Which is an initial definitive intervention for acute esophageal variceal bleeding?

• A. Balloon tamponade
• B. TIPS
• C. Endoscopic band ligation
• D. Endoscopic injection sclerosant

Answer: (C)

When treating acute esophageal variceal bleeding, the priority is to stop the bleed quickly through definitive therapy that directly addresses the varices, while also stabilizing the patient. Endoscopic band ligation is the best option here because it mechanically occludes the bleeding varices by placing rubber bands around them, leading to rapid hemostasis and obliteration of the variceal channels. It has high initial success in stopping the bleed and lowers the risk of rebleeding and mortality compared with other endoscopic methods.

Balloon tamponade is a temporizing measure used when bleeding cannot be controlled promptly and serves as a bridge to more definitive therapy; it carries significant risks, such as airway obstruction and esophageal injury, so it’s not a definitive treatment. Transjugular intrahepatic portosystemic shunt (TIPS) decreases portal pressure and is reserved for patients whose bleeding is refractory to endoscopic therapy or who are high-risk candidates for transplantation soon; it’s not the first-line definitive intervention. Endoscopic injection sclerosant was used in the past but is less favored now due to lower efficacy and more complications than band ligation.

So, endoscopic band ligation directly and effectively stops the variceal bleed as the primary definitive intervention in this scenario.