The current treatment of oesophageal varices

The wide range of management options available today are evaluated in this article. The advised management policy for acute variceal bleeding includes admission to a hospital with an interest in portal hypertension, resuscitation, the possible use of pharmacological agents to lower portal pressure, and definitive endoscopic therapy (either sclerotherapy or banding). More major surgical procedures (i.e. shunts or transection operations or TIPS) should be reserved for patients in whom endoscopic therapy falls. Long-term management to prevent recurrent variceal bleeding is somewhat more controversial. The options for the majority of patients are pharmacological therapy with beta-blockers, or repeated endoscopic therapy to eradicate varices, or a major surgical procedure, preferably a partial shunt. All patients should be considered for liver transplantation although few will ultimately end up as liver transplant candidates. Prophylactic therapy prior to a variceal bleed, other than beta-blockade in selected patients, is unjustified today because of the difficulty in identifying high-risk patients.