Management of variceal bleeding In addition to pharmacologic therapy endoscopy should be carried out as soon as possible If varices are found they are treated with either endoscopic ligation or sclerotherapy EVL is the treatment of choice for variceal bleeding Endoscopic scleropathy Variceal bleeding suspected based on history ABC's and resuscitation Sta vasopressin or octreotide infusion Variceal bleeding confirmed on EGD Endoscopic band ligation (or scleropathy) If bleeding stopped - Vasopressin/octreotide for 3-5 days. Complete 7 days of antibiotics. Repeat endoscopic banding every 10-14 days until eliminated If bleeding didn't stop - Balloon tampon ade consider TIPS or surgical shunt if TIPS fails or not vavilable Ref: Sabiston 20th edition Pgno : 1444