How to prevent recurrent variceal haemorrhage?

First-line therapy for the prevention of recurrent variceal haemorrhage is the combination of traditional non-selective beta blockers or carvedilol and endoscopic variceal ligation (EVL).

TIPS is the treatment of choice in patients who rebleed despite traditional NSBBs or carvedilol and EVL.

In patients who cannot get/tolerate EVL or carvedilol or traditional NSBBs, any of these therapies can be maintained alone and TIPS should be considered in patients with recurrent ascites.

In patients who bleed despite adherence to traditional NSBBs or carvedilol as primary prophylaxis, the combination of traditional NSBBs or carvedilol and EVL is recommended, and TIPS should be considered in those with recurrent ascites.

References:

Corrigendum to ‘Baveno VII – Renewing consensus in portal hypertension’ [J Hepatol (2022) 959-974] Journal of Hepatology, Vol. 77, Issue 2