Review article: current endoscopic therapeutic options in the management of variceal bleeding

Variceal bleeding is a frequent and rife-threatening complication of portal hypertension. The first episode of variceal bleeding is not only associate d with a high mortality, but also with a high recurrence rate in those who survive. Therefore, many studies and randomized clinical trials have focuse d on different therapeutic strategies aiming to prevent the first episode o f variceal bleeding (primary prophylaxis), to control haemorrhage during th e acute bleeding episode (emergency treatment), and to prevent re-bleeding (secondary prophylaxis). These strategies involve pharmacological, endoscop ic, surgical, and interventional radiological modalities. This review concentrates on the clinical aspects of the endoscopic modaliti es used to treat oesophageal variceal haemorrhage, including variceal injec tion sclerotherapy, variceal band ligation, and the use of tissue adhesives (glue) and their substitutes. We also draw conclusions from the available literature regarding the use of endoscopic modalities in primary prophylaxi s, emergency treatment, and secondary prophylaxis of variceal re-bleeding. The management of gastric varices and variceal breeding during pregnancy is also addressed.