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Bleeding Cirrhotic Patients: Endoscopic Therapy

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Multidisciplinary Approaches to Common Surgical Problems

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Abstract

Gastrointestinal (GI) hemorrhage is a serious medical condition commonly encountered in patients with cirrhosis. The etiology of bleeding is often grouped into causes proximal to the ligament of Treitz (upper GI bleed) or beyond it (lower GI bleed). Patients with cirrhosis are significantly more likely to present with upper GI bleed, which carries a higher risk of mortality. Gastrointestinal hemorrhage in cirrhosis is often driven by portal hypertension, though it may arise from other causes. The goal of therapy is to prevent and correct shock by providing resuscitative and supportive measures alongside medical, interventional radiologic, and endoscopic therapies to prevent further bleeding and complications of bleeding. Medical team members must be able to recognize and treat a variety of presentations of gastrointestinal hemorrhage in the cirrhotic patient. This chapter will provide an overview of general principles of evaluation and treatment, with a focus on the endoscopic management of upper GI bleeding, particularly bleeding due to portal hypertension.

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Notes

  1. 1.

    Sclerosing agents include sodium tetradecyl sulfate, sodium morrhuate, polidocanol, ethanolamine oleate, and ethanol.

  2. 2.

    Cyanoacrylate injection is not FDA approved, but is available at many tertiary centers in the United States. Injection may be performed with a standard upper endoscope or using endoscopic ultrasound.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

    John H. Holden & Umer A. Bhatti

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  1. John H. Holden
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  2. Umer A. Bhatti
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Correspondence to John H. Holden .

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Editors and Affiliations

  1. Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA

    Robert Lim

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Holden, J.H., Bhatti, U.A. (2019). Bleeding Cirrhotic Patients: Endoscopic Therapy. In: Lim, R. (eds) Multidisciplinary Approaches to Common Surgical Problems. Springer, Cham. https://doi.org/10.1007/978-3-030-12823-4_26

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  • DOI: https://doi.org/10.1007/978-3-030-12823-4_26

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