Login to MyKarger

New to MyKarger? Click here to sign up.

Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Review Article

Free Access

The Role of Endoscopy in Portal Hypertension

Biecker E. · Schepke M. · Sauerbruch T.

Author affiliations

Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany

Corresponding Author

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

E-Mail Tilman.Sauerbruch@ukb.uni-bonn.de

Related Articles for ""

Dig Dis 2005;23:11–17

Do you have an account?

Login Information

Contact Information

I have read the Karger Terms and Conditions and agree.


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


  1. Sauerbruch T, Scheurlen C, Neubrand M: Endoscopic treatment of variceal bleeding; in Tytgat GNJ, Classen M, Waye DJ, Nakazawa S (eds): Practice of therapeutic endoscopyy. London, Saunders, 2000, pp 13–29.
  2. Garcia-Tsao G: Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 2001;120:726–748.
  3. Kleber G, Sauerbruch T, Ansari H, Paumgartner G: Prediction of variceal hemorrhage in cirrhosis: A prospective follow-up study. Gastroenterology 1991;100:1332–1337.
  4. de Franchis R: Updating consensus in portal hypertension: Report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2000;33:846–852.
  5. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. N Engl J Med 1988;319:983–989
  6. Jensen DM: Endoscopic screening for varices in cirrhosis: Findings, implications, and outcomes. Gastroenterology 2002;122:1620–1630.
  7. Sauerbruch T, Wotzka R, Kopcke W, Harlin M, Heldwein W, Bayerdorffer E, Sander R, Ansari H, Starz I, Paumgartner G: Prophylactic sclerotherapy before the first episode of variceal hemorrhage in patients with cirrhosis. N Engl J Med 1988;319:8–15.
  8. Lui HF, Stanley AJ, Forrest EH, Jalan R, Hislop WS, Mills PR, Finlayson ND, Macgilchrist AJ, Hayes PC: Primary prophylaxis of variceal hemorrhage: A randomized controlled trial comparing band ligation, propranolol, and isosorbide mononitrate. Gastroenterology 2002;123:735–744.
  9. Sarin SK, Lamba GS, Kumar M, Misra A, Murthy NS: Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med 1999;340:988–993.
  10. Schepke M, Kleber G, Nurnberg D, Willert J, Koch L, Veltzke-Schlieker W, Hellerbrand C, Kuth J, Schanz S, Kahl S, Fleig WE, Sauerbruch T: Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology 2004;40:65–72.
  11. Imperiale TF, Chalasani N: A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001;33:802–807.
  12. Burroughs AK, Patch DW: Management of variceal haemorrhage in cirrhotic patients. Gut 2001;48:738–740.
  13. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Levy VG, Poupon R: Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology 2004;40:652–659.
  14. Nevens F: Review article: A critical comparison of drug therapies in currently used therapeutic strategies for variceal haemorrhage. Aliment Pharmacol Ther 2004;20(suppl 3):18–22; discussion 23.
  15. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT: A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology 2001;33:1060–1064.
  16. de Franchis R, Primignani M: Endoscopic treatments for portal hypertension. Semin Liver Dis 1999;19:439–455.
  17. Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T: Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 1999;29:1655–1661.
  18. Soares-Weiser K, Brezis M, Tur-Kaspa R, Paul M, Yahav J, Leibovici L: Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: A meta-analysis of randomized controlled trials. Scand J Gastroenterol 2003;38:193–200.
  19. Grace ND, Groszmann RJ, Garcia-Tsao G, Burroughs AK, Pagliaro L, Makuch RW, Bosch J, Stiegmann GV, Henderson JM, de Franchis R, Wagner JL, Conn HO, Rodes J: Portal hypertension and variceal bleeding: An AASLD single topic symposium. Hepatology 1998;28:868–880.
  20. D’Amico G, Pagliaro L, Bosch J: The treatment of portal hypertension: A meta-analytic review. Hepatology 1995;22:332–354.
