Long-term endoscopic management of variceal bleeding.

Recurrent hemorrhage from esophageal varices is a major source of morbidity and mortality in patients with portal hypertension. Esophageal sclerotherapy (EST) and more recently esophageal band ligation (EVL) can obliterate varices in 3-6 treatment sessions. Multiple band ligators make the use of overtubes unnecessary and make the procedure faster and more tolerable for the patient. EVL has several advantages, including fewer complications, fewer treatment sessions to obliteration, lower rebleeding rates, and lower mortality as compared to EST; the other advantages of EVL make it the treatment of choice for bleeding varices and long term management. The recommendations and rational for long term EST and EVL are presented and combination therapy and EUS guided EVL are discussed.