Esophageal Variceal Bleeding - Diagnosis and Management ...

Esophageal Variceal Bleeding - Diagnosis and Management Summary


Vasoactive agents - Octreotide: 

 • 50mcg bolus → 50mcg/hr infusion

 • Continue for 2-5 days, Can consider stopping 24h after hemostasis

Antibiotics - Ceftriaxone (or equivalent); 

 • 1g IV q24h, Duration = 7 days, Can transition to fluoroquinolone to complete course

Restrictive RBC transfusion threshold:

 • Goal Hgb 7-9 g/dL

PPI infusion - Commonly used adjunct to octreotide when unclear source (in case of PUD)


Endoscopic variceal ligation - EGD should be performed within 12 hours of presentation

Transjugular intrahepatic portosystemic shunt (TIPS)

 • Vasoactive agents can be discontinued following TIPS

 • Pre-TIPS evaluation (if feasible): TTE (evaluate R-sided cardiac function), Cross-sectional imaging (anatomy)


Surveillance EGD ~2 weeks after index procedure and every 2-4 weeks thereafter until eradication achieved

Non-selective ß-blocker:

 • Nadolol 20mg daily

 • Propranolol 10mg BID

 • Carvedilol 3.125mg BID

- Dr. Adam Winters @adam_c_winters

#Esophageal #Variceal #Bleeding #Diagnosis #Management #treatment #endoscopy #varices #hepatology
Contributed by

Dr. Gerald Diaz
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG: | Twitter:

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