Bleeding Esophageal Varices

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Treatment

The objective of therapy is to stop acute bleeding as soon as possible and manage persistent varices with medical and procedural therapies. Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, the patient may be placed on a ventilator to protect the airway and prevent blood from going down into the lungs.

In endoscopic therapy, an endoscope (a device with a light that can look inside of a body cavity) is used. The health care provider may directly inject the varices with a clotting agent or place a rubber band around the bleeding veins. This procedure is used in acute bleeding episodes and as prophylactic (preventive) therapy.

Acute bleeding may also be treated by a balloon tamponade -- a tube that is inserted through the nose into the stomach and inflated with air to produce pressure against the bleeding veins.

In transjugular intrahepatic portosystemic shunting (TIPS), a catheter is extended through a vein across the liver where it connects the portal system to the systemic venous system and decreases portal venous pressure.

Octreotide and vasopressin are medications that may be used to decrease portal blood flow and slow bleeding.

Emergency surgery may be necessary to treat patients for whom other treatment fails. Portacaval shunts that pass blood to the vena cava from the portal vein by a graft or resection of part of the esophagus are two treatment options, but these procedures have a high death rate.