Journal of the Chinese Medical Association
Volume 69, Issue 12 , Pages 553-560, December 2006

Prevention of Esophageal Variceal Rebleeding

  • Gin-Ho Lo

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr Gin-Ho Lo, Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, R.O.C.

Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Received 11 July 2006; accepted 25 October 2006.

Article Outline

The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

Key Words:  banding ligation , beta-blocker , sclerotherapy , transjugular intrahepatic portosystemic stent shunt , variceal rebleeding

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PII: S1726-4901(09)70328-4

doi:10.1016/S1726-4901(09)70328-4

Journal of the Chinese Medical Association
Volume 69, Issue 12 , Pages 553-560, December 2006

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