Penatalaksanaan Varises Esofagus

Oleh :

dr. Agnes Tjakrapawira

Penatalaksanaan varises esofagus yang belum ruptur adalah beta bloker nonselektif, seperti propranolol dan carvedilol, atau endoscopic variceal ligation (EVL). Sedangkan pada yang sudah ruptur diutamakan stabilisasi hemodinamik, agen vasoaktif seperti octreotide, dan tindakan endoskopi.

Penatalaksanaan varises esofagus bertujuan untuk stabilisasi hemodinamik pasien dengan perdarahan, mencegah komplikasi, dan mengobati jika komplikasi sudah terjadi. Penatalaksanaan dilakukan dengan tim interprofesional yang terdiri dari ahli gastroenterologi, internis, ahli bedah, dan ahli radiologi invasif.[1,2,7,19,22]

Penatalaksanaan pada Perdarahan Aktif

Referensi

1. Kovacs TOG, Jensen DM. Varices: Esophageal, Gastric, and Rectal. Clin Liver Dis. 2019;23(4):625-642. doi:10.1016/j.cld.2019.07.005
2. Mattos ÂZ, Schacher FC, John Neto G, Mattos AA. Screening for esophageal varices in cirrhotic patients - Non-invasive methods. Ann Hepatol. 2019;18(5):673-678. doi:10.1016/j.aohep.2019.06.003
4. Kraja B, Mone I, Akshija I, Koçollari A, Prifti S, Burazeri G. Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients. World J Gastroenterol. 2017;23(26):4806-4814. doi:10.3748/wjg.v23.i26.4806
7. Meseeha M, Attia M. Esophageal Varices. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK448078/
10. Pesce M, Magee C, Holloway RH, et al. The treatment of achalasia patients with esophageal varices: an international study. United European Gastroenterol J. 2019;7(4):565-572. doi:10.1177/2050640619838114
11. Verdaguer D S, Gana A JC. Enfrentamiento de pacientes pediátricos con várices esofágicas [Management of pediatric patients with esophageal varices]. Rev Med Chil. 2016;144(7):879-885. doi:10.4067/S0034-98872016000700008
12. Sauerbruch T, Wong F. Treatment of Oesophageal Varices in Liver Cirrhosis. Digestion. 2019;99(4):261-266. doi:10.1159/000492076
13. Pimenta JR, Ferreira AR, Fagundes ED, et al. Factors Associated With Bleeding Secondary to Rupture of Esophageal Varices in Children and Adolescents With Cirrhosis. J Pediatr Gastroenterol Nutr. 2017;64(2):e44-e48. doi:10.1097/MPG.0000000000001362
14. Carlson DS, Pfadt E. Bleeding esophageal varices. Nursing. 2012;42(12):72. doi:10.1097/01.NURSE.0000422664.70404.af
15. Shaheen AA, Nguyen HH, Congly SE, Kaplan GG, Swain MG. Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States. Liver Int. 2019;39(5):878-884. doi:10.1111/liv.14054
16. Yoon H, Shin HJ, Kim MJ, et al. Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis. World J Gastroenterol. 2019;25(3):367-377. doi:10.3748/wjg.v25.i3.367
17. Nery F, Correia S, Macedo C, et al. Nonselective beta-blockers and the risk of portal vein thrombosis in patients with cirrhosis: results of a prospective longitudinal study. Aliment Pharmacol Ther. 2019;49(5):582-588. doi:10.1111/apt.15137
18. Chakinala RC, Kumar A, Barsa JE, et al. Downhill esophageal varices: a therapeutic dilemma. Ann Transl Med. 2018;6(23):463. doi:10.21037/atm.2018.11.13
19. Zampino R, Lebano R, Coppola N, et al. The use of nonselective beta blockers is a risk factor for portal vein thrombosis in cirrhotic patients. Saudi J Gastroenterol. 2018;24(1):25-29. doi:10.4103/sjg.SJG_100_17
20. Monreal-Robles R, Cortez-Hernández CA, González-González JA, et al. Acute Variceal Bleeding: Does Octreotide Improve Outcomes in Patients with Different Functional Hepatic Reserve?. Ann Hepatol. 2018;17(1):125-133. doi:10.5604/01.3001.0010.7544
21. Boregowda U, Umapathy C, Halim N, Desai M, Nanjappa A, Arekapudi S, Theethira T, Wong H, Roytman M, Saligram S. Update on the management of gastrointestinal varices. World J Gastrointest Pharmacol Ther. 2019 Jan 21;10(1):1-21. doi: 10.4292/wjgpt.v10.i1.1. PMID: 30697445; PMCID: PMC6347650.
22. Abby Philips C, Sahney A. Oesophageal and gastric varices: historical aspects, classification and grading: everything in one place. Gastroenterol Rep (Oxf). 2016 Aug;4(3):186-95. doi: 10.1093/gastro/gow018. Epub 2016 Jun 19. PMID: 27324725; PMCID: PMC4976684.

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