Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 38: I Just Banded Actively Bleeding Varices In A Patient With Known Cirrhosis. The Patient Is Now Hemodynamically Stable. Is There Anything Else I Should Recommend? (continued)

Nagib Toubia, MD; Adil Habib, MD; Douglas M. Heuman, MD

Variceal bleeding is one of the mosst dramatic and catastrophic problems encountered in the practice of gastroenterology. Achieving initial hemostasis can be a daunting task. The endoscopist has to manage shock and protect the airway while attempting to visualize and ligate pulsing varices immersed in a pool of blood. If you have been able to achieve band ligation and the bleeding has stopped, congratulations—the worst may be over. But you are not quite done yet. Additional short-term measures to consider in this patient are pharmacologic reduction of portal pressure, antibiotic…