Korean J Gastroenterol.  2010 Sep;56(3):155-167. 10.4166/kjg.2010.56.3.155.

Prevention of Esophageal Variceal Bleeding

• Lee CH

• KMID: 948778
• DOI: http://doi.org/10.4166/kjg.2010.56.3.155

Abstract

Esophageal varices(EV) are present in 40% and 60% of Child-Pugh A and C patients, respectively when cirrhosis is diagnosed. EV bleeding is a life-threatening complication of liver cirrhosis with a high probability of recurrence. Treatment to prevent first EV bleeding or rebleeding is mandatory. In small EV with high risk of bleeding, nonselective beta-blockers should be used for the prevention of first variceal bleeding. For medium to large EV, nonselective beta-blockers or endoscopic variceal ligation (EVL) may be recommended to high risk varices. But, nonselective beta-blockers are the first treatment option to non-high risk varices and EVL is an alternative when nonselective beta-blockers are contraindicated or not tolerated. For the prevention of rebleeding, a combination of nonselective beta-blockers and EVL may be the best option. A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed.

Keyword

Esophageal and gastric varices; Prevention & control; Non selective beta-blocker; Ligation

MeSH Terms

Adrenergic beta-Antagonists/therapeutic use
Esophageal and Gastric Varices/drug therapy/*prevention & control
Gastrointestinal Hemorrhage/*etiology
Humans
Ligation
Portasystemic Shunt, Transjugular Intrahepatic
Sclerotherapy

Figure

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  Fig. 1. Recommendation of follow up endoscopy for screening of esophageal varices in liver cirrhosis.

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  Fig. 2. Primary prophylaxis for small esophageal varices.

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  Fig. 3. Primary prophylaxis for large esophageal varices.

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