Endoscopic Treatment of Portal Hypertension and Its Complications

Endoscopic therapy is a key component in the management algorithm for variceal and nonvariceal hemorrhage related to portal hypertension. Band ligation is the endoscopic treatment of choice for acute esophageal variceal bleeding, and for preventing a first episode of bleeding (primary prophylaxis) and rebleeding (secondary prophylaxis). In contrast, endoscopic cyanoacrylate injection is the preferred modality for cardio-fundal variceal bleeding. Thrombin injection and endoscopic ultrasound guided angiotherapy are alternative treatment options for gastric variceal obliteration. The management of ectopic varices requires a multidisciplinary approach, and the choice of therapy is dictated, in part, by location of varices, vascular anatomy, and available expertise. Endoscopic therapy is of limited value for the control of chronic blood loss from portal hypertensive gastropathy but is at the forefront in the management of gastric antral vascular ectasia associated with portal hypertension, which includes argon plasma coagulation, band ligation, and radiofrequency ablation.