Acute esophageal variceal hemorrhage remains a catastrophic event with a high mortality from either exsanguination or hepatic coma precipitated by shock and the stress associated with massive blood transfusion, increased protein load in the gut, and the trauma of various procedures employed in an effort to arrest the bleeding. Survival from such an episode is followed by an increased risk of recurrent hemorrhage and a poorer prognosis than that of a patient with portal hypertension who has not sustained a variceal bleeding episode. Endoscopic injection sclerotherapy, especially if performed via the flexible instrument, would seem to be the treatment of choice for the acute variceal hemorrhage. It may prove to have a role in the subsequent management for the prevention of recurrent hemorrhage in certain categories of patients, although its exact place has yet to be defined.
Allison JG. The Role of Injection Sclerotherapy in the Emergency and Definitive Management of Bleeding Esophageal Varices. JAMA. 1983;249(11):1484–1487. doi:10.1001/jama.1983.03330350060031
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