Surgical Endoscopy

, Volume 2, Issue 3, pp 149–155 | Cite as

The use of sclerotherapy for the management of oesophageal varices in portal hypertension

  • John Terblanche
Original Articles

Summary

Although sclerotherapy is currently the most widely used treatment for the management of both acute variceal bleeding and the long-term management of patients with varices, its definitive role in the treatment of these patients has yet to be finally proven. Sclerotherapy appears to be the most effective treatment for the majority of patients with acute variceal bleeding. Failures require either a shunt or a transection and/or devascularisation procedure. Current evidence favours simple staple gun transection or a shunt (either a portacaval shunt or a side-to-side narrow diameter polytetrafluoroethylene graft between the portal vein and vena cava). In long-term management of patients after a variceal bleed the currently favoured treatment is repeated sclerotherapy. However, failures should be identified early. We define failures as patients who present with varices that are either difficult to eradicate by sclerotherapy or who have repeated life-threatening variceal bleeds during the course of repeated injection sclerotherapy. Such patients should have either a portal-to-systemic shunt or a transection and devascularisation operation. Further controlled trials are required to define the specific indications for the individual forms of therapy. Prophylactic treatment for varices that have not yet bled is unjustified at present.

Key words

Portal hypertension Sclerotherapy Oesophageal varices 

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Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • John Terblanche
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
  2. 2.Medical Research Council, Liver Research CentreUniversity of Cape TownCape TownSouth Africa

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