Esophageal Variceal Bleeding - Scoping Summary

GENERAL PRINCIPLES OF MANAGEMENT (VARICEAL-B):

V - Vasoconstrictor therapy: (Octreotide 50mcg bolus -> infusion for 2-5 days)

A - Antibiotics : ( Ceftriaxone Igm IV Qdaily for 5-7 days) -> consider stopping once hemostasis is acquired/vasoactive meds dc'd, do not extent as an OP

R - Resuscitation/Restrictive (Critical, Target Hgb>7gm/dL)

I - ICU level care/ Intubate -> Individualize ; intubation a/w adverse CP outcomes Hayat et. al GIE 2017, consider for active hematemesis, AMS

C - Coagulopathy -> Don't reverse INR, PLTs>50, Fibrinogen >120 refer to AGA practice guidelines; TEG -> dec. in blood products 

E - Endoscopy - W/in 12 hrs of presentation 

AL - ALternative/Rescue Tx

B - Beta blockade -> Do not initiate in acute settings

- Pre-endoscopic Care

- Endoscopy 101

- Post-Banding Ulcers

- Refractory Bleeding and Rescue Therapies

- Controversies Regarding Variceal Bleed Management



By Dr. Hassaan Zia @HassaanZiaMD via ScopingSundays @ScopingSundays



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