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Endoscopy 2002; 34(2): 119-128
DOI: 10.1055/s-2002-19845
State of the Art Review

© Georg Thieme Verlag Stuttgart · New York

Variceal Bleeding and Portal Hypertension: Much to Learn, Much to Explore

D.  K.  Bhasin1 , N.  J. S.  Malhi1
  • 1Dept. of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Accepted after Revision

Publication Date:
14 August 2002 (online)

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The newer diagnostic and therapeutic options continue to evolve and important developments have been made in the field of variceal bleeding and portal hypertension. A meeting was held at Baveno to update consensus on different terminologies in relation to portal hypertension. β-blockers continue to be the mainstay for primary prophylaxis of variceal bleeding, and endoscopic variceal ligation (EVL) is fast emerging as a strong contender. The role of vasoactive drugs in the management of variceal bleeding was assessed. Octreotide and terlipressin were shown to be as effective as sclerotherapy in achieving initial hemostasis, and octreotide was shown to be safe and efficacious in the prevention of rebleeding. EVL was superior to endoscopic sclerotherapy (EST) for obliteration of esophageal varices. Sequential and simultaneous ligation and sclerotherapy were more effective than ligation alone, in reducing the recurrence rate after variceal obliteration. For gastric varices, cyanoacrylate glue continues to be the first line of treatment, and band ligation is being assessed further. Bleeding ectopic varices were dealt by appropriate endoscopic means. Endosonography has developed strongly in the assessment of variceal eradication and prediction of variceal recurrence. Transjugular intrahepatic portosystemic shunting (TIPS) significantly reduces rebleeding rates compared to EVL.

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D. K. Bhasin, M.D., D.M.

Department of Gastroenterology · Postgraduate Institute of Medical Education and Research

#1041, Sector 24-B · Chandigarh 160023 · India

Fax: + 91-172-744401

Email: dkbhasin@sancharnet.in

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