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Primary prophylaxis of variceal bleed: drugs versus endoscopy
Author(s) -
SCHIEDERMAIER PETER
Publication year - 2004
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2004.03672.x
Subject(s) - medicine , varices , sclerotherapy , bleed , portal hypertension , endoscopy , ligation , varix , surgery , complication , gastroenterology , cirrhosis
Variceal hemorrhage is a serious complication of portal hypertension with a high mortality rate up to 50%. The risk of bleeding is high in patients with large varices and red color signs and in patients with advanced liver failure. Therefore, upper endoscopy must be performed in all patients with portal hypertension. In patients with no or small varices bleeding risk is less than 10% and prophylactic therapy cannot be recommended. All patients with moderate and large varices should receive non‐selective β‐blocker therapy. Nitrates cannot be recommended, neither alone or in combination therapy. Endoscopic sclerotherapy should not be performed to prevent variceal hemorrhage. By contrast, endoscopic variceal ligation is as safe and effective in preventing variceal hemorrhage and should be offered to patients with high risk varices and to patients who have contraindications or who cannot tolerate β‐blocker therapy. Whether the combination of β‐blockers and endoscopic variceal ligation is more effective than β‐blockers alone, and whether HVPG guided β‐blocker therapy offers an advantage warrants further investigation.