F. Lammer et al., MANAGEMENT AND PREVENTION OF BLEEDING FRO M ESOPHAGEAL-VARICES, Schweizerische medizinische Wochenschrift, 124(23), 1994, pp. 1024-1033
Acute bleeding from esophageal varices is a medical emergency It requi
res a structured therapeutic strategy adapted to local resources. The
primary goal is to stop bleeding, preferably by endoscopic sclerothera
py or ligation. If endoscopic intervention is not possible as a first-
line treatment, balloon tamponade or vasoactive drugs (terlipressin or
octreotid) are therapeutic options to be followed as soon as possible
by sclerotherapy or ligation. After successful hemostasis, the next g
oal is to prevent rebleeding. This is achieved primarily by eradicatin
g sclerotherapy or ligation. In special situations, long-term therapy
with a non-cardioselective beta receptor blocker is an alternative. Th
e combined approach using sclerotherapy or ligation plus beta receptor
blocker offers no significant advantage. Primary prophylaxis of bleed
ing from esophageal varices by long-term beta receptor blocker therapy
is advised in patients with medium-sized or large varices. Apart from
strategies aimed at the therapy or prophylaxis of bleeding from esoph
ageal varices, measures to prevent or treat chronic liver diseases sho
uld be implemented in order to reduce the development of liver cirrhos
is as the leading cause of esophageal varices.