Optimal treatment in acute variceal bleeding

SUMMARY Different treatment strategies have been used to control variceal haemorrhage including drugs, oesophageal tambonade, endoscopie sclerotherapy or ligation, TIPS, and surgery. Optimal therapy should stop bleeding and prevent early rebleeding. The initial resuscitation of patients is as important as the other specific measures to promote haemostasis. Balloon tambonade is a highly effective treatment to achieve a temporary control of bleeding but it carries a very high risk of complications. Pharmacologie treatment has the theoretical advantage of allowing specific therapy without requiring any complicated equipment and experienced personnel. Drugs currently used in the treatment include vasopressin, terlipressin and somatostatin or its analogues octreotide and vapreotide. In clinical studies somatostatin was more effective than vasopressin and as effective as terlipressin but with improved safety profile. Endoscopie treatments (sclerotherapy and ligation) are highly effective in achieving haemostasis but they are largely depended on the experience of the endoscopist. The association of endoscopie with pharmacologie therapy (preferably somatostatin), used as soon as the diagnosis is suspected (before the endoscopy) and continued for five days, currently appears to be the best approach to treatment. TIPS is indicated in patients in whom bleeding cannot be controlled or recurs after two sessions of endoscopie treatment. Keywords: Portal hypertension, bleeding oesophageal varices, cirrhosis, sclerotherapy, lipation, vasoactive drugs.