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Prevention of early variceal rebleeding adding banding to terlipressin therapy
  1. Francesco Salerno,
  2. Massimo Cazzaniga
  1. Department of Internal Medicine, Policlinico IRCCS San Donato, Università di Milano, Italy
  1. Correspondence to Dr Francesco Salerno, Department of Internal Medicine, University of Milan, Policlinico IRCCS San Donato, Via Morandi, 30, 20097 San Donato Milanese (MI), Italy; francesco.salerno{at}unimi.it

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Bleeding from rupture of oesophageal varices is one of the most dreadful complications occurring in patients with cirrhosis.1 Therefore, many efforts have been made in pursuing new therapeutic strategies able to arrest variceal bleeding and prevent rebleeding. Over the last 20 years, these efforts allowed the reduction of the bleeding-related mortality of patients with cirrhosis from 40–50% to 15–20%.2 3 The result is good but still needs to be improved.

Mortality in patients with cirrhosis who bleed is closely related to failure either to control bleeding within the first 48 h or to prevent early rebleeding, which occurs within the first 5 days after the index bleeding episode has ceased.1 4 Most frequent causes of death are shock, terminal liver failure, renal failure, sepsis and multiorgan failure. In patients in whom the acute bleeding is arrested, the risk of developing one of these events is markedly increased by early rebleeding. For this reason, treatments which effectively prevent early rebleeding could also reduce in-hospital mortality.

The standard management of patients with cirrhosis with variceal haemorrhage includes adequate resuscitation, early administration of antibiotics to prevent bacterial infections, infusion of …

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