Management of variceal bleeding in the 1990s
J. Michael Henderson, MB, CHBAddress reprint requests to J.M.H., Department of General Surgery, A80, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
William D. Carey, MD
David P. Vogt, MD
David S. Barnes
Margaret G. Zelch, MD
Cathy Blake, MSN, RN
Variceal bleeding is a common and serious problem.OBJECTIVE
To review the current management of patients with variceal bleeding.SUMMARY
Therapeutic options now include pharmacologic reduction of portal hypertension, endoscopic obliteration of varices, placement of decompressive shunts (both surgical and percutaneous), and liver transplantation. Each of these options may be required in different settings. A nonselective beta blocker can prophylactically reduce the risk of an initial bleed. Acute variceal bleeding is best managed by endoscopic sclerosis. Selection of therapy to prevent recurrent bleeding should be based on a full evaluation of the risk of bleeding and of liver failure.CONCLUSIONS
Successful management requires a multidisciplinary team, full patient evaluation, and selection of appropriate therapy.