Management algorithm in variceal upper gastrointestinal bleeding
DOI:
https://doi.org/10.14748/v1w7k930Keywords:
variceal bleeding, upper gastrointestinal tract, portal hypertension, endoscopic haemostasis, endoscopic band ligationAbstract
Introduction:
Variceal upper gastrointestinal bleeding is a life-threatening complication of portal hypertension in patients with advanced chronic liver disease, associated with high rates of early rebleeding and mortality. Despite advances in pharmacological, endoscopic, and interventional therapies, optimal management requires timely, coordinated, and evidence-based decision-making.
Aim:
The aim of this review is to present an updated, practical, and evidence-based algorithm for the management of acute variceal upper gastrointestinal bleeding, focusing on early stabilization, endoscopic treatment, and interventional strategies.
Materials and Methods:
A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Articles published in English involving human subjects were included. The review covered original studies, randomized controlled trials, systematic reviews, meta-analyses, and international clinical guidelines relevant to the management of variceal bleeding.
Results:
Early initiation of vasoactive agents and antibiotic prophylaxis, restrictive transfusion strategies, and timely endoscopic intervention are central to effective management. Endoscopic band ligation remains the treatment of choice for esophageal varices, while cyanoacrylate injection and endoscopic ultrasound (EUS)-guided therapies are preferred for gastric varices. In high-risk patients, early or rescue transjugular intrahepatic portosystemic shunt placement improves outcomes. Temporary mechanical measures serve as bridging therapies in refractory cases.
Conclusion:
Management of acute variceal bleeding should follow a structured, stepwise algorithm integrating pharmacological, endoscopic, and interventional approaches. Individualized risk assessment and multidisciplinary decision-making are essential to improve survival and reduce rebleeding in this high-risk population.
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