Endoscopic management of esophageal variceal hemorrhage: injection, banding, glue, octreotide, or a combination?

Bleeding from esophageal varices presents a considerable challenge to clinicians. Adequate fluid resuscitation must be undertaken before urgent endoscopy. Pharmacotherapy of acute variceal hemorrhage consists of either vasopressin plus nitroglycerin or intravenous octreotide. Vasopressin should not be used alone because of a high incidence of side effects such as cardiac and/or visceral ischemia. Band ligation appears superior to sclerotherapy primarily because of decreased rebleeding from varices and decreased esophageal stricture formation among patients undergoing band ligation. Future trials with newer sclerosant agents, such as cyanoacrylate, are anxiously awaited.