  21. Goulis J, Burroughs A: Portal hypertensive bleeding; in McDonald JWD, Burroughs A, Feagan BG (eds): Evidence-based gastroenterology and hepatology. London, Blackwell, 2004.
  22. Bosch J, Abraldes JG, Groszmann R: Current management of portal hypertension. J Hepatol 2003;38(suppl 1):S54–S68.
    External Resources
  23. Teres J, Bosch J, Bordas JM, Garcia Pagan JC, Feu F, Cirera I, Rodes J: Propranolol versus sclerotherapy in preventing variceal rebleeding: A randomized controlled trial. Gastroenterology 1993;105:1508–1514.
  24. Westaby D, Polson RJ, Gimson AE, Hayes PC, Hayllar K, Williams R: A controlled trial of oral propranolol compared with injection sclerotherapy for the long-term management of variceal bleeding. Hepatology 1990;11:353–359.
  25. Dollet JM, Champigneulle B, Patris A, Bigard MA, Gaucher P: Endoscopic sclerotherapy versus propranolol after hemorrhage caused by rupture of esophageal varices in patients with cirrhosis. Results of a 4-year randomized study. Gastroentérol Clin Biol 1988;12:234–239.
  26. Singh P, Pooran N, Indaram A, Bank S: Combined ligation and sclerotherapy versus ligation alone for secondary prophylaxis of esophageal variceal bleeding: A meta-analysis. Am J Gastroenterol 2002;97:623–629.
  27. Lo GH, Chen WC, Chen MH, Hsu PI, Lin CK, Tsai WL, Lai KH: Banding ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding. Gastroenterology 2002;123:728–734.
  28. Patch D, Sabin CA, Goulis J, Gerunda G, Greenslade L, Merkel C, Burroughs AK: A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology 2002;123:1013–1019.
  29. Villanueva C, Minana J, Ortiz J, Gallego A, Soriano G, Torras X, Sainz S, Boadas J, Cusso X, Guarner C, Balanzo J: Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med 2001;345:647–655.
  30. Lo GH, Lai KH, Cheng JS, Chen MH, Huang HC, Hsu PI, Lin CK: Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: A prospective, randomized trial. Hepatology 2000;32:461–465.
  31. Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK: ‘Salvage’ transjugular intrahepatic portosystemic shunts: Gastric fundal compared with esophageal variceal bleeding. Gastroenterology 1998;114:981–987.
  32. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK: Prevalence, classification and natural history of gastric varices: A long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16:1343–1349.
  33. Feretis C, Dimopoulos C, Benakis P, Kalliakmanis B, Apostolidis N: N-butyl-2-cyanoacrylate (Histoacryl) plus sclerotherapy versus sclerotherapy alone in the treatment of bleeding esophageal varices: A randomized prospective study. Endoscopy 1995;27:355–357.
  34. Ramond MJ, Valla D, Mosnier JF, Degott C, Bernuau J, Rueff B, Benhamou JP: Successful endoscopic obturation of gastric varices with butyl cyanoacrylate. Hepatology 1989;10:488–493.
  35. Oho K, Iwao T, Sumino M, Toyonaga A, Ta-nikawa K: Ethanolamine oleate versus butyl cyanoacrylate for bleeding gastric varices: a nonrandomized study. Endoscopy 1995;27:349–354.
  36. Sarin SK, Jain AK, Jain M, Gupta R: A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol 2002;97:1010–1015.
  37. Gallet B, Zemour G, Saudemont JP, Renard P, Hillion ML, Hiltgen M: Echocardiographic demonstration of intracardiac glue after endoscopic obturation of gastroesophageal varices. J Am Soc Echocardiogr 1995;8:759–761.
  38. Kinkhabwala M, Mousavi A, Iyer S, Adamsons R: Bleeding ileal varicosity demonstrated by transhepatic portography. AJR Am J Roentgenol 1977;129:514–516.

Article / Publication Details

First-Page Preview
Abstract of Review Article

Published online: May 19, 2005
Issue release date: July 2005

Number of Print Pages: 7
Number of Figures: 5
Number of Tables: 2

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: https://www.karger.com/DDI

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.