Complications
Patients with acute variceal bleeding have a high risk of severe bacterial infection, including spontaneous bacterial peritonitis. They should be treated with short-term prophylactic antibiotics (e.g., ceftriaxone). Prophylactic antibiotics reduce the rate of bacterial infection, treatment failure, rebleeding, and mortality.[6][29]
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See Management recommendations.
Patients with portal hypertension who develop gastrointestinal bleeding from any aetiology, but most commonly from oesophageal varices, often develop hepatic encephalopathy (HE). The incidence of HE in the 2 years after transjugular intrahepatic portosystemic shunt (TIPS) placement is up to 55%.[83]
Following endoscopic variceal band ligation (EVBL), bleeding may occur when the bands fall off. As a result, repeat EVBL is often necessary. If bleeding continues despite repeated procedures, more definitive treatment, typically with trans-jugular intrahepatic porto-systemic shunt (TIPS), is recommended.[55]
The placement of bands or sclerosing agents often leads to fibrosis in the lower oesophagus. In some cases this may lead to narrowing of the oesophagus and development of an oesophageal stricture.
The risk of bleeding in patients with medium to large varices is 15% per year.[4]
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