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Introduction In September 2021, the Italian Society of Liver Diseases (AISF) issued guidelines for the management of portal hypertension (PH) and ascites
.
This article mainly provides guidance and recommendations for the management of acute varicose bleeding in liver cirrhosis
.
2021 AISF: Management of Acute Variceal Bleeding from Cirrhosis 1.
What is the most effective drug and endoscopic treatment for acute esophageal varices bleeding (AVB) of liver cirrhosis? (1) A combination of drugs and endoscopy must be used to treat AVB
.
Evidence quality: high; strength of recommendation: strong (2) Drug therapy includes a combination of vasoconstrictors, prophylactic antibiotics, and restrictive blood transfusion strategies
.
Evidence quality: high; Strength of recommendation: strong (3) Once the patient's hemodynamics is stable, endoscopy should be performed within 24 hours; for patients with unstable hemodynamics, endoscopy is recommended within 12 hours
.
Evidence quality: low; strength of recommendation: weak (4) When technically feasible, endoscopic ligation (EBL) is better than sclerotherapy, and EBL should be performed in the same operation when AVB is diagnosed
.
Evidence quality: high; strength of recommendation: strong 2.
After AVB, which patients are suitable for transjugular intrahepatic portosystemic shunt (TIPS) placement? (1) AVB patients who have failed endoscopic treatment or early rebleeding should be referred for TIPS treatment
.
Evidence quality: high; strength of recommendation: strong (2) Patients with CTP score C (CTP<14) should be considered for early TIPS therapy (within 72 hours)
.
Evidence quality: high; strength of recommendation: strong (3) The best management method for AVB patients should include early referral to a specialist center
.
Evidence quality: low; strength of recommendation: strong 3.
What is the timing and best way to prevent rebleeding from varicose veins? (1) EBL combined with non-selective β-receptor blocker (NSBB) is the gold standard therapy for secondary prevention after AVB, which can improve survival
.
Evidence quality: high; strength of recommendation: strong (2) For patients with severe circulatory dysfunction, care should be taken when using NSBB
.
Evidence quality: low; strength of recommendation: moderate (3) TIPS is suitable for the first rebleeding during the period of adequate secondary prevention
.
Evidence quality: high; strength of recommendation: strong 4.
What is the best way to treat gastric varices? (1) NSBB can be recommended for primary prevention, but for GOV2 and high-risk isolated gastric varices (IGV), endoscopic treatment can also be considered
.
Evidence quality: low; strength of recommendation: weak (2) Cyanoacrylate injection is the recommended endoscopic treatment for gastric varices bleeding
.
Evidence quality: low; strength of recommendation: strong Reference: Italian Association for the Study of the Liver (AISF).
Portal Hypertension and Ascites: Patient-and Population-centered Clinical Practice Guidelines by the Italian Association for the Study of the Liver (AISF) )[J].
Dig Liver Dis.
2021 Sep;53(9):1089-1104.
Contribution email: tougao@medlive.
cn
.
This article mainly provides guidance and recommendations for the management of acute varicose bleeding in liver cirrhosis
.
2021 AISF: Management of Acute Variceal Bleeding from Cirrhosis 1.
What is the most effective drug and endoscopic treatment for acute esophageal varices bleeding (AVB) of liver cirrhosis? (1) A combination of drugs and endoscopy must be used to treat AVB
.
Evidence quality: high; strength of recommendation: strong (2) Drug therapy includes a combination of vasoconstrictors, prophylactic antibiotics, and restrictive blood transfusion strategies
.
Evidence quality: high; Strength of recommendation: strong (3) Once the patient's hemodynamics is stable, endoscopy should be performed within 24 hours; for patients with unstable hemodynamics, endoscopy is recommended within 12 hours
.
Evidence quality: low; strength of recommendation: weak (4) When technically feasible, endoscopic ligation (EBL) is better than sclerotherapy, and EBL should be performed in the same operation when AVB is diagnosed
.
Evidence quality: high; strength of recommendation: strong 2.
After AVB, which patients are suitable for transjugular intrahepatic portosystemic shunt (TIPS) placement? (1) AVB patients who have failed endoscopic treatment or early rebleeding should be referred for TIPS treatment
.
Evidence quality: high; strength of recommendation: strong (2) Patients with CTP score C (CTP<14) should be considered for early TIPS therapy (within 72 hours)
.
Evidence quality: high; strength of recommendation: strong (3) The best management method for AVB patients should include early referral to a specialist center
.
Evidence quality: low; strength of recommendation: strong 3.
What is the timing and best way to prevent rebleeding from varicose veins? (1) EBL combined with non-selective β-receptor blocker (NSBB) is the gold standard therapy for secondary prevention after AVB, which can improve survival
.
Evidence quality: high; strength of recommendation: strong (2) For patients with severe circulatory dysfunction, care should be taken when using NSBB
.
Evidence quality: low; strength of recommendation: moderate (3) TIPS is suitable for the first rebleeding during the period of adequate secondary prevention
.
Evidence quality: high; strength of recommendation: strong 4.
What is the best way to treat gastric varices? (1) NSBB can be recommended for primary prevention, but for GOV2 and high-risk isolated gastric varices (IGV), endoscopic treatment can also be considered
.
Evidence quality: low; strength of recommendation: weak (2) Cyanoacrylate injection is the recommended endoscopic treatment for gastric varices bleeding
.
Evidence quality: low; strength of recommendation: strong Reference: Italian Association for the Study of the Liver (AISF).
Portal Hypertension and Ascites: Patient-and Population-centered Clinical Practice Guidelines by the Italian Association for the Study of the Liver (AISF) )[J].
Dig Liver Dis.
2021 Sep;53(9):1089-1104.
Contribution email: tougao@medlive.
cn