On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (Live and Virtual)| September 2026-Patel AGSE Bleeding Varices 2026

Patel AGSE Bleeding Varices 2026

Pdf Summary

This document reviews current approaches to <strong>acute variceal hemorrhage</strong> management, focusing on both <strong>esophageal</strong> and <strong>gastric</strong> varices.

Key clinical reminders include that acute bleeding may be triggered by <strong>thrombosis, tumor, or alcohol</strong>, with <strong>6-week mortality of 15–20%</strong> and the <strong>highest rebleeding risk in the first 5 days</strong>. High-risk features for rebleeding include <strong>Child-Pugh C</strong>, <strong>active bleeding at endoscopy</strong>, <strong>portal pressure gradient ≥20 mmHg</strong>, and <strong>acute kidney injury</strong>. Before endoscopy, patients should receive <strong>vasoactive drugs immediately for 2–5 days</strong>, <strong>antibiotic prophylaxis</strong>, treatment of <strong>encephalopathy</strong>, <strong>transfusion to hemoglobin 7 g/dL</strong>, and <strong>airway protection when needed</strong>.

For <strong>esophageal varices</strong>, first-line endoscopic therapy is <strong>band ligation</strong>, applied carefully to the largest or most high-risk columns, starting at the gastroesophageal junction and avoiding circumferential banding. If bleeding persists, options include <strong>repeat endoscopy</strong>, <strong>sclerotherapy</strong>, <strong>tamponade</strong> with balloon devices, <strong>esophageal stenting</strong>, or <strong>TIPS</strong>, depending on availability and patient factors.

For <strong>gastric varices</strong>, management depends on varix type and portal/shunt anatomy. Treatment options include <strong>cyanoacrylate glue injection</strong>, <strong>EUS-guided coil embolization with or without glue</strong>, and <strong>interventional radiology therapies</strong>. The document highlights that EUS-guided therapy may reduce embolization risk and improve obliteration.

<strong>Hemostatic powders</strong> are not standard guideline therapy and are generally not recommended for variceal bleeding, though they may be used selectively in emergencies.

Finally, the presentation emphasizes the importance of having a <strong>prepared plan</strong>, keeping <strong>variceal kits</strong> available, using the <strong>first intervention as the best intervention</strong>, and involving <strong>advanced endoscopy and interventional radiology early</strong>.

Keywords

acute variceal hemorrhage

esophageal varices

gastric varices

band ligation

cyanoacrylate glue

EUS-guided coil embolization

TIPS

vasoactive drugs

antibiotic prophylaxis

rebleeding risk