Primary prophylaxis for bleeding from esophageal varices

Esophageal varices develop in 30-70% of patients with liver cirrhosis. One-third of these varices will eventually bleed and first episode could be fatal in 40-50% of patients. Because of this, primary prophylaxis can be justified if patients at high risk of bleeding can be identified. Many endoscopic findings can identify the patients likely to bleed in near future. The results of primary prophylaxis with portacaval shunts and endoscopic sclerotherapy have been disappointing. Nonselective betablockers have been found effective in preventing bleeding from varices and their use is justified for this purpose.