Acute esophageal variceal
hemorrhage (AEVH) is a severe complication of
portal hypertension. Its management has rapidly evolved in recent years. Traditional methods included
vasoconstrictor and balloon tamponade.
Vasoconstrictors were shown to control approximately 80% of the
bleeding episodes and are generally used as a first-line
therapy. Following the use of
vasoconstrictors, endoscopic
therapy is often used to arrest the
bleeding varices and prevent early rebleeding. A meta-analysis showed that the combination of
vasoconstrictor and endoscopic
therapy is superior to endoscopic
therapy alone for controlling AEVH. Balloon tamponade may be used to achieve temporary control of the
hemorrhage in case of severe
bleeding. A transjugular intrahepatic portosystemic
stent shunt may be needed in patients with refractory acute variceal
hemorrhage. Surgical intervention is now widely contraindicated during acute variceal
hemorrhage, except for patients with good liver reserve. Conversely, apart from the control of acute variceal
hemorrhage, prophylactic
antibiotics were shown to be helpful in the prevention of
bacterial infection and to prevent early variceal rebleeding. With the introduction of new treatment modalities and the measures taken to manage patients with AEVH, the mortality due to AEVH has significantly decreased in recent years.