The newer diagnostic and therapeutic options continue to evolve and important developments
have been made in the field of variceal bleeding and portal hypertension. A meeting
was held at Baveno to update consensus on different terminologies in relation to portal
hypertension. β-blockers continue to be the mainstay for primary prophylaxis of variceal
bleeding, and endoscopic variceal ligation (EVL) is fast emerging as a strong contender.
The role of vasoactive drugs in the management of variceal bleeding was assessed.
Octreotide and terlipressin were shown to be as effective as sclerotherapy in achieving
initial hemostasis, and octreotide was shown to be safe and efficacious in the prevention
of rebleeding. EVL was superior to endoscopic sclerotherapy (EST) for obliteration
of esophageal varices. Sequential and simultaneous ligation and sclerotherapy were
more effective than ligation alone, in reducing the recurrence rate after variceal
obliteration. For gastric varices, cyanoacrylate glue continues to be the first line
of treatment, and band ligation is being assessed further. Bleeding ectopic varices
were dealt by appropriate endoscopic means. Endosonography has developed strongly
in the assessment of variceal eradication and prediction of variceal recurrence. Transjugular
intrahepatic portosystemic shunting (TIPS) significantly reduces rebleeding rates
compared to EVL.
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D. K. Bhasin, M.D., D.M.
Department of Gastroenterology · Postgraduate Institute of Medical Education and Research
#1041, Sector 24-B · Chandigarh 160023 · India
Fax: + 91-172-744401
eMail: dkbhasin@sancharnet.in
