Optimizing General Management of Acute Variceal Bleeding in Cirrhosis

Abstract

As soon as acute gastrointestinal bleeding is confirmed in patients with portal hypertension, treatment with vasoactive drugs and prophylactic antibiotics should be instituted. Once hemodynamic stability has been achieved, emergency endoscopy should be performed and endoscopic therapy (preferably with legation) should be carrier out when variceal bleeding is disclosed. It is advisable to maintain drug therapy for 5 days to prevent early rebleeding. When this treatment fails, TIPS should be considered. Balloon tamponade is indicated in patients with massive bleeding, as a bridge until definitive treatment could be instituted. Self-expanding metal stents are an alternative to tamponade which may even improve the outcomes. Recent data suggest that patients at high-risk of failure may benefit from invasive treatments such as early TIPS, while those with low-risk may do well with less intensive therapy including shorter administration of vasoactive drugs. However, these possibilities should be further investigated in future studies providing therapy according to stratification of risk.