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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 β-blockers should be used for the prevention of first variceal bleeding. For medium to large EV, nonselective β-blockers or endoscopic variceal ligation (EVL) may be recommended to high risk varices. But, nonselective β-blockers are the first treatment option to non-high risk varices and EVL is an alter-native when nonselective β-blockers are contraindicated or not tolerated. For the prevention of rebleeding, a combination of nonselective β-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.
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Fig. 1.
Recommendation of follow up endoscopy for screening of esophageal varices in liver cirrhosis.
Table 1.
Likelihood (%) of Bleeding of Untreated Varices within 23 Months in the North Italian Endoscopic Club study (adopted from NEJM 1988;319:983)
Table 2.
Comparision of EVL and Non-selective β-blocker for Primary Prophylaxis for Esophageal Variceal Bleeding
Table 3.
Meta-Analysis Results of EVL plus β-blockers Compared with EVL for the Prevention of Recurrent Esophageal Variceal Bleeding (25 Trials, 2,159 subjects)
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