Esophageal Variceal Bleeding - Diagnosis and Management Summary PRE-ENDOSCOPY Vasoactive agents - Octreotide: • 50mcg bolus → 50mcg/hr infusion • Continue for 2-5 days, Can consider stopping 24h after hemostasis Antibiotics - Ceftriaxone (or equivalent); • 1g IV q24h, Duration = 7 days, Can transition to fluoroquinolone to complete course Restrictive RBC transfusion threshold: • Goal Hgb 7-9 g/dL PPI infusion - Commonly used adjunct to octreotide when unclear source (in case of PUD) PERI-ENDOSCOPY Endoscopic variceal ligation - EGD should be performed within 12 hours of presentation Transjugular intrahepatic portosystemic shunt (TIPS) • Vasoactive agents can be discontinued following TIPS • Pre-TIPS evaluation (if feasible): TTE (evaluate R-sided cardiac function), Cross-sectional imaging (anatomy) POST-ENDOSCOPY Surveillance EGD ~2 weeks after index procedure and every 2-4 weeks thereafter until eradication achieved Non-selective ß-blocker: • Nadolol 20mg daily • Propranolol 10mg BID • Carvedilol 3.125mg BID - Dr. Adam Winters @adam_c_winters #Esophageal #Variceal #Bleeding #Diagnosis #Management #treatment #endoscopy #varices #hepatology
