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Variceal Haemorrhage Secondary Prophylaxis — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyVariceal Haemorrhage Secondary ProphylaxisRACP Adult Medicine

A 55-year-old man with known cirrhosis presents with acute upper GI bleeding. He is haemodynamically stable after resuscitation. Endoscopy reveals grade III oesophageal varices with red wale signs but no active bleeding. Band ligation is performed. What long-term therapy should be commenced for secondary prophylaxis?

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Correct answer: C — Propranolol plus repeat band ligation

After variceal bleeding, secondary prophylaxis with BOTH non-selective beta-blocker (propranolol or carvedilol) AND repeat endoscopic band ligation (EVL) provides the best outcomes. EVL is repeated every 2–4 weeks until variceal obliteration. NSBB alone or EVL alone is inferior to the combination. Carvedilol is increasingly preferred over propranolol due to its additional anti-alpha-1 activity reducing portal pressure.

Reference: eTG – 2025 – Gastrointestinal; Baveno VII – 2022 – Portal Hypertension Consensus