The role of endoscopic therapy in the treatment of bleeding varices

Sabine Bohnacker, Parupudi V.J. Sriram, Nib Soehendra

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

The role of endoscopy in bleeding varices is both diagnostic and therapeutic. While sclerotherapy of oesophageal varices remains an established modality, ligation has, in view of its higher safety margin, turned out to be superior in recent years. The excellent initial results of ligation are, however, tainted by a higher recurrence rate in the long term. Since the endpoint of treatment is the achievement and maintenance of variceal eradication, the addition of low-dose sclerotherapy following initial eradication by ligation seems to be the optimal method to combine the best of both techniques. In the management of life-threatening bleeding from oesophageal varices and gastric varices, cyanoacrylate remains the only promising non-surgical option. Primary endoscopic prophylaxis is still under evaluation. It is only justified in high-risk patients with large varices bearing red colour signs and in the presence of an intolerance of or contra-indication to propranolol. When indicated, ligation seems to be preferable, and the addition of low-dose sclerotherapy after initial variceal eradication may maintain the benefits accrued in such high-risk patients. The present review examines the available evidence regarding the above issues in the recent literature.

Original languageEnglish (US)
Pages (from-to)477-494
Number of pages18
JournalBailliere's Best Practice and Research in Clinical Gastroenterology
Volume14
Issue number3
DOIs
StatePublished - Jun 2000
Externally publishedYes

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Keywords

  • Bleeding
  • Endoscopy
  • Therapy
  • Varices

ASJC Scopus subject areas

  • Gastroenterology

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