Which procedure is used for refractory esophageal variceal bleeding to decrease portal hypertension?

Which procedure is used for refractory esophageal variceal bleeding to decrease portal hypertension?

• A. Endoscopic band ligation
• B. Transjugular intrahepatic portosystemic shunt (TIPS)
• C. Laparoscopic cholecystectomy
• D. Esophageal dilation

Answer: (B)

Reducing portal hypertension to control esophageal variceal bleeding when standard endoscopic measures fail. In portal hypertension, varices form and can bleed severely. Endoscopic band ligation is effective for many initial bleeds, but when bleeding is refractory to such therapy, decreasing the pressure driving blood into the varices is the key goal. A transjugular intrahepatic portosystemic shunt provides that by creating a channel inside the liver that connects the portal venous system to the hepatic venous system. This shunt diverts blood away from the high-pressure portal circulation, lowering portal venous pressure, decompressing the varices, and thereby reducing the risk of recurrent hemorrhage. It’s especially used as a rescue therapy in refractory cases or as a bridge to transplantation. The other options don’t address portal hypertension. Endoscopic band ligation is a frontline treatment for active variceal bleeding but isn’t sufficient when bleeding is refractory. Laparoscopic cholecystectomy targets gallbladder disease, not variceal bleeding. Esophageal dilation treats strictures, not variceal bleeding or portal hypertension.

Reducing portal hypertension to control esophageal variceal bleeding when standard endoscopic measures fail. In portal hypertension, varices form and can bleed severely. Endoscopic band ligation is effective for many initial bleeds, but when bleeding is refractory to such therapy, decreasing the pressure driving blood into the varices is the key goal. A transjugular intrahepatic portosystemic shunt provides that by creating a channel inside the liver that connects the portal venous system to the hepatic venous system. This shunt diverts blood away from the high-pressure portal circulation, lowering portal venous pressure, decompressing the varices, and thereby reducing the risk of recurrent hemorrhage. It’s especially used as a rescue therapy in refractory cases or as a bridge to transplantation.

The other options don’t address portal hypertension. Endoscopic band ligation is a frontline treatment for active variceal bleeding but isn’t sufficient when bleeding is refractory. Laparoscopic cholecystectomy targets gallbladder disease, not variceal bleeding. Esophageal dilation treats strictures, not variceal bleeding or portal hypertension.