THE CURRENT TREATMENT OF ESOPHAGEAL-VARICES

The wide range of management options available today are evaluated in this article. The advised management policy for acute variceal bleedin g includes admission to a hospital with an interest in portal hyperten sion, resuscitation, the possible use of pharmacological agents to low er portal pressure, and definitive endoscopic therapy (either scleroth erapy or banding). More major surgical procedures (i.e. shunts or tran section operations or TIPS) should be reserved for patients in whom en doscopic therapy fails. Longterm management to prevent recurrent varic eal bleeding is somewhat more controversial. The options for the major ity of patients are pharmacological therapy with beta-blockers, or rep eated endoscopic therapy to eradicate varices, or a major surgical pro cedure, preferably a partial shunt. All patients should be considered for liver transplantation although few will ultimately end up as liver transplant candidates. Prophylactic therapy prior to a variceal bleed , other than beta-blockade in selected patients, is unjustified today because of the difficulty in identifying high-risk patients.