Prevention of recurrent XXXX : non-surgical procedures.

@entity1 @entity1169 @entity82 @entity548 @entity409 @entity360
@entity1 with @entity82 , who have survived an episode of @entity548 , often have far-advanced @entity409 and therefore, on average, a severely restricted life expectancy. Still, the prognosis for the individual @entity1 varies greatly depending on the presence or absence of large varices and the @entity1 classification. Centres evaluating @entity548 often attract different @entity1 populations. Comparison of the outcome of the complete series of @entity1 is usually meaningless since results reflect the composition of the @entity1 population rather than the applied therapy. The natural history of @entity1 with @entity548 should be defined by @entity1 category, allowing more precise definition of the therapeutic aims and subsequently assessment of the results. Persistent lowering of the portal pressure by pharmacological modulation of the portal haemodynamic system is now feasible due to the availability of long-acting oral medication. @entity1169 is still the leading drug and, in one centre, its use in predominantly @entity1 A @entity1 was associated with a marked reduction in recurrent @entity360 and subsequently mortality rate. These results could not be reproduced in another centre. Both the restricted indication as well as the uncertain efficacy limit the current use of @entity1169 , but further pharmacological developments are bound to appear. Endoscopic sclerotherapy has become the treatment of choice in the prevention of recurrent @entity548 . The proponents of paravasal injection report excellent efficacy in combination with a low incidence of side-effects, whereas mainly theoretical reasons are advanced by users of intravariceal injections. Still, @entity548 remains an important clinical problem in the period between the start of sclerotherapy and the eradication of varices. Combination of sclerotherapy with portal antihypertensive medication might become the treatment of choice until eradication of varices has been achieved; thereafter either continued medication or repeated endoscopy will maintain an avariceal state and effective prevention of recurrent @entity548 .
