The Management of an Episode of Variceal Bleeding

  • David Westaby


Variceal bleeding is the most serious consequence of portal hypertension and represents a major gastrointestinal emergency, the optimum management of which encompasses a wide range of medical and surgical skills. Both the natural history and the treatment of an episode of variceal hemorrhage are distinct from other causes of upper gastrointestinal bleeding and as such there is considerable emphasis placed upon early diagnosis.


Portal Hypertension Esophageal Varix Variceal Bleeding Portal Pressure Gastric Varix 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Westaby S, Wilkinson S, Warren R, Williams R (1978) Spleen size and portal hypertension in cirrhosis. Digestion 17: 63–68PubMedCrossRefGoogle Scholar
  2. 2.
    Atkinson M (1981) Bleeding from the oesophagus. In: Dykes P, Keighley M (eds) Gastrointestinal haemorrhage. J Wright, Bristol, p 29Google Scholar
  3. 3.
    Silverstein F, Gilbert D, Tedesco F, Buenger N, Persing J (1981) The national ASGE survey on upper gastro-intestinal bleeding. Parts 1–3. Gastrointest Endosc 27: 73–102PubMedCrossRefGoogle Scholar
  4. 4.
    Waldram R, Nunnerley H, Davis M, Laws J, Williams R (1977) Detection and grading of oesophageal varices by fibre-optic endoscopy and barium swallow with and without buscopan. Clin Radiol 28: 137–141PubMedCrossRefGoogle Scholar
  5. 5.
    Warren K (1980) Hepato-splenic schistosomiasis, a great neglected disease of the liver. Gut 19: 572–577CrossRefGoogle Scholar
  6. 6.
    Kingham J, Levison D, Stanfield A, Dawson A (1981) Non-cirrhotic intrahepatic portal hypertension, a long-term follow-up study. Q J Med 199: 259–268Google Scholar
  7. 7.
    Webb L, Sherlock S (1979) The aetiology, presentation and natural history of extra hepatic portal venous obstruction. Q J Med 192: 627–639Google Scholar
  8. 8.
    Christenson E, Fauerholdt L, Schlichting P, Juhl E, Poulsen H, Tygstrup H (1981) Aspects of the natural history of gastro-intestinal bleeding in cirrhosis and the effect of prednisolone. Gastroenterology 81: 944–952Google Scholar
  9. 9.
    Dagradi A, Mehler R, Tan D, Stempion S (1970) Sources of upper gastrointestinal bleeding in patients with liver cirrhosis and large esophagogastric varices. Am J Gastroenterol 54: 458–463PubMedGoogle Scholar
  10. 10.
    Cotton P (1981) Severe upper gastro-intestinal bleeding. Part 4. Problems for emergency endoscopic management. Clin Gastroenterol 10: 59–64PubMedGoogle Scholar
  11. 11.
    Mitchell K, MacDougall B, Silk D, Williams R (1982) A prospective reappraisal of emergency endoscopy in patients with portal hypertension. Scand J Gastroenterol 17: 965–968PubMedGoogle Scholar
  12. 12.
    Lebrec D, Benhamou J-P (1985) Ectopic varices in portal hypertension. Clin Gastroenterol 14: 105–122PubMedGoogle Scholar
  13. 13.
    Hosking S, Kennedy H, Seddon I, Triger D (1987) The role of propranolol in congestive gastropathy of portal hypertension. Hepatology 7: 437–441PubMedCrossRefGoogle Scholar
  14. 14.
    Quintero E, Pique J, Bombi J, Bordas J, Sentis J, Elena M, Bosch J, Rodes J (1987) Gastric mucosal vascular ectasias causing bleeding in cirrhosis. Gastroenterology 93: 1054–1059PubMedGoogle Scholar
  15. 15.
    Graham D and Smith J (1981) The course of patients after variceal hemorrhage. Gastroenterology 80: 800–809PubMedGoogle Scholar
  16. 16.
    De Dombal F, Clarke J, Clamp S, Malizia G, Kotwal M, Morgan A (1986) Prognostic factors in upper GI bleeding. Endoscopy 18 (Suppl 2): 6–10PubMedCrossRefGoogle Scholar
  17. 17.
