Esophageal Varices Rebleeding Prophylaxis Treatment: Who is the Champion?

Cosmas Rinaldi Adithya Lesmana(1),

(1) 1) Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta 2) Digestive Disease & GI Oncology Centre, Medistra Hospital, Jakarta 3) Gastrointestinal Cancer Centre, MRCCC Siloam Semanggi Hospital, Jakarta
Corresponding Author


Portal hypertension (PH) is still a big challenge in clinical practice, where the presence of esophageal varices (EV) is the most common complication found in liver cirrhosis (LC) patients. The progression of PH condition in LC patients would lead to decompensated stage with more complications, such as variceal bleeding, the presence of ascites, hepatic encephalopathy, and hepatorenal syndrome.[1,2] Bleeding of EV (BEV) is a critical clinical which carry high mortality. Therefore, not only early detection and how the PH condition can be diagnosed well, but also how we can manage to prevent its complication, especially for primary as well as secondary BEV prophylaxis.[3]


Simonetto DA, Liu M, Kamath PS. Portal hypertension and related complications: Diagnosis and management. Mayo clin proc. 2019;94:714-26 [PMID: 30947834 DOI: 10.1016/j.mayocp.2018.12.020]

Berzigotti A. Advances and challenges in cirrhosis and portal hypertension. BMC Med. 2017;15:200 [DOI: 10.1186/s12916-017-0966-6]

Garcia-Tsao G, Bosch J, Groszmann RJ. Portal hypertension and variceal bleeding-unresolved issues. Summary of an American Association for The Study of Liver Diseases and European Association for the Study of the Liver single-topic conference. Hepatol. 2008;47:1764-72 [PMID: 18435460 DOI: 10.1002/hep.22273]

Sarin SK, Kumar A, Angus PW, Baijal SS, Baik SK, Bayraktar Y, et al. Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatol Int 2011;5:607-24 [PMID: 21484145 DOI: 10.1007/s12072-010-9236-9]

Lesmana CRA, Raharjo M, Gani RA. Managing liver cirrhotic complications: Oveview of esophageal and gastric varices. Clin and Mol Hepatol 2020;26:444-460 [PMID 33053928 DOI: 10.3350/cmh.2020.0022]

European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406-60 [PMID: 29653741 DOI: 10.1016/j.jhep.2018.03.024]

Funakoshi N, Duny Y, Valats JC, Segalas-Largey F, Flori N, Bismuth M, et al. Meta-analysis: beta-blockers versus banding ligation for primary prophylaxis of esophageal variceal bleeding. Ann Hepatol 2012;11:369-83 [DOI: 10.1016/S1665-2681(19)30934-2]

Steib CJ, Gerbes AL. Secondary prophylaxis for variceal bleeding: carvedilol vs. propanolol. Hepatol Int 2017;11:141-2 [DOI: 10.1007/s12072-017-9791-4]

Stanley AJ, Dickson S, Hayes PC, Forrest EH, Mills PR, Tripathi D, et al. Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal bleeding. J Hepatol 2014;61:1014-9 [PMID: 24953021 DOI: 10.1016/j.jhep.2014.06.015]

Malandris K, Paschos P, Katsoula A, Manolopoulos A, Andreadis P, Sarigianni M, et al. Carvedilol for prevention of variceal bleeding: a systematic review and meta-analysis. Ann Gastroenterol 2019;32:287-97 [PMID: 31040627 DOI: 10.20524/aog.2019.0368]

Dunne PDJ, Sinha R, Stanley AJ, Lachlan N, Ireland H, Shams A, et al. Randomised clinical trial: standard of care versus early-transjugular intrahepatic porto-systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding. Aliment Pharmacol Ther 2020;52:98-106 [PMID: 32452561 DOI: 10.1111/apt.15797]

Nicoara-Farcau O, Han G, Rudler M, Angrisani D, Monescillo A, Torres F, et al. Effects of early placement of transjugular portosystemic shunts in patients with high-risk acute variceal bleeding: a meta-analysis of individual patient data. Gastroenterol 2021;160:193-205.e10 [PMID: 32980344 DOI: 10.1053/j.gastro.2020.09.026]

Wong YJ, Ho WLD, Abraldes JG. Pre-emptive TIPSS in acute variceal bleeding: current status, controversies, and future directions. J Clin Transl Hepatol 2022;10:1223-8 [DOI: 10.14218/JCTH.2022.00240]

Trebicka J, Gu W, Ibanez-Samaniego L, Hernandez-Gea V, Pitarch C, Garcia E, et al. Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS. J Hepatol 2020;73:1082-91 [DOI: 10.1016/j.jhep.2020.04.024]

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