Compression Hemostasis in Refractory Esophageal Bleeding

   RELEVANCE. Efficiency and safety of compression hemostasis with esophageal self-expanding nitinol stents Danis compared to the Sengstaken–Blakemore tube in the treatment program of refractory esophageal bleeding still remains a controversial issue.

   AIM OF THE STUDY. To conduct a comparative analysis of the effectiveness of Danis self-expanding compression hemostasis nitinol stent and the Sengstaken-Blakemore tube for variceal esophageal bleeding refractory to drug and endoscopic treatment.

   MATERIAL AND METHODS. The first comparison group included 44 patients, in whose complex treatment program tamponade with a Sengstaken-Blakemore tube was used to save lives. The second main group of the study consisted of 15 patients in whom compression hemostasis was performed using Danis self-expanding nitinol stent. Statistical processing was carried out using the Kolmogorov-Smirnov, Student, χ² and Fisher exact tests. Differences were considered statistically significant at p ≤ 0.05.

   RESULTS. In the comparison group, complications occurred in 44 (100 %), in the main group complications were observed in 8 patients (53.3 %). Accordingly, reliable mechanical hemostasis was achieved in 33 (75.0 %) and 13 clinical observations (86.7 %); trophic changes in the esophageal mucosa were detected in 12 (27.2 %) and 8 patients (53.3 %). When assessing the function of external respiration, 5^th and 2^nd degrees of decrease in the ventilation capacity of the lungs, as well as 3^rd and 1^st degrees of decrease in the vital capacity of the lungs were established. The overall mortality was 56.8 % in the comparison group and 26.7 % in the main group.

   CONCLUSION. Self-expanding compression hemostasis nitinol stent Danis as a bridge to the choice of definitive therapy compared to tamponade with the Sengstaken–Blakemore tube is a promising alternative first-line treatment for patients with refractory esophageal bleeding. At the same time, it is necessary to conduct randomized controlled studies to confirm the safety and effectiveness of self-expanding nitinol stents.

1. Ekk NV. K voprosu o perevyazke vorotnoy veny. Military Medical Journal. 1877;130(11,2):1–2. (In Russ.)

2. De Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743–752. doi: 10.1016/j.jhep.2015.05.022 PMID: 26047908

3. Manukyan GV, Shertsinger AG, Zhigalova SV, Semenova TS, Martirosyan RA. Primary Prevention of Bleeding from Esophageal and Gastric Varices in Patients With Portal Hypertension. Annals of HPB Surgery. 2016;21(2):93–104. (In Russ.) doi: 10.16931/1995-5464.2016293-104

4. Escorsell À, Pavel O, Cárdenas A, Morillas R, Llop E, Villanueva C, et al. Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial. Hepatology. 2016;63(6):1957–1967. doi: 10.1002/hep.28360 PMID: 26600191

5. Bosch J, Berzigotti A, Garcia-Pagan JC, Abraldes JG. The management of portal hypertension: rational basis, available treatments and future options. J Hepatol. 2008; 48(Suppl1):S68–S92. doi: 10.1016/j.jhep.2008.01.021 PMID: 18304681

6. Shertsinger AG, Zhao AV, Ivashkin VT, Maevskaya MV, Pavlov ChS, Vertkin AL, et al. Treatment of Bleedings from Varicose Veins of the Esophagus and Stomach. Annals of HPB Surgery. 2013;18(3):110–129.

7. Fortune BE, Garcia-Tsao G, Ciarleglio M, Deng Y, Fallon MB, Sigal S, et al. Child-Turcotte-Pugh Class is Best at Stratifying Risk in Variceal Hemorrhage: Analysis of a US Multicenter Prospective Study. J Clin Gastroenterol. 2017;51(5):446–453. doi: 10.1097/MCG.0000000000000733 PMID: 27779613

8. Escorsell À, García-Pagán JC, Bosch J. Esophageal Stents for Acute Variceal Bleeding: Expanding the Possibilities. Dig Dis Sci. 2018;63(2):275–276. doi: 10.1007/s10620-017-4854-x PMID: 29255994

9. Garcia-Pagán JC, Di Pascoli M, Caca K, Laleman W, Bureau C, Appenrodt B, et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol. 2013;58(1):45–50. doi: 10.1016/j.jhep.2012.08.020 PMID: 22940408

10. De Franchis R, Faculty BV. Revising consensus in portal hypertension: report of the Baveno Y consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53(4):762–768. doi: 10.1016/j.jhep.2010.06.004 PMID: 20638742

11. Maufa F, Al-Kawas FH. Role of Self-Expandable Metal Stents in Acute Variceal Bleeding. Int J Hepatol. 2012;2012:418369. doi: 10.1155/2012/418369 PMID: 22928113

12. Maiwall R, Jamwal KD, Bhardwaj A, Bhadoria AS, Maras JS, Kumar G, et al. SX-Ella Stent Danis Effectively Controls Refractory Variceal Bleed in Patients with Acute-on-Chronic Liver Failure. Dig Dis Sci. 2018;63(2):493–501. doi: 10.1007/s10620-017-4686-8 PMID: 28780608

13. Iber FL. Methodology and reviews of clinical trials in portal hypertension. Edited by A.K. Burroughs, 325 pp. New York: Excerpta Medica;1987. Hepatology. 1987;8(3):701. doi: 10.1002/HEP.1840080351

14. De Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005;43:167–176. doi: 10.1016/j.jhep.2005.05.009 PMID: 15925423

15. Garcia-Tsao G, Bosch J, Groszmann R. Portal hypertension and variceal bleeding, unresolved issues. Summary of an American Association for the study of liver disease and of the European Association for the Study of the Liver single-topic conference. Hepatology. 2008;47:1764–1772. doi: 10.1002/hep.22273 PMID: 18435460

16. Sengstaken RW, Blakemore AH. Balloon tamponage for the control of hemorrhage from esophageal varices. Ann Surgery. 1950;131(5):781–789. doi: 10.1097/00000658-195005000-00017 PMID: 15411151

17. Safka V, Hulek P (eds). Current Practice of Danis Stent. Hradec Kralove: Olga Cermakova; 2014.

18. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652–659. doi: 10.1002/hep.20339 PMID: 15349904

19. Chong CF. Esophageal rupture due to Sengstaken-Blakemore tube misplacement. World J Gastroenterol. 2005;11(41):6563–6565. doi: 10.3748/wjg.v11.i41.6563 PMID: 16425437

20. Collyer TC, Dawson SE, Earl D. Acute upper airway obstruction due to displacement of a Sengstaken-Blakemore tube. Eur J Anaesthesiol. 2008;25(4):341–342. doi: 10.1017/S0265021507002852 PMID: 18334039

21. Feneyrou B, Hanana J, Daures JP, Prioton JB. Initial control of bleeding from esophageal varices with the Sengstaken-Blakemore tube. Experience in 82 patients. Am J Surg. 1988;155(3):509–511. doi: 10.1016/s0002-9610(88)80124-7 PMID: 3257849

22. Escorsell À, Bosch J. Self-expandable metal stents in the treatment of acute esophageal variceal bleeding. Gastroenterol Res Pract. 2011;2011:910986. doi: 10.1155/2011/910986 PMID: 22013436

23. Anisimov AY, Loginov AV, Ibragimov RA, Anisimov AA. Endoscopic hemostasis with self-expanding nitinol stents (literature review). Annals of HPB Surgery. 2020;25(1):94–105. (In Russ.) doi: 10.16931/1995-5464.2020194-105