EMERGENCY ENDOSCOPY STRATEGIES FOR IMPROVED OUTCOMES

Variceal haemorrhage is the most serious complication of portal hypert ension and is associated with a high mortality rate. The first stage o f treatment is to stabilize the patient, followed by emergency diagnos tic endoscopy to identify the source of the bleeding. If active varice al bleeding is found, endoscopic intervention is performed to induce h aemostasis. The endoscopic techniques commonly used to treat bleeding gastro-oesophageal varices include injection sclerotherapy and band li gation. Sclerotherapy achieves haemostasis through the induction of th rombosis or by external compression of the vessel and should be perfor med during diagnostic endoscopy. Band ligation achieves haemostasis by physical constriction of the varix. Band ligation may be less effecti ve than sclerotherapy in the treatment of actively bleeding oesophagea l varices and is therefore recommended for subsequent elective treatme nt of non-bleeding varices. However, such techniques are difficult to perform during active bleeding. This has prompted the search for impro ved treatment protocols. Vasoactive drugs which lower portal hypertens ion have been administered before, during and after endoscopy and may offer an improvement in treatment. Data from several trials have sugge sted that pharmacotherapy in combination with endoscopic intervention is more effective than endoscopic treatment alone. Furthermore, pharma cotherapy continued for 5 days following endoscopy significantly reduc es the incidence of variceal rebleeding. A strict regimen for emergenc y endoscopy should be used with sclerotherapy forming the basis of tre atment-administered in combination with pharmacotherapy, to optimize c linical outcome. However, there is still debate concerning what is the most effective drug for treating variceal haemorrhage.