Non-surgical treatment of variceal bleeding.

Variceal bleeding is still one of the key therapeutic problems inpatients with portal hypertension. Vasoactive drugs for the treatment of acute hemmorrhage as well as for the prevention of first and recurrent bleeding have been shown to be effective, in some situations as effective as endoscopic sclerotherapy. In recent years, endoscopic band ligation has replaced sclerotherapy for the prevention of rebleeding and become the new nonsurgical standard in this situation. Furthermore, the transjugular, intrahepatic, portosystemic stent shunt (TIPS) has gained widespread acceptance as a salvage procedure for acute bleeders unresponsive to other treatments as well as the second line approach to failures of chronic endoscopic or drug therapy for prevention of rebleeding. Primary prophylaxis is still the domain of beta-blockers or/and long-acting nitrates.