Endoscopic treatment of acute variceal bleeding

Abstract

Variceal bleeding is life-threatening with a 6-week mortality rate of approximately 20 %. Mortality has decreased over the past 30 years and the improvement in endoscopic techniques is one of the major factors contributing to higher survival rates. The available data suggest that vasoactive drugs combined with endoscopic therapy are the best strategy to follow, and endoscopic variceal ligation is the recommended form of endoscopic treatment. Gastric variceal bleeding is associated with higher mortality rates; endoscopic therapy with tissue adhesives is currently recommended in the setting of fundal variceal bleeding, whereas TIPS is preferred in cases of rebleeding or uncontrolled bleeding. Despite their efficacy, all endoscopic procedures are accompanied by several complications, most of which are minor, but can sometimes be serious and life-threatening. Despite improvements in endoscopic management of acute variceal bleeding, there is a need for further studies investigating novel endoscopic techniques with better efficacy and safety than the currently used methods.