Prevention of recurrent variceal bleeding

After control of variceal bleeding, the risk of recurrent bleeding approaches 70%. In secondary prophylaxis, both endoscopic therapy (sclerotherapy or banding ligation) and pharmacotherapy (beta-blockers with or without isosorbide-5-mononitrate) are effective in reducing the rate of rebleeding. The effect on mortality is less striking and in some studies not significant. Although many randomized trials are published, we lack criteria for selection of the optimal therapy in the individual patient in routine daily practice. The designs of published studies are multiple, with differences in timing of randomization, severity and causes of liver disease, definitions of end-points such as rebleeding, duration of follow-up, etc. These variations in addition to variation in the natural history and treatment given in the control groups make comparisons between studies difficult. This review summarizes the endoscopic and pharmacological treatment for the secondary prevention of variceal bleeding.