Final answer:
For preventing a variceal bleed in a cirrhotic patient with large gastric varices and a MELD score of 20, non-surgical options like sclerotherapy or endogenous thermal ablation are often preferred. If needed, a more invasive procedure, trans jugular intrahepatic portosystemic shunt (TIPS), can be considered to reduce portal hypertension and prevent bleeding.
Step-by-step explanation:
For a cirrhotic patient with large gastric varices and a Model for End-Stage Liver Disease (MELD) score of 20, the prevention of a variceal bleed is crucial. Considering the serious health risks and the advanced stage of liver disease, non-surgical procedures are often the treatment of choice.
Sclerotherapy and endogenous thermal ablation are two commonly used methods. However, in cases where these methods are not suitable or have failed, a more invasive approach such as the trans jugular intrahepatic portosystemic shunt (TIPS) procedure might be considered. TIPS can help reduce portal hypertension by creating a channel within the liver to reconnect the portal and systemic circulation, thereby alleviating the pressure on the varices.
It's essential to consider the patient's overall condition and potential complications when choosing a treatment method. A multidisciplinary approach involving gastroenterologists, hepatologists, and interventional radiologists is ideal for managing patients with serious liver disease and preventing complications such as variceal hemorrhage.