Prevention of recurrent variceal bleeding. Endoscopic and pharmacologic treatment

Abstract

SUMMARY
Bleeding from esophageal and gastric varices is the most
severe complication of portal hypertension. The long-term
probability of rebleeding of patients surviving a variceal
bleed is about 60%, with a mean risk of death of about 45%.
Thus, all patients who survive an episode of variceal bleeding
must be treated to prevent rebleeding. Pharmacological
therapy with beta-blockers has been shown to reduce
the rebleeding rate by about 40%. Endoscopie methods such
as sclerotherapy and rubber band ligation have also been
shown to be effective in reducing the incidence of variceal
rebleeding. Banding was markedly superior to sclerotherapy
in preventing rebleeding, while mortality was similar with
either treatment. The advantage of combining sclerotherapy
with beta-blockers appears to be small. The value of combining
banding and sclerotherapy with the aim of reducing
variceal recurrence is still unproven. In conclusion, the first
line treatment for prevention of recurrent variceal haemorrhage
is either â-blockade or band ligation. In patients who
have a contraindication to â -blockers therapy or who have
bled while on â-blockers, band ligation is the preferred treatment
to prevent recurrent variceal hemorrhage.
Key Words: Portal hypertension, Variceal haemorrhage,
beta-blockers, sclerotherapy; endoscopie banding ligation,
meta-analysis