What is the emergency procedure indicated after variceal ligation if bleeding continues?

After variceal ligation, if bleeding continues, the recommended emergency procedure is the Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure. TIPS is a minimally invasive procedure that creates a shunt between the portal and systemic circulation, which helps reduce portal pressure. This reduction in pressure can effectively decrease the risk of further bleeding from esophageal varices, which are often a complication of portal hypertension seen in patients with liver cirrhosis.

In cases where variceal ligation is insufficient to control bleeding, TIPS provides an alternative means of managing the complications of portal hypertension. It directly alleviates the pressure that leads to the formation and potential rupture of varices. This is critical in emergency settings where timely management of continued bleeding is essential to prevent severe morbidity or mortality.

Other procedures like variceal resection are not commonly performed in an emergency setting due to the complexities and risks involved. Endoscopic band ligation, while an effective initial treatment, is not intended for cases of severe bleeding that persist after initial management. Balloon tamponade can temporarily control bleeding but is generally used as a short-term measure while preparing for definitive interventions like TIPS.