North American Journal of Medical Sciences

REVIEW ARTICLE
Year
: 2013  |  Volume : 5  |  Issue : 10  |  Page : 573--579

Primary prevention of variceal bleeding: Pharmacological therapy versus endoscopic banding


Zeid Karadsheh1, Harmony Allison2 
1 Department of Medicine, Brockton Hospital, Brockton, USA
2 Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA

Correspondence Address:
Zeid Karadsheh
257 Northampton Street, Unit 507, Boston, MA 02118
USA

Variceal bleeding is one of the most feared complications in patients with liver cirrhosis. It continues to be a leading cause of death among patients with liver cirrhosis. Although its prognosis has improved over the last several decades, it still carries substantial mortality. Preventing variceal bleeding has been extensively studied and evaluated in several studies in the recent years and the comparison between the different modalities available to prevent variceal bleeding has been an area of discussion. Currently the two most widely used modalities to prevent variceal bleeding are pharmacologic (non-selective beta-blockers [NSBB]) and endoscopic (variceal band ligation [VBL]) which have replaced sclerotherapy in the recent years. In addition to NSBB and recent carvedilol, different other medications have been evaluated including isosorbide mononitrates, spironolactone and angiotensin blocking agents. Comparing the outcomes and adverse effects of these two modalities has been evaluated in different studies. Some studies have showed superiority of VBL until recently, when carvedilol has been included, however; overall mortality has been similar in most trials. Despite that, NSBB remain the first line treatment, as they are cheaper and relatively effective in preventing both esophageal and gastric bleeding. The following sections discuss the primary prevention of variceal bleeding with a focus on NSBB, carvedilol and VBL.


How to cite this article:
Karadsheh Z, Allison H. Primary prevention of variceal bleeding: Pharmacological therapy versus endoscopic banding.North Am J Med Sci 2013;5:573-579


How to cite this URL:
Karadsheh Z, Allison H. Primary prevention of variceal bleeding: Pharmacological therapy versus endoscopic banding. North Am J Med Sci [serial online] 2013 [cited 2021 May 11 ];5:573-579
Available from: https://www.najms.org/article.asp?issn=1947-2714;year=2013;volume=5;issue=10;spage=573;epage=579;aulast=Karadsheh;type=0