THE CRITICAL problem presented by the cirrhotic patient during massive hemorrhage from esophageal varices can be attacked actively by either the transthoracic or the peroral route. An entirely satisfactory way to stop variceal hemorrhage has not yet been found, and all must agree that at times it is impossible to control it by any means. Control is urgent, not only because of the blood loss itself but also for prevention of liver failure. If blood is readily available for transfusion, liver failure is more frequently a threat to life than exsanguination. Therefore it is most important that hemorrhage be checked quickly, even though blood replacement can be kept abreast of blood loss.
The goal of emergency treatment of bleeding esophageal varices at Walter Reed Army Hospital is control of bleeding until portal decompression—preferably by portacaval shunt—can be accomplished. It is believed that at present no definitive procedure can safely be