The role of stenting in patients with variceal bleeding

Uncontrolled acute variceal hemorrhage due to failure of standard endoscopic therapy increases the risk of decompensation of liver disease and multiorgan failure leading to death. In this article, we aim to provide a structured and comprehensive review of the management of variceal bleeding by the use of self-expanding metal stent(s) (SEMS). The intricacies of the appropriate patient and stent selection, technicality of stent placement, deployment, and follow-up will be discussed. Furthermore, certain stent models with unique delivery system that eliminates the need of endoscopic or radiographic guidance will be reviewed. While patients with uncontrolled acute variceal hemorrhage are at a very high risk of adverse events, SEMS complications and the steps to prevent them will also discussed. As a vast majority of these cases represent advanced liver disease, liver transplant is ultimately required, thus, making SEMS an effective bridge to definitive therapy.