A review of the literature on the management of esophagogastric varices published
in the last 12 months shows that the data are still quite conflicting. In the primary
and secondary prophylaxis of variceal bleeding, β-blockers are still the mainstay
of pharmacotherapy. Measurement of the hepatic portal venous pressure gradient is
considered to be a reliable parameter for successful reduction of portal pressure
using medical therapy. However, intolerance of propranolol requiring discontinuation
of therapy has been observed in approximately 30 % of patients. Patients’ compliance
with medication may represent another drawback of medical therapy.
The role of endoscopic band ligation in secondary prophylaxis is now indisputable,
especially in comparison with sclerotherapy. In the primary prevention of variceal
bleeding, band ligation is beginning to have a competitive edge over pharmacological
therapy.
Acute variceal bleeding is no longer a frequent morbid emergency. Most cases of bleeding
can now be managed successfully with band ligation and N-butyl-2-cyanoacrylate obliteration. N-butyl-2-cyanoacrylate has come into increasingly widespread use in the treatment
of bleeding gastric fundal varices in which surgery or transjugular intrahepatic portosystemic
shunting were previously regarded as the preferred therapies.
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S. Seewald, M.D.
Dept. of Interdisciplinary Endoscopy · Hamburg-Eppendorf Hospital ·
University of Hamburg · Martinistrasse 52 · 20246 Hamburg · Germany
Fax: + 49-40-42803-4420 ·
Email: seewald@uke.uni-hamburg.de
