Variceal Hemorrhage

Variceal hemorrhage is a complication of portal hypertension that has high mortality and high recurrence rates. Management of variceal bleeding involves three areas: treatment of active hemorrhage, prevention of rebleeding, and prevention of first variceal bleeding. There are two main therapeutic avenues: methods directed at reducing portal pressure, such as pharmacologic therapy, shunt surgery, and TIPS; and methods that act locally by decreasing or interrupting blood flow through a specific varice, such as sclerotherapy, banding, and balloon tamponade. The relative effectiveness of each of these interventions is discussed in this article.