Antonio Caballero Mateos PhD Profile picture
Dec 23, 2022 11 tweets 6 min read Read on X
🔦Endoscopic Diagnosis & Management of Esophagogastric Variceal Hemorrhage
🗒️ESGEGuidelines2022

16 Keys:

1⃣Pts w compensated advanced CLD & >10mmHg portalHT➡️NSBB (carvedilol) therapy💊

@ESGE_news #LiverTwitter #MedEd #GITwitter #MedTwitter @ASGEendoscopy @endoscopyjrnl
🧵👇 Image
2⃣ Patients unable to receive NSBB therapy with a screening upper endoscopy 🔦that demonstrates high risk esophageal varices ➡️ endoscopic band ligation (EBL). Repeat after 2-4 weeks until eradication
🕵️‍♂️Surveillance every 6 months in the first year Image
3⃣ In hemodynamically stable patients with acute upper GI hemorrhage and no ❤️ disease ➡️Restrictive red blood cell transfusion strategy:

🕑When? ▶️ Hemoglobin threshold ≤ 70 g/L
🎯Post Transfusion target: 70–90 g/L Image
4⃣ Patients with ACLD presenting with suspected acute variceal bleeding:
▶️Stratify risk with Child and MELD scores 🗒️
▶️GI endoscopy 🔦

5⃣ Iniciate vasoactive agents💉: terlipressin, octreotide, or somatostatin when suspected acute variceal bleeding 🩸. Continue up to 5 days
6⃣ Antibiotic prophylaxis using ceftriaxone 1 g/day 💊 for up to 7 days for all patients with ACLD presenting with acute variceal hemorrhage🩸

7⃣ IV💉erythromycin 250 mg be given 30–120 minutes prior to upper GI endoscopy🔦 in patients with suspected acute variceal hemorrhage🩸
8⃣Suspected variceal hemorrhage➡️endoscopic evaluation🔦: within 12 hours 🕑from the time of patient presentation. Previously: hemodynamic resuscitation.

9⃣ EBL for the treatment of acute esophageal variceal hemorrhage🩸 Image
1⃣0⃣If high risk for recurrent esophageal variceal bleeding 🩸following endoscopic 🔦hemostasis (Child C  ≤ 13 or Child B > 7 with active EVH at the time of 🔦 despite vasoactive agents💉, or HVPG > 20mmHg)➡️pre-emptive TIPS within 72h (preferably 24h) must be considered🤔 Image
1⃣1⃣Persistent esophageal variceal bleeding despite 💉vasoactive pharmacological and endoscopic 🔦therapy ➡️ urgent rescue TIPS 🕑should be considered

1⃣2⃣Endoscopic 🔦💉cyanoacrylate injection for acute gastric (cardiofundal) variceal (GOV2, IGV1) hemorrhage. Image
1⃣3⃣Endoscopic 💉🔦cyanoacrylate injection or EBL in patients with GOV1-specific bleeding🩸.

1⃣4⃣Urgent rescue TIPS / balloon-occluded retrograde transvenous obliteration (BRTO) for gastric variceal bleeding when failure of 🔦💉endoscopic hemostasis or early recurrent bleeding🩸 Image
1⃣5⃣Patients with EBL for acute EVH ➡️ scheduled for follow-up EBLs at 1-4 weeks intervals to eradicate esophageal varices (2ªprophylaxis)

1⃣6⃣Use of NSBBs (propranolol or carvedilol) in combination with endoscopic therapy🔦 for secondary prophylaxis in EVH in patients with ACLD
Thanks for sharing!

Full text link: thieme-connect.de/products/ejour…

@ESGE_news @endoscopyjrnl

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Antonio Caballero Mateos PhD

Antonio Caballero Mateos PhD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @Dr_ACaballero_

Sep 3
🗒️2024 ECCO Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment 💊

@Y_ECCO_IBD
 #IBD #MedEd #GITwitter #MedTwitter

1️⃣4️⃣ Statements and 6️⃣Practice points

1️⃣ 5-ASA is not recommended🚫for the induction or maintenance therapy in CD➡️consistent lack of evidence.

🧵👇
Image
Image
@Y_ECCO_IBD 2️⃣ Budesonide💊 is recommended for inducing clinical remission in patients with active, mild-to-moderate CD limited to the ileum / ascending colon🎯

👉Additionally, systemic corticosteroids are suggested for induction therapy in patients with active, moderate-to-severe CD💉
@Y_ECCO_IBD 3️⃣Thiopurine monotherapy💊 is not🚫  recommended for induction therapy in CD, but it can be considered for maintenance 👌

4️⃣Parenteral 💉methotrexate is suggested for both induction and maintenance therapy in moderate-to-severe CD
Read 14 tweets
Jul 23, 2023
📚 ECCO Guidelines on Extraintestinal Manifestations in IBD 🏥:

A thread 🧵
32 Statements by @Y_ECCO_IBD summarized 👇

@my_ueg @JCC_IBD @manu_barreiro @TrianaLobaton @GianlucaPellino

#Medtwitter #GITwitter #MedEd #IBD Image
@Y_ECCO_IBD @my_ueg @JCC_IBD @manu_barreiro @TrianaLobaton @GianlucaPellino 🔍 S1: 🚨 Thrombotic events are more than 2x as frequent in patients with IBD than in the general population, with similar prevalence in ulcerative colitis and Crohn’s disease 🦠. The most important risk factors? Active disease, hospitalization, and surgery 🏥. Image
@Y_ECCO_IBD @my_ueg @JCC_IBD @manu_barreiro @TrianaLobaton @GianlucaPellino S2.1: 💉 Use prophylactic dose of low-molecular-weight heparin during hospitalization or major surgery 🏥. Post-surgery IBD patients should continue at least 3 weeks post discharge 📆. Consider thromboprophylaxis  in posthospitalization patients or those with severe IBD flare 🤔
Read 29 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(