Advances in portal hypertension management: Evolution of the Baveno guidelines

Table 4 Prevention of recurrent bleeding from varices

Baveno version (reference), year of publication	First-line therapy	Alternative therapy	Rescue therapy (failure of first-line)	Gastric varices	Special considerations
I[8], 1992	Traditional NSBBs or sclerotherapy	No specific recommendation	Sclerotherapy, NSBBs, surgical shunt, and liver transplantation	Traditional NSBBs	Risk assessment debated
II[16], 1996	Traditional NSBBs or EBL	Combined therapy proposed but untested	TIPS or surgical shunts	No specific recommendation	Consider transplantation for advanced cirrhosis
III[17], 2000	Traditional NSBBs or EBL	EBL preferred in NSBB-intolerant patients; Combined therapy should be further investigated	TIPS or surgical shunts	No specific recommendation	Consider transplantation for advanced liver disease
IV[18], 2005	Traditional NSBBs + EBL	EBL preferred in NSBB-intolerant patients	TIPS or surgical shunts for Child-Pugh A/B patients; Liver transplantation for Child-Pugh B/C patients	IGV1, GOV2: N-butyl-cyanoacrylate, TIPS or NSBBs; GOV1: N-butyl-cyanoacrylate, EBL, NSBBs	Start prophylaxis by day 6
V[19], 2010	Traditional NSBBs + EBL	EBL preferred in NSBB-intolerant patients; The addition of ISMN to NSBBs for hemodynamic non-responders; Those who are unable or unwilling to be treated with EBL: NSBBs + ISMN	TIPS preferred; Surgical shunt in Child-Pugh A and B pts if TIPS is unavailable; Transplantation should be considered	IGV1, GOV2: N-butyl-cyanoacrylate or TIPS; GOV1: N-butyl-cyanoacrylate, EBL, NSBBs	TIPS as bridge to transplantation
VI[20], 2015	Traditional NSBBs + EBL	NSBB monotherapy if EBL contraindicated; EBL monotherapy only if intolerance/contraindications to NSBB	TIPS preferred	No specific recommendation	PHG has to be distinguished from GAVE because treatments are different
VII[1], 2022	Traditional NSBBs (including carvedilol) + EBL	Any therapy alone if intolerance the combination therapy	TIPS preferred	No specific recommendation	Argon plasma coagulation or hemospray were introduced for recurrent bleeding in PHG

APC: Argon plasma coagulation; EBL: Endoscopic band ligation; GAVE: Gastric antral vascular ectasia; GOVs: Gastroesophageal varices; IGVs: Intragastric varices; ISMN: Isosorbide mononitrate; NSBBs: Non-selective beta-blockers; PHG: Portal hypertensive gastropathy; TIPS: Transjugular intrahepatic portosystemic shunt.