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Abstract Summary Although slightly different techniques and different sclerosants are used, the results are not strikingly different. Various sclerotherapy techniques have proved successful in the management of acute variceal bleeding. Individual units must utilize the technique with which they have the most experience. Once active variceal bleeding is diagnosed on emergency endoscopy, immediate EIS should be performed. When this is not possible bleeding should be controlled by balloon tube tamponade with subsequent delayed EIS after resuscitation. Patients with variceal bleeding that has stopped at the time of diagnostic endoscopy can either be treated by immediate sclerotherapy or be observed initially and subsequently treated using the long term management policy of the unit concerned. Over 90% of actively bleeding patients should be controlled using emergency EIS. Failures are defined as patients who have more than two acute variceal bleeds during a single hospital admission in spite of EIS. Such patients should be identified early and treated either by simple staplegun transaction, or by emergency portacaval shunt. |