Prevention of recurrent variceal bleeding. Endoscopic and pharmacologic treatment

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�-blockade or band ligation. In patients who have a contraindication to � -blockers therapy or who have bled while on �-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