Introducere: Ligaturarea endoscopicã (LE) şi scleroterapia sunt metode de primã intenåie în tratamentul varicelor
esofagiene (VE) hemoragice, acestea însã sunt deseori ineficiente în cazul hemoragiilor semnificative cu limitarea
câmpului vizual. Scopul studiului – aprecierea eficacitãåii hemostatice a stentului metalic auto-expandabil
(SMAE) în cazul VE şi hemoragie semnificativã în cazurile ineficacitãåii sau complicaåii ale metodelor endoscopice
de hemostazã.
Pacienåi şi Metodã: În studiu au fost incluşi 6 pacienåi B:F=1:6, cu vârsta medie (d.s.) – 51.1(1.95) ani, cu cirozã
hepaticã (CH) decompensatã şi hemoragie. Sursele de hemoragie au fost: VE (n=3) şi ulcerele post LE (n=3).
Criteriul major de selectare a fost limitarea câmpului de vedere în timpul examenului endoscopic. Severitatea
CH a fost apreciatã conform Child-Pugh: “C” – n=6, scorul mediu la internare fiind 11.3(0.4). Scorul mediu
MELD – 23.7(2.48). În toate cazurile a fost aplicat SMAE acoperit (SX-ELLA stent Danis, 135 mm x 25
mm, ELLA-CS, Hradec-Kralove, Czech Republic). Definiåiile utilizate corespund Consensului Baveno (IV-V).
Rezultate: Hemostaza iniåialã a fost obåinutã în toate cazurile. Migrarea distalã paråialã a SMAE, diagnosticatã
radiografic şi CT a fost în 3/6(50%), SMAE fiind repoziåionat endoscopic. Letalitatea la 30 zile –(n=3):
insuficienåa hepaticã (n=2) şi hemoragie din VE localizate inferior de capãtul distal al stentului (n=1).
Concluzii: Rezultatele preliminare demonstreazã eficacitatea SMAE în cazul pacienåilor decompensaåi, VE
hemoragice şi ineficacitatea tratamentului endoscopic. Sunt necesare studii suplimentare pe loturi mai mari de
pacienåi pentru formularea concluziilor finale.

Introduction: Endoscopic band ligation (EBL) and sclerotherapy are generally used as a first-line therapy of
bleeding esophageal varices (EV) but have significant limitations in massive bleeding with minor endoscopic
view. The study aim was to assess self-expanding metal stent (SEMS) hemostatic efficacy in severe EV hemorrhage
in case of failure to control acute bleeding or hemorrhagic complications after endoscopic treatment.
Patients and Methods: A total of six patients F:M=1:6, mean (s.d.) - 51.1(1.95) years with advanced liver cirrhosis
and massive bleeding were enrolled in the study. The bleeding sites were: EV (n=3) and post EBL esophageal ulcers
(n=3). The main selection criteria were minor endoscopic view at the time of endoscopy. Liver disease severity was
classified according Child – Pugh: “C” – n=6, the mean score on admission was 11.3(0.4). Mean MELD score –
23.7(2.48). A removable covered SEMS (SX-ELLA stent Danis, 135 mm x 25 mm, ELLA-CS, Hradec-Kralove,
Czech Republic) was inserted in this group of patients. All definitions were used according to Baveno Consensus
(IV-V).
Results: Initial hemostasis was achieved in all patients. Partial distal SEMS migration was documented on X-ray
and CT-scan in 3/6(50%) and stent reposition was achieved by second-look endoscopy. The 30-days mortality
(n=3): hepatic failure (n=2) and hemorrhage from EV below stent distal part (n=1).
Conclusions: The preliminary result demonstrates that SEMS is effective in high-risk patients with massive EV
bleeding and standard endoscopic therapy treatment failure. However a larger series is necessary in order to draw
final conclusions.