Management of Refractory Variceal Bleeding

Abstract

Fifteen to 20% of patients with cirrhosis and variceal bleeding will develop refractory bleeding, i.e., persistent bleeding despite the use of vasoactive treatment, antibiotics, and endoscopic treatment. In this situation, Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the best therapeutic option. As TIPS may not be immediately available, temporary procedures such as balloon tamponade or oesophageal stents have to be used as “bridge therapy” to control bleeding. In this review, the current data on these different options are analyzed.