Update on the management of refractory variceal bleeding

Received: August 10, 2020; Accepted: August 24, 2020; Published: August 31, 2020 Acute variceal bleeding (AVB) is seen in 50-70% of patients with cirrhosis & portal hypertension (PHT) [1]. Over the passage of time the severity of the variceal bleeding and complications related to it have significantly reduced. This reduction in complications is due to improvement in the clinical management, universal availability of vasopressor drugs, improved endoscopic therapies as well as due to availability of definitive treatment options such as trans jugular intra hepatic porto systemic shunt (TIPS) and liver transplantation. About 10-20% patients presenting with AVB do not respond to the initial management (defined as failure to control bleeding within 48 hrs) and develop re bleeding within 5 days of starting the therapy (after initial control of bleeding), these patients can be defined to have refractory variceal bleeding (Figure 2).