https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840220145

The treatment of portal hypertension: A meta-analytic review

These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool.The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage; (3) secondary prophylaxis of variceal haemorrhage; and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions.

https://gut.bmj.com/content/gutjnl/64/11/1680.full.pdf

UK guidelines on the management of variceal haemorrhage in cirrhotic patients

Background. Endoscopic sclerotherapy is an accepted treatment for bleeding esophageal varices, but it is associated with substantial local and systemic complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, may be safer. We compared the effectiveness and safety of the two techniques. Methods. In this randomized trial we compared endoscopic sclerotherapy and endoscopic ligation in 129 patients with cirrhosis who had proved bleeding from esophageal varices. Sixty-five patients were treated with sclerotherapy, and 64 with ligation. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications and recurrences of bleeding, the number of treatments needed to eradicate varices, and survival. Results. Active bleeding at the first treatment was controlled by sclerotherapy in 10 of 13 patients (77 percent) and by ligation in 12...

https://www.nejm.org/doi/pdf/10.1056/NEJM199206043262304

Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.

https://www.liver.theclinics.com/article/S1089-3261(05)70186-0/pdf

Natural history of portal hypertension in patients with cirrhosis.

Objective: Comparison of the safety and efficacy of endoscopic sclerotherapy and ligation for the treatment of bleeding esophageal varices. Design: Randomized, controlled trial. Setting: An urban c...

Endoscopic ligation compared with sclerotherapy for the treatment of bleeding esophageal varices

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840050410

Suyenori Yamada

Papers

A prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy.