Commentary

Variceal bleeding is a serious complication of liver cirrhosis; it occurs in one third of patients with varices and is refractory in 10 % – 20 % of patients. Endoscopic band ligation is the initial treatment for bleeding esophageal varices. Nonetheless, some varices are refractory or recur within 6 – 12 hours.

For these cases, a Sengstaken–Blakemore balloon can be used to tamponade the bleeding. Other alternatives include acute transjugular intrahepatic portosystemic shunting (TIPS) using an intravascular stent, delivering hemostatic powder, or placing a self-expandable metallic stent (SEMS).

Dedicated fully covered SEMS have a low complication rate and may be a useful alternative in patients for whom balloon tamponade is considered. SEMS placement allows bridging the patient to a more definitive treatment, which, in most situations, will again be band ligation or a TIPS procedure.

Publication History

Article published online:
25 March 2020