A 60-year-old man with alcohol-related cirrhosis undergoes surveillance endoscopy which reveals large esophageal varices with red wale marks but has never bled. According to Baveno VII criteria, what is the recommended primary prophylaxis?

• A Emergency band ligation only if bleeding occurs
• B Octreotide infusion for 5 days
• C Transjugular intrahepatic portosystemic shunt (TIPS)
• D Non-selective beta-blockers (propranolol) or endoscopic band ligation ✓

Explanation

Primary prophylaxis of variceal bleeding is indicated for medium or large varices (or small varices in Child-Pugh C). Either non-selective beta-blockers (propranolol, nadolol, carvedilol) or endoscopic variceal ligation is effective. Band ligation is preferred if beta-blockers are contraindicated. TIPS is reserved for secondary prophylaxis or acute refractory bleeding. Octreotide is used in acute bleeding, not prophylaxis. Band ligation reduces bleeding risk from approximately 30% to around 15% in 2 years.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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