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International Journal of Hepatology
Volume 2012 (2012), Article ID 750150, 6 pages
http://dx.doi.org/10.1155/2012/750150
Review Article

Prevention and Management of Gastroesophageal Varices in Cirrhosis

1Division of Hepatology and Gastroenterology, McGill University Health Center, McGill University, Montreal, QC, Canada H3A 1A1
2Internal Medicine Office, Jewish General Hospital, Montreal, QC, Canada H3T 1E2

Received 24 January 2012; Accepted 5 March 2012

Academic Editor: Averell Sherker

Copyright © 2012 Yen-I Chen and Peter Ghali. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Variceal hemorrhage is one of the major complications of liver cirrhosis associated with significant mortality and morbidity. Its management has evolved over the past decade and has substantially reduced the rate of first and recurrent bleeding while decreasing mortality. In general, treatment of esophageal varices can be divided into three categories: primary prophylaxis (prevention of first episode of bleeding), management of acute bleeding, and secondary prophylaxis (prevention of recurrent hemorrhage). The goal of this paper is to describe the current evidence behind the management of esophageal varices. We will discuss indications for primary prophylaxis and the different modes of therapy, pharmacological and interventional treatment in acute bleeding, and therapeutic options in preventing recurrent bleeding. The indications for TIPS will also be reviewed including its possible benefits in acute variceal hemorrhage.