Endoscopic treatment of oesophageal varices

Major variceal bleeding is a life-threatening complication of portal hypert ension. Therapy for bleeding may be difficult and requires expertise and ap propriate facilities. Endoscopic therapy using either injection sclerothera py or band ligation after adequate resuscitation and diagnostic endoscopy i s the preferred first-line treatment. Bleeding not controlled by initial en doscopic therapy requires balloon tamponade followed by repeat variceal lig ation or sclerotherapy. Patients who continue to bleed after endoscopic the rapy are best treated with percutaneous radiological transjugular intrahepa tic portosystemic shunt stent (TIPSS) insertion. After variceal eradication , patients require lifelong surveillance endoscopy and re-obliteration of v arices by endoscopic therapy if they recur. Betablockers to prevent recurre nt bleeding are reserved for selected patients. Patients with severe liver decompensation have a poor prognosis and should be evaluated for liver tran splantation. Prophylactic endoscopic therapy in patients who have never ble d from varices is contraindicated as it is associated with increased morbid ity and mortality.