Evidence for Treatment of Acute Esophageal Variceal Bleeding • Octreotide (PMID: 11870374) - Endoscopic banding + octreotide compared to endoscopic banding, RR of rebleeding=0.8. No mortality benefit • PPI (PMID: 25583938) - No role in acute esophageal variceal bleed (given empirically until endoscopy). May help prevent bleeding from the ulcer caused by endoscopic banding • Antibiotics (PMID 21707680) - Compared to placebo, RR of death=0.79. RR of bacterial infection= 0.35. RR of rebleeding=0.53 • Endoscopic Variceal Banding/Sclerotherapy (PMID: 7611595) • Stops bleeding in around 90% of cases. Endoscopic Variceal Banding >>> Sclerotherapy • TIPS (PMID: 8698192) - Stops bleeding in around 90% of cases. Early TIPS (within 72 hours) compared to TIPS if necessary. Early TIPS associated with longer transplantation free survival at 1 year, without increased risk of hepatic encephalopathy. • Surgery (PMID: 7748083) - Stops bleeding in close to 100% of cases, around 50% mortality. by Dr. Anthony Xu @AnthonyXuMD #Variceal #Bleeding #varices #management #ebm #evidence #gastroenterology
