Esophageal or gastric varices

(4–20%)

(Clin Gastro Hepatol 2015;13:2109; J Gastro Hepatol 2016;31:1519; Hep 2017;65:310)

See “cirrhosis”

2° to portal HTN. If isolated gastric → r/o splenic vein thrombosis.

Pharmacologic

• Start octreotide pending EGD if suspect varices: Rx for 2–5 d

• Abx: 20% cirrhotics p/w GIB have infxn, & ~50% develop infxn during hospitalization;

ppx antibiotics w/ IV

CTX, cipro, or levoflox × 7 d

Nonpharmacologic

* Esophageal varices:

endoscopic band ligation (>90% success). Covered esophageal stent placement or balloon tamponade if refractory as bridge to TIPS (consider early espec. if Child-Pugh score C).

• Gastric varices: arteriography w/ coiling, or if available, endoscopic injection of cyanoacrylate (glue). If refractory: TIPS or balloon-retrograde transvenous obliteration (BRTO).