What is the long-term outlook (prognosis) for people with bleeding esophageal varices?

Bleeding esophageal varices is life-threatening and can be fatal in up to 50% of patients. People who have had an episode of bleeding esophageal varices are at risk for bleeding again.

Treatment with variceal ligation is effective in controlling first-time bleeding episodes in about 90% of patients. But, about half of patients treated for bleeding varices with variceal ligation will have another episode of bleeding within 1 to 2 years. Medication and lifestyle changes can help reduce the risk of recurrence.

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.

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.

Liver transplant many be an option for patients who have severe cirrhosis and/or repeated episodes of bleeding varices. Liver transplant is only performed at selected centers around the country that meet very strict criteria.

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