The Role of Endoscopy in Portal HypertensionBiecker E. · Schepke M. · Sauerbruch T.
Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
Prof. Dr. T. Sauerbruch
Department of General Internal Medicine, University Hospital of Bonn
Sigmund-Freud-Strasse 25, DE–53105 Bonn (Germany)
Tel. +49 228 287 5255, Fax +49 228 287 4322
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Endoscopy plays a major role in the management of gastrointestinal varices in portal hypertension. It is used for the prophylaxis of the first bleeding episode, therapy of active bleeding and prophylaxis of recurrent bleeding. Today not only nonselective betablockers, but also endoscopic band ligation is an option in the primary prophylaxis of the first bleeding episode in patients with large esophageal varices. Acutely bleeding varices should be treated by ligation, pharmacological and antibiotic therapy. Prophylaxis of recurrent bleeding despite endoscopic and pharmacologic treatment is patient dependent: shunt surgery is an option in young patients in a good medical condition (Child-Pugh class A). In patients with refractory ascites and a bilirubin level below 3 mg/dl, TIPS is a good option. Nevertheless, the first-line treatment in most patients in Germany is endoscopic band ligation. Bleeding from ectopic varices and due to hypertensive gastropathy should be treated individually either by endoscopy, TIPS or drug therapy.
© 2005 S. Karger AG, Basel
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