Abstract
The Baveno V meeting concluded that either nonselective beta-blockers (NSBB) or endoscopic band ligation (EBL) may be recommended to prevent the first variceal bleeding in patients with medium or large varices, the final decision being based on several specific considerations. Further studies and meta-analyses focused on the “specific considerations” leading to the best decision considering that good quality trials failed to show any significant difference between the two therapies in variceal bleeding, bleeding-related mortality, and all-cause mortality. The main conclusions arising from these studies are the following: (1) NSBB must be administered at high doses (>75 mg/day) to be as effective as EBL, and (2) potential adverse events are higher when using NSBB, but those complicating EBL are far more serious, leading to death in some cases. Thus, EBL must be used in patients with intolerance or contraindications to NSBB as well as in those patients developing refractory ascites or SBP, in whom NSBB may aggravate the circulatory dysfunction. In the remaining patients, the decision must be personalized according to patient’s situation.
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