The management of patients with portal hypertension and oesophageal varices.
The management of patients with portal hypertension and oesophageal varices remains controversial. Patients with suspected variceal bleeding are resuscitated, and emergency endoscopy is mandatory to determine the source of bleeding. Both intravenous pitressin and the Sengstaken tube are useful in stopping haemorrhage temporarily, but bleeding frequently recurs. In such patients additional treatment is necessary. Currently acceptable alternatives are percutaneous transhepatic obliteration of varices, oesophageal transection with the stapling gun, or peroesophageal injection sclerotherapy. Data are presented to support the use of the latter technique, which is proposed as the treatment of patients whohave bled previously include conventional medical therapy with treatment of each recurrent haemorrhage as it occurs, the use of newer forms of shunts such as the Warren shunt, and repeated sclerotherapy. Whem sclerotherapy is used, a case is made for peroesophageal injection sclerotherapy using a modified, rigid Negus oesophagoscope under general anaesthesia.
D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000601:surgery / Q000628:therapy*; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000628:therapy*; D008722:Methods