Management of acute variceal hemorrhage

TIPS: transjugular intrahepatic portosystemic shunt; CTP: Child-Turcotte-Pugh.
* Temporizing measures to acutely control hemorrhage include balloon tamponade and endoscopic esophageal covered stent placement (for patients with uncontrolled bleeding despite endoscopic therapy). Balloon tamponade is associated with significant complications and rebleeding upon balloon deflation. If balloon tamponade is chosen, the patient should be intubated prior to balloon placement.
¶ CTP class C cirrhosis or CTP class B with active bleeding at time of endoscopy.
Δ If bleeding is modest, repeat endoscopic therapy may be attempted.