Endoscopic treatment of esophageal variceal hemorrhage

Endoscopy is the most commonly utilized therapeutic intervention in the initial attempt to control active hemorrhage. Initial management depends on patient hemodynamic stability at the time of presentation. Hemodynamically unstable patients are resuscitated with supportive medical therapy, which includes intravascular volume resuscitation with iv fluids and blood products, and chemotherapeutic attempt to lower portal pressure with iv vasopressin or somatostatin. The patient's condition is monitored in the Intensive Care Unit. Endoscopy is performed as soon as the patient is hemodynamically stable, for both diagnostic and therapeutic purpose. Hemodynamically stable patients undergo endoscopy as an initial diagnostic test, and therapeutic intervention to control bleeding. Portal pressure lowering agents are used in conjunction to endoscopic intervention to prevent early rebleeding. Patients who fail endoscopic and medical treatment are referred for transjugular intrahepatic portosystemic shunt (TIPS) placement or surgical treatment. Liver transplantation may be considered in selected cases for patients with end-stage liver disease.

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