Variceal rebleeding: Drugs, endoscopy or both

Abstract

Bleeding from oesophageal varices is a serious complication to cirrhosis with a high risk of rebleeding and mortality. It is therefore of great importance to initiate secondary prophylaxis as soon as possible. Treatment with a non-selective beta-blocker (NSBB) reduces the risk of rebleeding and mortality (Evidence 1a, A). Treatment should be started as soon as possible and not later than 1 week after the index bleeding. Effect of NSBB on the risk of rebleeding and survival can be assessed by haemodynamic evaluation (evidence 1a, A). Band ligation reduces the risk of rebleeding and mortality (evidence 1a, A). Ligation sessions should be continued every 2–4 weeks until varices have been eradicated. The combination of beta-blockers and band ligation should be the preferred therapy as it results in lower risk of rebleeding compared to either therapy alone (evidence 1a, A).