VARICEAL BLEEDING - WHAT ARE THE TREATMENT OPTIONS

Management of variceal hemorrhage is complex and can be difficult. Ini tially, the severity of the bleeding episode must be assessed and the intravascular volume repleted. Several treatment options are available . A trial of pharmacologic therapy (eg, vasopressin) may control acute bleeding. Temporary balloon tamponade of varices is helpful if bleedi ng continues. Endoscopic sclerotherapy and variceal ligation appear to be equally beneficial, although fewer complications have been reporte d with the latter. Transjugular intrahepatic portacaval shunt (TIPS) a nd portalsystemic shunt surgery are alternatives when endoscopic thera py fails; TIPS is preferred in patients awaiting liver transplantation . Ultimately, the choice of treatment is based on the expertise availa ble at each medical center.