The role of endoscopic therapy in the treatment of bleeding varices

The role of endoscopy in bleeding varices is both diagnostic and therapeuti c. While sclerotherapy of oesophageal varices remains an established modali ty, ligation has, in view of its higher safety margin, turned out to be sup erior in recent years. The excellent initial results of ligation are, howev er, tainted by a higher recurrence rate in the long term. Since the endpoin t of treatment is the achievement and maintenance of variceal eradication, the addition of low-dose sclerotherapy following initial eradication by lig ation seems to be the optimal method to combine the best of both techniques . In the management of life-threatening bleeding from oesophageal varices a nd gastric varices, cyanoacrylate remains the only promising non-surgical o ption. Primary endoscopic prophylaxis is still under evaluation. It is only justified in high-risk patients with large varices bearing red colour sign s and in the presence of an intolerance of or contra-indication to proprano lol. When indicated, ligation seems to be preferable, and the addition of l ow-dose sclerotherapy after initial variceal eradication may maintain the b enefits accrued in such high-risk patients. The present review examines the available evidence regarding the above issues in the recent literature.