Uh, and so, and Juan, you know, uh, where is, um, where is EUS coiling of varices occurring in your center? Do you like it? Are you, are you using them? What's your feeling?

Yes.

You, you know, I think, uh, in gastric varices with glue is one, uh, clinical scenario you can really do harm by doing an endoscopy if you are not an expert or whatever.

So for example, centralizing the treatment of gastric varices in a few people that really have this expertise that can look, uh...

And I think this is, uh, a glue, uh, 2.0, you know, is, is better than the, than the previous glue.

There is, uh, for me, there is no question a- about that, and the literature shows that.

So the threshold, for example, for doing primary prophylaxis that has been, uh, all, all around, we give beta blockers even if there is a trial that shows that glue might be better.

Yeah.

And what is your approach to non-selected beta blockers in the decompensated cirrhotic? If a patient presents with variceal bleeding whilst on a non-selected beta blocker, do you withhold it while starting vasoactive agents such as octreotide or terlipresin?

Yeah, so there are two questions.

In patients with the composite cirrhosis, I do an endoscopy in everybody because the indication for beta blockers is determined by the presence of viruses.

So if the patient has viruses, if the patient has large viruses, recent data suggests that maybe combining both treatments, beta blockers and body cell ligation, might be So lately, in these patients that are high risk of having a first variceal bleeding, I do combination therapy.

In patients that present with acute variceal bleeding, I hold the beta blockers because being on a beta blockade, an increased heart rate is an important response to hypovolemia.

We don't know how the patient is going to go.

Octotide induces also bradycardia, so I put the beta blockers on hold.

And in what scenarios would you consider stopping non-selective beta blocker therapy?