A 50-year-old male with a history of alcohol use presents with sudden hematemesis and melena. Vital signs: BP 85/50 mmHg, HR 122 bpm. Physical examination reveals spider angiomas, palmar erythema, and splenomegaly. Following fluid resuscitation and initiation of IV octreotide and ceftriaxone, upper endoscopy demonstrates actively spurting esophageal varices. What is the endoscopic intervention of choice?

Answer and explanation

Correct answer: D. Endoscopic Variceal Ligation (Banding)

  1. Step 1: Endoscopic Variceal Ligation (EVL / Banding) is the gold standard endoscopic treatment for bleeding esophageal varices.
  2. Step 2: EVL has superior efficacy in controlling bleeding, lower rebleeding rates, and significantly fewer complications (such as esophageal strictures and perforations) compared to endoscopic sclerotherapy.
  3. Step 3: Balloon tamponade is a temporary bridge (< 24 hours) for uncontrollable bleeding, and TIPS is rescue therapy for endoscopic failures.
Answer
Endoscopic Variceal Ligation (Banding).
Why not the others: 'Endoscopic sclerotherapy' has higher rebleeding and complication rates; 'Sengstaken-Blakemore balloon' is a temporary rescue bridge, not definitive therapy; 'Immediate TIPS without endoscopy' is premature before an endoscopic attempt.

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