ABSTRACT
Management of varices can be divided into three categories: primary prophylaxis to prevent the first episode of bleeding, emergency treatment during an acute bleeding episode, and secondary prophylaxis to prevent re-bleeding. Nasogastric tube placement to remove particulate matter and administration of a prokinetic agent such as erythromycin can facilitate successful endoscopic management of variceal hemorrhage. Emergent endoscopic therapy is the definitive treatment of choice for acute variceal hemorrhage and can be performed at the same time as diagnostic endoscopy. In 2010, Garcia-Pagan et al. studied the early use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and acute esophageal variceal hemorrhage as a secondary prophylaxis therapy. Abdominal surgery is an alternative means to control variceal hemorrhage; however, the mortality rate is high, approaching 50% with surgery. TIPS are contraindicated in patients with heart failure, polycystic liver disease, severe pulmonary hypertension, uncontrolled systemic infection or sepsis, and severe tricuspid regurgitation.
