Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis

Abstract

Variceal bleeding is a life threatening situation with mortality rates of at least 20%. Prophylactic treatment with non-selective beta blockers (NSBBs) is recommended for patients with small varices that have not bled but with increased risk for bleeding. The recommended treatment strategies on primary prevention of variceal bleeding in patients with medium and large-sized varices are NSBBs or endoscopic band ligation. Nitrates, shunt surgery and sclerotherapy are not recommended in this setting. In this review, the most recent data on prevention of esophageal variceal bleeding are presented. Available data derived from randomized-controlled trials suggest both treatment strategies, and according to Baveno V consensus in portal hypertension “the choice of treatment should be based on local resources and expertise, patient preference and characteristics, side-effects and contra-indications”.

Keywords: Cirrhosis; Portal hypertension; Esophageal varices; Primary prevention; β-Blockers; Endoscopic band ligation

Core tip: The significance of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis is major, considering the high mortality rates that accompany the acute bleeding episode. Current management guidelines suggest the use of either non-selective beta-blockers or endoscopic band ligation with same efficacy between them. In this review, we summarize data from randomized clinical trials or prospective studies together with meta-analytical data, when applicable, to present the most updated recommendations on primary prevention of esophageal variceal bleeding.