02-24-2007, 04:52 PM
Initial Mx with fluid resusc and ABCs, than
endoscopic banding or sclerotherapy both arrest bleeding in 80-90% of cases and reduce chances of rebleeding by 50%.
Banding: endoscopic tx of choice, repeat session req at 1-2 wks, have low rate of rebleeding, complications and death as compared to sclerotharapy.
Sclerotherapy: ethonalamine, tetradecyl sulphate- complications occur in 20-30% cases-chest pain, fever, esoph ulceration, stricture and perforation.
Somatostatin: not avail in USA.
Octreotide: reduce portal press, efficacy equals banding/sclerotherapy.
Banding/sclerotherapy+octretride= superior than each used alone.
CMDT
endoscopic banding or sclerotherapy both arrest bleeding in 80-90% of cases and reduce chances of rebleeding by 50%.
Banding: endoscopic tx of choice, repeat session req at 1-2 wks, have low rate of rebleeding, complications and death as compared to sclerotharapy.
Sclerotherapy: ethonalamine, tetradecyl sulphate- complications occur in 20-30% cases-chest pain, fever, esoph ulceration, stricture and perforation.
Somatostatin: not avail in USA.
Octreotide: reduce portal press, efficacy equals banding/sclerotherapy.
Banding/sclerotherapy+octretride= superior than each used alone.
CMDT