolic Associated Fatty Liver Disease (MAFLD), and an urgent endoscopy was performed 12 hours after admission following initial resuscitation. The endoscopy revealed small oesophageal varices and large fundic gastric varices (GOV2)… see video. He was treated with Histoacryl glue injection which proved very tricky. Subsequently, he was entered into a trial (REACT-AVB) comparing early pre-emptive TIPSS vs Standard of Care (SOC)…see video... -- Acute variceal bleeding (AVB) is a severe complication of portal hypertension and occurs at a rate of around 10%-15% per year in patients with cirrhosis. Approximately 50% of cirrhotic patients develop varices and at least 2,000 patients are admitted to hospital in England per year with variceal bleeding, which has an inpatient mortality of 15% and 1 year mortality of up to 40% [1]. The 2015 UK guidelines from the BSG recommend endoscopic therapy (variceal band ligation [VBL] for treating acute oesophageal variceal bleeding or glue injection for acute gastric variceal bleeding) in combination with drug therapy (Terlipressin and antibiotics) in acute variceal bleeding [2,3]. Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is recommended where these measures fail to control bleeding. This well-established emergency strategy is often referred to as “rescue” or “salvage” TIPSS therapy. However, although rescue TIPSS therapy controls variceal bleeding in over 90% of patients, the mortality can be as high as 36% at six weeks and 42% at 1 year [4,5]. Patients with advanced cirrhosis (Child Pugh score more than13) have high mortality and TIPSS in this patient group is likely to be futile [4]. Recently there has been much interest in TIPSS, not as a rescue therapy for ongoing acute variceal bleeding, but as early (i.e. prophylactic or pre-emptive) therapy after initial control of bleeding with endoscopic and drug therapy. The patients most likely to benefit from early TIPSS are those at highest risk of rebleeding and mortality. The risk of variceal rebleeding can be as high as 60%, with each variceal rebleeding episode associated with 20% mortality, particularly in the first five days following a bleed [6]. Therefore, early interventions during the acute variceal bleeding episode are likely to have the greatest impact on outcomes. CONTINUED IN FIRST COMMENT.... j397boWYFow |
| Category | Education |
| Tags | endoscopy | therapeutic endoscopy | gut | GI tract | medicine | gastroenterology | monz | monz ahmed | monzahmed | monzur ahmed | HISTOACRYL | glue | TIPSS | REACT-AVB | early TIPSS | pre-emptive TIPSS | varices | gastric varices | oesophageal varices | endotherapy |
