Back to Basics: Management of Esophageal Variceal Bleeding

Management of Esophageal Variceal Bleeding
Author:  Sydney Tabaac, MD
  • Vasoactive Drugs
    • Octreotide: decrease splanchnic blood flow
    • Vasopressin: reduces portal pressure; increases systemic vasoconstriction - associated w MI & small bowel necrosis
    • B-blocker (propranolol): used as prophylaxis in long-term management
  • Antibiotics
    • 3rd generation cephalosporin (CTX): mortality benefit, decrease risk of infection, renal failure and rebleed
  • Endoscopic: banding ligation (better outcomes; preferred treatment) or sclerotherapy (50% rebleed)
  • Balloon tamponade: Sengstagen-Blakemore tube (bridging measure to endoscopic therapy)
  • Variceal decompression: TIPS, esophageal transection or portacaval shunt


Zetterman R.  The clinical management of esophageal varices.  Jan 20, 2012.  Accessed on November 11, 2018.