Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|Dr. A. Rajput - Sat Aug 23, 2003 11:59 am||
a 53 yr male..presented with anorexia ..weight loss..6 kgs in months,..was investigated..nuclear scan and ct scan of the liver showed a smaller right lobe with a knobby outline s/o cirrhosis..the left lobe was hypertrophied..and the liver function tests were normal. no jaundice. endocscopy showed grade 4 varices with cherry red spots.no active bleed or h/o bleed in the past.
is a prophylactic band ligation and sclerotherapy indicated? or shud one wait for an episode of heamatemeis?
|Dr. Yasser Mokhtar - Sat Aug 23, 2003 9:32 pm||
Dear Dr. Rajput,
The current medical evidence is to go medications in the form of non-selective beta blockers such as propranolol or nadolol which were proven to decrease the portal venous pressure.
As regards to sclerotherapy or band ligation. There is controversy about sclerotherapy because the studies that were conducted showed increased mortality in patients treated with sclerotherapy for primary prevention of bleeding.
As regards to band ligation, it was found that it decreases the rate of bleeding and mortality in comparison to no treatment. However, when compared to beta blockers, it was found that it decreases the first bleeding rate but mortality is not changed in addition to high recurrence rate.
So, recommendation at the present time is to evaluate all patients who have cirrhosis with an upper endoscopy and start patients on beta blockers. If the patient is a high risk for bleeding or can not tolerate beta blockers, then band ligation should be performed.
i think your patient fits the category of high risk for bleeding with grade 4 varices, so he should have band ligation and started on beta blockers.
Thank you very much for bringing up such a clinically relevant question.
Yasser Mokhtar, M.D.
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