Acute variceal bleeding: general management

Table 1 Randomized studies of terlipressin

Study (ref)	Number of patients	Child C	Failure to control bleeding	Death
	C/T	%	C/T	C/T
Terlipressin vs placebo
Walker, 1986[40]	25/25	50	12/5	8/3
Freeman, 1989[41]	16/15	29	10/6	4/3
Soderlund, 1990[42]	29/31	33	13/5	11/3
Levacher, 1995[43]	43/41	81	23/12	20/12
POR (95%CI)			0.33	0.38
			(0.19-0.57)	(0.22-0.69)
P value			0.0001	0.001

Table 2 Reports of TIPS for acute variceal bleeding

Authors	Patients	Child score A/B	Source of bleeding, Gastric/Oesophageal/42 d (%)	Immediate control of bleeding (in completed TIPS)	Early rebleeding (within 1mo)	Mortality
Other
McCormick (1994)[116]	20	1/7/12	3/17/-	20/20	6	11 (55)
Jalan (1995)[109]	19	3/3/13	-/19	17/17	3	8 (42)
Sanyal (1996)[117]	30	1/7/22	4/26/-	29/29	2	12 (40)
Chau (1998)[97]	112	5/27/80	28/84/-	110	15	41 (37)
Gerbes (1998)[114]	11	1/3/7	8/11	10	3	3 (27)
Banares (1998)[112]	56	11/22/23	19/37/-	53/55	8	15 (28)

Key Concepts:﹒ Aim is not only stop bleeding but prevent early rebleeding as this significantly impairs survival﹒ Prophylactic use of antibiotics is manadatory﹒ Vasoactive drugs administered before diagnostic endoscopy for at least 48 h, and perhaps 5 d﹒ No more than 2 sessions of endoscopic therapy during the first 5 d of admission﹒ TIPS as salvage therapy for continued bleeding