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Refractory Variceal Bleeding — RACP Adult Medicine MCQ

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HardGastroenterologyRefractory Variceal BleedingRACP Adult Medicine

A 50-year-old man with known cirrhosis presents with massive haematemesis. Endoscopy reveals actively spurting oesophageal varices. Two sessions of EVL fail to control bleeding. BP is 80/50 mmHg despite resuscitation. What is the most appropriate next step?

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Correct answer: C — Balloon tamponade (Sengstaken-Blakemore tube)

When endoscopic therapy fails to control variceal bleeding (after two attempts), balloon tamponade (Sengstaken-Blakemore or Minnesota tube) is used as a bridge to definitive therapy (TIPS). This is a temporising measure only (maximum 24 hours) due to risk of oesophageal necrosis. Urgent TIPS should be arranged.

Reference: Gastroenterological Society of Australia – 2024 – Variceal Bleeding Guidelines