In the last 20 years clinicians have witnessed the influx of new and creative modalities to treat variceal bleeding, a serious complication of portal hypertension. In the past physicians were sometimes reluctant to manage patients with variceal hemorrhage because controlling the bleeding was difficult and frequently unsuccessful. Perhaps the turning point was the introduction of cyclosporine to clinical practice in 1980. This potent immunosuppressive agent significantly improved the results of liver transplantation and quickly became an accepted therapy for patients with cirrhosis. Patients with cirrhosis began to trickle to liver transplantation programs and this was the beginning of a multidisciplinary approach toward treating the complications of portal hypertension, with transplantation often being the ultimate goal. Soon after the advent of transjugular intrahepatic portosystemic shunts (TIPS), new pharmaceutical agents and new endoscopic techniques for controlling bleeding paved the way for a team effort in the management of portal hypertension. That integrated approach is the emphasis of this book.
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