title: An update on the management of acute esophageal variceal bleeding.
abstract: The mortality rate in acute variceal haemorrhage remains high (around 15%). Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and prophylactic antibiotics. Effective resuscitation (haemostasis, volume management) is essential to prevent complications. Treatment failure is best managed by transjugular intrahepatic portosystemic shunt (TIPS). Balloon tamponade or specifically designed covered oesophageal stents can be used as a bridge to definitive therapy in unstable patients. Early, pre-emptive TIPS should be the first choice in patients at high risk of treatment failure (Child-Pugh B with active bleeding or Child-Pugh C<14). This article reviews the most recent advances in the management of variceal bleeding and discusses the recent recommendations of the Baveno VI consensus conference.
authors.affiliation: Cirrhosis Care Clinic (CCC), Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Canada.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Cabrera
authors.affiliation: Cirrhosis Care Clinic (CCC), Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Canada.
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
authors.affiliation: Cirrhosis Care Clinic (CCC), Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Canada. Electronic address: juan.g.abraldes@ualberta.ca.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
mesh_terms: D000208:Acute Disease; D003663:Decision Trees; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans
keywords: Acute variceal haemorrhage; Baveno VI recommendations; Early TIPS; Endoscopic ligation; Fármacos vasoactivos; Hemorragia aguda por varices; Ligadura endoscópica; Recomendaciones Baveno VI; Tratamiento; Treatment; Uso precoz de derivación portosistémica; Vasoactive drugs