Variceal bleeding endoscopic interventions

The major aims of interventional procedures for portal hypertension are prophylactic and emergent treatment of variceal bleeding, control of hepatic encephalopathy, and treatment of refractory ascites. Hypersplenism associated with hematological disorder is an additional clinical problem in patients with portal hypertension. At present, the main primary embolotherapies available for portal hypertension are balloon-occluded retrograde transvenous obliteration (BRTO) and partial splenic embolization (PSE). In Japan, BRTO has recently been applied for gastric varices instead of either endoscopic treatment or transhepatic intrahepatic portosystemic shunt (TIPS) procedure, and numerous studies have reported that this method has an excellent success rate. Its efficacy for control of hepatic encephalopathy has also been demonstrated. 

Injection therapy with CAs is now the first-line of endoscopic intervention for bleeding gastric varices and secondary prevention of gastric variceal bleeds outside the United States. ... 

XVb.3.2. Prophylaxis. There is little evidence to justify prophylactic endoscopic or surgical intervention in patients with varices which have not yet bled. Available trials have often been small and assumptions based upon aggregation may not be well justified. Non-selective beta-blockade with propanolol appears however to halve the risk of bleeding. 

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