Gastroesophageal varices: prevention of bleeding and rebleeding.

Nonselective beta-adrenergic blockers (propranolol and nadolol) are effective in preventing initial variceal hemorrhage, although their influence on improving survival is less dramatic. There is no role for either sclerotherapy or prophylactic portosystemic shunts for the prevention of initial variceal hemorrhage. Both endoscopic therapy (sclerotherapy, esophageal variceal ligation) and nonselective beta-adrenergic blockers are effective in reducing the risk of recurrent bleeding related to portal hypertension; however, there are significant numbers of failures with both approaches, and the effect on survival is less impressive. Randomized controlled trials evaluating each of these therapeutic options are reviewed in this article.