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Liver Diseases pp 617-626 | Cite as

Endoscopic and Pharmacological Treatment of Esophageal Varices

  • Antonio Facciorusso
  • Rosario Vincenzo Buccino
  • Nicola Muscatiello
Chapter

Abstract

Bleeding from gastroesophageal varices (GEV) represents a potentially lethal complication of liver cirrhosis. Currently gastroscopy is the milestone as a screening test for varices and it is routinely offered once the diagnosis of cirrhosis is confirmed; however, non-invasive elastography techniques offer valuable alternatives and may help to discriminate patients at high risk of developing GEVs and first episode of bleeding from low-risk subjects.

Non-selective beta-blockers (NSBBs) and terlipressin represent the most commonly used pharmacological agents for prevention and management of acute bleeding, respectively. However, novel evidence suggest beneficial effects with the use of other molecules such as carvedilol or simvastatin.

Endoscopic band ligation is the most effective endoscopic treatment in the setting of either acute bleeding and primary/secondary prevention and it has nearly completely replaced sclerotherapy in the clinical practice.

Aim of this chapter is to provide an overview on recent improvements and latest developments concerning the pharmacological and endoscopic treatment of esophageal varices, particularly based on the most robust evidence-based findings.

Keywords

Cirrhosis EVBL Sclerotherapy NSBB TIPS 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Antonio Facciorusso
    • 1
  • Rosario Vincenzo Buccino
    • 1
  • Nicola Muscatiello
    • 1
  1. 1.Gastroenterology Unit, Department of Medical SciencesUniversity of FoggiaFoggiaItaly

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