How are esophageal varices treated?
The goals of treatment are to:
- Prevent more liver damage.
- Prevent varices from bleeding.
- Control bleeding if it occurs.
Preventing liver damage
People who have liver disease need to avoid toxins that cause additional stress on the liver and more damage to it. Some suggestions for maintaining a healthier liver include:
- Avoid alcoholic beverages of any kind.
- Limit use of household cleaners and chemicals.
- Eat a healthier diet that is low in fat and high in fruits and vegetables, whole grains and lean proteins.
- Maintain a healthy body weight (excess body fat puts stress on the liver).
Medications to reduce blood pressure in the portal vein can reduce the risk of bleeding. The most commonly used medications are a group called beta blockers. These include propranolol (Inderal®), nadolol (Corgard®) and carvedilol (Coreg®).
Patients with a high risk of bleeding may undergo preventive treatment with the same techniques that are used to stop bleeding. The most commonly used technique is variceal ligation.
Bleeding from esophageal varices is an emergency that requires immediate treatment. In the hospital, patients receive large amounts of fluid and blood to replace what has been lost.
Two different, non-surgical treatments are available to stop variceal bleeding--variceal ligation performed through an endoscope, and transjugular intrahepatic portosystemic shunt (TIPS) done by a radiologist using x-ray.
- Variceal ligation: In this procedure, tiny elastic bands are wrapped around the varices to cut off blood flow through the varices. This can be performed on as many veins as necessary in one session. After the bleeding is controlled, patients may be given a drug to prevent bleeding from starting again. Variceal ligation should be repeated every 4 weeks until varices have stopped bleeding. An upper endoscopy should be repeated every 6 to 12 months thereafter to make sure no varices have reoccurred. Complications associated with variceal ligation include blood loss, puncture of the esophagus, difficulty swallowing, abnormal heartbeat, infection, fever and reduced or shallow breathing rate. All of these complications are rare.
- Transjugular intrahepatic portal-systemic shunting (TIPS): This is a procedure to reduce portal blood pressure that can be used in patients who have esophageal varices that bleed due to severe cirrhosis. A small, thin tube called a catheter is inserted into a vein in the neck. The catheter is passed through the body to the liver where the hepatic and portal veins are close. (The hepatic vein carries blood from the liver back to the heart.) Next, a wire is passed through the catheter. It is used to poke through the hepatic vein to the portal vein. The wire is removed and a stent (a tiny wire coil) is passed through the catheter to the connection site. The stent is placed in the new channel between the portal and hepatic veins. The stent holds the connection site open so blood can flow more easily from the portal vein to the hepatic vein and exit the liver. This reduces the pressure in the portal vein, which reduces the pressure in the varices, which reduces their risk of bleeding. TIPS can be very effective in preventing bleeding, but it also can cause serious complications, particularly in patients with advanced liver disease, including confusion and liver failure.