What is your approach to secondary prophylaxis and post-discharge planning after an acute esophageal variceal bleed in a patient with ongoing alcohol use disorder and major social barriers (uninsured, homeless)?

Obviously, these questions are moot in the setting of an acute variceal bleeding when a life-saving TIPS becomes necessary; we then deal with these issues afterwards.

We frankly go as far as we can with medical/endoscopic therapy before considering TIPS as an option for repeated bleeding episodes, w...

Typically only consider TIPS if there is specific high risk given risk of severe HE and associated complications in patient with poor follow-up. Recommend early palliative care in the scenario you are describing. EGD should not be repeated until 4 weeks - too often or too soon risks banding ulcers a...