Acute variceal bleeding is the major cause of mortality in patients with cirrhosis. The standard medical and endo-scopic treatment has reduced the mortality of variceal bleeding from 50% to 10–20%. The refractory variceal bleedis either because of failure to control the bleed or failure of secondary prophylaxis. The patients refractory to standardmedical therapy need further interventions. The rescue therapies include balloon tamponade, self-expanding metalstents (SEMS) placement, shunt procedures, including transjugular intrahepatic portosystemic shunt (TIPS),balloon-occluded retrograde transvenous obliteration (BRTO), and endoscopic ultrasound (EUS) guided coiling.

“The standard management of variceal bleeding includes hemodynamic stabilization, prophylactic antibiotics, vasoactive agents like terlipressin, somatostatin, and its analogs
and endoscopic treatment. Endsocopic variceal ligation (EVL) and injection sclerotherapy are standard endoscopic therapy performed after the initial stabilization of the patient. EVL is presently the preferred initial therapy because of higher success rate and lowers adverse effect compared to sclerotherapy. For gastric varices, the preferred initial modality of treatment is glue or thrombin injection.”

Rodge GA,et al Management of Refractory Variceal Bleed in Cirrhosis. J Clin Exp Hepatol. 2022 Mar-Apr;12(2):595-602. Free Full Text