Life expectancy in liver cirrhosis after the first variceal hemorrhage: how can survival be improved?

A first hemorrhage from esophageal or fundal varices in a patient with liver cirrhosis marks the onset of a period with a high risk of rebleeding and death. The risk of rebleeding can be decreased by serial sclerotherapy, esophageal transection, or shunt surgery. However, the influence of these treatments on long-term survival is unconvincing. After endoscopic sclerotherapy the 4-year survival is 35-60%. After liver transplantation the 5-year survival is 65%. Endoscopic sclerotherapy, transection, and shunt surgery should be considered symptomatic treatments, primarily devised to decrease the rebleeding risk. Liver transplantation improves survival and, in addition, decreases the rebleeding risk in patients with esophageal varices.