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Early control of bleeding is paramount and traditionally has taken the form of endoscopic therapy to mechanically reduce variceal blood flow, or vasoactive drugs that decrease splanchnic and/or azygous blood flow. Although sclerotherapy has been shown to reduce bleeding compared with placebo,1 it results in more frequent adverse events than medical interventions2 and has largely been superseded by variceal band ligation. Indeed ligation has been shown to reduce rebleeding and mortality compared with sclerotherapy and is the current gold standard for acute bleeding and secondary prophylaxis.3 A recent evaluation combining the two endoscopic modalities demonstrated no benefit over ligation alone in preventing rebleeding or mortality.4 The systematic review by Banares et al suggests a potential benefit from combining vasoactive drugs with endoscopic therapy with improved initial endoscopic control of bleeding and five day haemostasis, albeit with no reduction in mortality. 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Early control of bleeding is paramount and traditionally has taken the form of endoscopic therapy to mechanically reduce variceal blood flow, or vasoactive drugs that decrease splanchnic and/or azygous blood flow. Although sclerotherapy has been shown to reduce bleeding compared with placebo,1 it results in more frequent adverse events than medical interventions2 and has largely been superseded by variceal band ligation. Indeed ligation has been shown to reduce rebleeding and mortality compared with sclerotherapy and is the current gold standard for acute bleeding and secondary prophylaxis.3 A recent evaluation combining the two endoscopic modalities demonstrated no benefit over ligation alone in preventing rebleeding or mortality.4 The systematic review by Banares et al suggests a potential benefit from combining vasoactive drugs with endoscopic therapy with improved initial endoscopic control of bleeding and five day haemostasis, albeit with no reduction in mortality. This is a high quality systematic review with assessment of the quality of all included …" /> <meta name="og-title" property="og:title" content="All that glitters is not gold" /> <meta name="og-url" property="og:url" content="https://gut.bmj.com/content/51/5/623" /> <meta name="og-site-name" property="og:site_name" content="Gut" /> <meta name="og-description" property="og:description" content="Addition of vasoactive drug therapy improved the effectiveness of injection sclerosis or band ligation for acute variceal bleeding but failed to produce a significant reduction in mortality Initial presentation with variceal bleeding is associated with a 20–30% risk of mortality within the first two weeks. Early control of bleeding is paramount and traditionally has taken the form of endoscopic therapy to mechanically reduce variceal blood flow, or vasoactive drugs that decrease splanchnic and/or azygous blood flow. Although sclerotherapy has been shown to reduce bleeding compared with placebo,1 it results in more frequent adverse events than medical interventions2 and has largely been superseded by variceal band ligation. Indeed ligation has been shown to reduce rebleeding and mortality compared with sclerotherapy and is the current gold standard for acute bleeding and secondary prophylaxis.3 A recent evaluation combining the two endoscopic modalities demonstrated no benefit over ligation alone in preventing rebleeding or mortality.4 The systematic review by Banares et al suggests a potential benefit from combining vasoactive drugs with endoscopic therapy with improved initial endoscopic control of bleeding and five day haemostasis, albeit with no reduction in mortality. 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class="panel-separator"></div><div class="panel-pane pane-highwire-article-citation col-mobile-10 col-narrow-10 col-normal-11 article-title" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node147880" data-node-nid="147880" id="node-147880--21350245917" data-pisa="gutjnl;51/5/623" data-pisa-master="gutjnl;51/5/623" data-apath="/gutjnl/51/5/623.atom"><cite class="highwire-cite highwire-cite-highwire-article highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">All that glitters is not gold</div> <span class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="gutjnl;51/5/623" data-atom-uri="/gutjnl/51/5/623.atom" data-request-view="full"></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div 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class="name">R Jalan</span></li></ol><ol class="affiliation-list"><li class="aff"><address>Liver Failure Group, Institute of Hepatology, University College London, London, UK</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label"></span>Correspondence to:<br/> Dr R Jalan, Liver Failure Group, Institute of Hepatology, University College London, 69–75 Chenies Mews, London WC1E 6HX, UK;<br/> <span class="em-link"><span class="em-addr">r.jalan{at}ucl.ac.uk</span></span></li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-1" > <div class="pane-content"> <p><a 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You will be able to get a quick price and instant permission to reuse the content in many different ways.</p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-ajax-pane-content permissions-box pane-highwire-permission-link" id="request-permissions"> <h2 class="pane-title"><span class='panels-ajax-pane-title' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></span></h2> <div class="pane-content"> <div class='panels-ajax-pane panels-ajax-pane-new-70fd4c70-563e-4b94-ae3b-2a97f3980c13' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article extract-view"><span class="highwire-journal-article-marker-start"></span><ul class="kwd-group KWD"><li class="kwd"><a href="/keyword/endoscopy" class="hw-term hw-article-keyword hw-article-keyword-endoscopy" rel="nofollow">endoscopy</a></li><li class="kwd"><a href="/keyword/variceal-bleeding" class="hw-term hw-article-keyword hw-article-keyword-variceal-bleeding" rel="nofollow">variceal bleeding</a></li><li class="kwd"><a href="/search/%20text_abstract_title%3Avasoactive%2Bdrugs%20text_abstract_title_flags%3Amatch-phrase%20sort%3Apublication-date" class="hw-term hw-article-keyword hw-article-keyword-vasoactive-drugs" rel="nofollow">vasoactive drugs</a></li></ul><div class="section notes arthw-remark" id="notes-1"> <p id="p-1">Addition of vasoactive drug therapy improved the effectiveness of injection sclerosis or band ligation for acute variceal bleeding but failed to produce a significant reduction in mortality</p> </div><p id="p-2">Initial presentation with variceal bleeding is associated with a 20–30% risk of mortality within the first two weeks. Early control of bleeding is paramount and traditionally has taken the form of endoscopic therapy to mechanically reduce variceal blood flow, or vasoactive drugs that decrease splanchnic and/or azygous blood flow. Although sclerotherapy has been shown to reduce bleeding compared with placebo,<sup>1</sup> it results in more frequent adverse events than medical interventions<sup>2</sup> and has largely been superseded by variceal band ligation. Indeed ligation has been shown to reduce rebleeding and mortality compared with sclerotherapy and is the current gold standard for acute bleeding and secondary prophylaxis.<sup>3</sup> A recent evaluation combining the two endoscopic modalities demonstrated no benefit over ligation alone in preventing rebleeding or mortality.<sup>4</sup></p><p id="p-3">The systematic review by Banares <em>et al</em> suggests a potential benefit from combining vasoactive drugs with endoscopic therapy with improved initial endoscopic control of bleeding and five day haemostasis, albeit with no reduction in mortality. 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