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Gastroenterologists should strive to improve the outcomes associated with acute variceal hemorrhage by optimizing care delivery and clinician preparedness through training. Unfortunately, data regarding contemporary outcomes and management of acute variceal hemorrhage are limited. Dr Elliot Tapper and colleagues performed a systematic review of cohort studies examining outcomes and management of acute variceal hemorrhage from 1990 to 2016. The researchers pooled data on mortality and utilization of medical therapy, endoscopic interventions, balloon tamponade, and salvage procedures. The team found that the pooled 6-week mortality rate after acute variceal hemorrhage was 18%.  | | The overall rate of balloon tamponade use was 11% | | Clinical Gastroenterology & Hepatology |
Sclerotherapy was used in 19% of cases, and no endoscopic intervention was provided in 14% of patients. The research team noted that the overall rate of balloon tamponade use was 11%. Salvage procedures were used in 6%, falling to 2% among patients treated after 2000. Although pooled rates of timely endoscopy and vasoactive medication use were high, only half of patients received prophylactic antibiotics. In studies that enrolled patients exclusively after 2000, 14% of patients received sclerotherapy, salvage transjugular portosystemic shunt fell to 2%, balloon tamponade use fell slightly to 9%, and vasoactive medication and prophylactic antibiotic use rose to 91%, and 63%, respectively. Dr Tapper's team concludes, "Acute variceal hemorrhage is associated with high mortality rates and suboptimal implementation of evidence-based therapies including prophylactic antibiotics and endoscopic interventions, suggesting a need for quality improvement." "In addition, the frequent need for balloon tamponade, and sclerotherapy suggests that specific attention to these procedures in gastroenterology training curricula may be warranted."
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