Primary prophylaxis of bleeding from esophageal varices in cirrhosis

Abstract

Prophylaxis of the first bleeding from esophageal varices became a clinical option more than 20 years ago, and gained a large diffusion in the following years. It is based on the use of nonselective beta-blockers, which decreases portal pressure, or on the eradication of esophageal varices by endoscopic band ligation of varices. In patients with medium or large varices either of these treatments is indicated. In patients with small varices only medical treatment is feasible, and in patients with medium and large varices with contraindication or side-effects due to beta-blockers, only endoscopic band ligation may be used. In this review the rationale and the results of the prophylaxis of bleeding from esophageal varices are discussed.

Keywords: RWM, red wale marks; band ligation; beta-blockers; portal hypertension.

Figure 1

Course of the risk of growth of esophageal varices in patients treated with nadolol or placebo (from Ref. 17).

Figure 2

Meta-analysis of beta-blockers versus. placebo in the prophylaxis of first variceal bleeding in patients with small esophageal varices.

Figure 3

Preference between nonselective beta-blockers and endoscopic band ligation in the survey of the expert panel participating to the Baveno V consensus conference (2010). Panel A: answers to the question: “what do you consider the best approach for primary prophylaxis of variceal bleeding?”; panel B: answers to the question: “In your current clinical practice for primary prophylaxis, which is the first option?”.