Primary Prophylaxis of Variceal Bleeding in Liver Cirrhosis

Variceal hemorrhage is a life-threatening complication of portal hypertension. Prevalence of gastroesophageal varices may reach 70% in patients with advanced liver disease; therefore prophylaxis of variceal bleeding is recommended for this population. Indications for primary prophylaxis include presence of large esophageal varices, presence of high-risk stigmata, and/or Child-Turcotte-Pugh class C in patients with small varices. Nonselective beta-blockers (NSBB) and endoscopic variceal band ligation are the cornerstone for prevention of first variceal bleeding. Although NSBB are preferred on patients with small esophageal varices and high-risk features, the decision should be individualized and contraindications and potential adverse effects of both therapies should be considered.