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
3⃣ In hemodynamically stable patients with acute upper GI hemorrhage and no ❤️ disease ➡️Restrictive red blood cell transfusion strategy:
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🩸
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🤔
1⃣1⃣Persistent esophageal variceal bleeding despite 💉vasoactive pharmacological and endoscopic 🔦therapy ➡️ urgent rescue TIPS 🕑should be considered
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🩸
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
@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 🏥.
@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 🤔