Role of Self-Expandable Metal Stents in Acute Variceal Bleeding

Table 2

Rescue therapies for refractory esophageal variceal bleeding.

Modality	Candidate	Efficacy in controlling bleeding	Complications	Limitation
BT	Refractory esophageal bleeding as bridge to definitive therapy.	More than 80% but tube should be removed within 24 hours.	Potentially lethal complications including esophageal perforation aspiration and pneumonia.	Limited efficacy and high complication rate in in-experienced hands.; Temporary measure
Surgery	Acute variceal bleeding unresponsive to medical and endoscopic therapy.	Heterogeneous group but generally very effective.	Hepatic encephalopathy.; Liver decompensation.	Requires expertise with exception of modified; Sugiura procedure.
TIPS	Acute variceal bleeding unresponsive to medical and endoscopic therapy.	More than 90%.	Hepatic encephalopathy.	Limited availability
			Liver decompensation.	Occlusion and stenosis.
				Not suitable or contraindicated in many patients.
SEMSs	Refractory esophageal bleeding as bridge to definitive therapy.	70–100% and stent can be left in place for as long as 2 weeks.	Minor esophageal ulcer.	Temporary measures
			Migration.	Require a repeat endoscopy for removal.
			Compression of left main bronchus.