Question:
Which one of the following treatment modalities is NOT used for the management of acute blood loss due to ruptured oesophageal varices?
Which one of the following treatment modalities is NOT used for the management of acute blood loss due to ruptured oesophageal varices?
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Separate drugs and procedures that act within minutes from ones meant for long-term prevention.
Updated On: Jul 16, 2026
- Endoscopic sclerotherapy
- Endoscopic band ligation
- Octreotide
- Propranolol
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The Correct Option is D
Solution and Explanation
Step 1: Understanding the Question:
The question asks which of the listed treatments is NOT used in the acute setting of a bleeding oesophageal varix, as opposed to long-term prevention of bleeding.
Step 2: Key Concept or Approach:
Acute variceal bleeding is a medical emergency treated with measures that stop bleeding quickly and lower portal pressure within minutes to hours, such as endoscopic therapy and vasoactive drugs. Propranolol, a non-selective beta-blocker, is used for chronic prophylaxis, reducing portal pressure gradually over days to weeks, and it is not given during an active bleed because its blood-pressure-lowering effect can worsen the haemodynamic instability of an actively bleeding patient.
Step 3: Working Through the Options:
Endoscopic sclerotherapy directly injects a sclerosing agent into the bleeding varix to stop haemorrhage acutely. Endoscopic band ligation mechanically strangulates the varix with a rubber band and is now the preferred first-line endoscopic technique for acute bleeding. Octreotide, a somatostatin analogue, is given as an infusion to reduce splanchnic blood flow and portal pressure rapidly, buying time for endoscopy. Propranolol takes days to lower portal pressure meaningfully and its hypotensive effect is undesirable during active haemorrhage, so it plays no role in the acute episode; its place is in preventing the first bleed or a rebleed once the patient is stable.
Step 4: Conclusion:
Propranolol is NOT used for the management of acute bleeding from ruptured oesophageal varices.
The question asks which of the listed treatments is NOT used in the acute setting of a bleeding oesophageal varix, as opposed to long-term prevention of bleeding.
Step 2: Key Concept or Approach:
Acute variceal bleeding is a medical emergency treated with measures that stop bleeding quickly and lower portal pressure within minutes to hours, such as endoscopic therapy and vasoactive drugs. Propranolol, a non-selective beta-blocker, is used for chronic prophylaxis, reducing portal pressure gradually over days to weeks, and it is not given during an active bleed because its blood-pressure-lowering effect can worsen the haemodynamic instability of an actively bleeding patient.
Step 3: Working Through the Options:
Endoscopic sclerotherapy directly injects a sclerosing agent into the bleeding varix to stop haemorrhage acutely. Endoscopic band ligation mechanically strangulates the varix with a rubber band and is now the preferred first-line endoscopic technique for acute bleeding. Octreotide, a somatostatin analogue, is given as an infusion to reduce splanchnic blood flow and portal pressure rapidly, buying time for endoscopy. Propranolol takes days to lower portal pressure meaningfully and its hypotensive effect is undesirable during active haemorrhage, so it plays no role in the acute episode; its place is in preventing the first bleed or a rebleed once the patient is stable.
Step 4: Conclusion:
Propranolol is NOT used for the management of acute bleeding from ruptured oesophageal varices.
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