Salvage therapies for refractory variceal hemorrhage

Refractory variceal bleeding is defined as bleeding that continues through adequate pharmacologic and endoscopic therapy. In patients with end-stage liver disease, the only option for long-term salvage is liver transplantation. In patients with well-preserved liver function (Child's class A and class B-7), other salvage options such as surgical shunt, TIPS, and devascularization procedures can achieve good outcome. The long-term survival depends on the underlying liver disease, rather than on the variceal bleeding per se.