Implications of a sclerotherapy program for the medical and surgical care of bleeding in portal hypertension.

The results of endoscopic sclerotherapy are promising and, at first sight, this technique offers a relatively simple and widely available method of achieving definitive control and preventing rebleeding from the esophageal varices. While it is an attractive option to operation, there is a small but significant group of patients, both at initial presentation and follow-up examination, in whom sclerotherapy is inappropriate. It remains to be determined whether shunt operation or a gastric vascularization procedure is superior. It must be remembered that surgical intervention may be required for a number of nonvariceal complications which may arise in patients with portal hypertension. Despite the apparent simplicity of endoscopic sclerotherapy, the management of these patients unquestionably requires a team of physicians, surgeons and nurses with back-up facilities from other personnel who are experienced in this problem, if mortality is to be kept to a minimum. The management of bleeding esophageal varices requires considerably more than a simple injection of sclerosant into a varix and a chronic sclerotherapy program imposes a large and inevitably increasing workload on a gastroenterologic unit.