Which of the following statement(s) is/are true concerning the management of gastroesophageal variceal hemorrhage?

a.Vasopressin decreases portal pressure through the process of splanchnic vasoconstriction

b.Somatostatin is as effective as vasopressin but without the cardiac side effects

d.Endoscopic sclerotherapy is more effective than conservative medical therapy in the treatment of bleeding esophageal varices

A number of invasive and noninvasive therapies exist for the treatment of bleeding esophageal varices. Vasopressin is frequently used in the treatment of acute variceal hemorrhage and acts by decreasing portal venous pressure or flow through splanchnic vasoconstriction. Vasopressin alone has been reported to temporarily control variceal hemorrhage in 50% to 75% of patients, however, it can be associated with cardiac and peripheral extremity cutaneous ischemia. Somatostatin also acts as a vasoconstrictor to reduce splanchnic flow, with trials demonstrating similar efficacy in controlling acute hemorrhage when compared to vasopressin but without the cardiac side effects. Balloon tamponade is generally used for the temporary control of acute variceal hemorrhage unresponsive to vasopressin or sclerotherapy. Initial control of acute variceal hemorrhage occurs in about 80% of patients, but bleeding recurs promptly on deflation of the balloons in over 50%. Endoscopic sclerotherapy has become the primary treatment for bleeding esophageal varices. A number of clinical trials demonstrate that emergent sclerotherapy is able to halt variceal bleeding that fails to respond to more conservative measures, with no increase in frequency or severity of complications. The long-term survival of patients treated with sclerotherapy continues to be debated. Metaanalysis has been performed on the data from seven randomized clinical trials evaluating the effect of repeated sclerotherapy on long-term survival. This analysis demonstrates that sclerotherapy reduces the number of deaths by 25% therefore supporting the use of sclerotherapy as an effective means of prolonging survival in patients who have experienced variceal hemorrhage.