    Jones P, Johnston S, McEwan A, Kyle J, Needham C (1973) Further haemorrhage after admission to hospital for gastro-intestinal bleeding. Br Med J 3: 660–664PubMedCrossRefGoogle Scholar
  18. 18.
    Olsson R (1972) The natural history of esophageal varices. A retrospective study of 244 cases with liver cirrhosis. Digestion 6: 65–74PubMedCrossRefGoogle Scholar
  19. 19.
    Peterson W, Barnet C, Smith H, Allen M, Corbett D (1981) Routine early endoscopy in upper gastro-intestinal tract bleeding. A randomised controlled trial. N Engl J Med 304: 925–929PubMedCrossRefGoogle Scholar
  20. 20.
    Villeneuve J-P, Pomier-Layrargues G, Infante-Rivard C, Willems B, Huet M, Marleau D, Viallet A (1986) Propranolol for the prevention of recurrent variceal hemorrhage, A controlled trial. Hepatology 6: 1239–1243PubMedCrossRefGoogle Scholar
  21. 21.
    Vlavianos P, Gimson A, MacMathuna P, Hayllar K, Westaby D, Williams R (to be published) The prognostic significance of systemic and portal hemodynamic parameters in patients with cirrhosis and portal hypertension. HepatologyGoogle Scholar
  22. 22.
    The North Italian Endoscopy Club for the study and treatment of esophageal varices (1988) Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and espohageal varices, a prospective multicentre study. N Engl J Med 319: 983–989CrossRefGoogle Scholar
  23. 23.
    Lebrec D, De Fleury P, Rueff B, Nahum H, Benhamou J-P (1980) Portal pressure, size of esophageal varices and risk of gastro-intestinal bleeding in alcoholic cirrhosis. Gastroenterology 79: 1139–1144PubMedGoogle Scholar
  24. 24.
    Vinel J, Cassigneuil J, Levade M, Voight J, Pascal J-P (1986) Assessment of short-term prognosis after variceal bleeding in patients with alcoholic cirrhosis by early measurement of porto-hepatic gradient. Hepatology 6: 116–117PubMedCrossRefGoogle Scholar
  25. 25.
    Burroughs A, D’Heygere F, McIntyre N (1986) Pitfalls in studies of prophylactic therapy for variceal bleeding in cirrhotics. Hepatology 6: 1407–1413PubMedCrossRefGoogle Scholar
  26. 26.
    Garcia Pagan J, Teres J, Calvet X, Bosch J, Ródes J (1989) Factors which influence the prognosis of the first episode of variceal hemorrhage in patients with cirrhosis. In: Bosch J, Rodes J (eds) Recent advances in the pathophysiology and therapy of portal hypertension. Ares-Serono Symposia, Rome, pp 287–301Google Scholar
  27. 27.
    Pagliaro L, D’Amico G, Malizia G, Tine F, Traina M, Pasta L (1987) Prognostic factors for short-term survival in variceal bleeding. In: Burroughs A (ed) Methodology and reviews of clinical trials in portal hypertension. Excerpta Medica, Amsterdam, pp 53–62Google Scholar
  28. 28.
    Garden O, Motyl H, Gilmour W, Utley R, Carter D (1985) Prediction of outcome following acute variceal bleeding. Br J Surg 72: 91–95PubMedCrossRefGoogle Scholar
  29. 29.
    Moreau R, Roulot D, Braillon A, Gaudin C, Hadengue A, Bacq Y, Lebrec D (1989) Low dose of nitroglycerin failed to improve splanchnic hemodynamics in patients with cirrhosis: Evidence for an impaired cardiopulmonary baroreflex function. Hepatology 10: 93–97PubMedCrossRefGoogle Scholar
  30. 30.
    Lautt W, Greenway C (1987) Conceptual review of the hepatic vascular bed. Hepatology 7: 946–951CrossRefGoogle Scholar
  31. 31.
    Greig P, Langer B, Blendis L, Taylor B, Glynn M (1980) Complications after peritoneovenous shunting for ascites. Am J Surg 139: 125–131PubMedCrossRefGoogle Scholar
  32. 32.
    Post J, Rose J, Shore S (1951) Intravenous use of salt-poor albumin: Effects in 34 patients with decompensated hepatic cirrhosis. Arch Intern Med 87: 775–778CrossRefGoogle Scholar
  33. 33.
    Kravetz D, Bosch J, Arderiu M, Pizcueta P, Rodes J (1989) Hemodynamic effects of blood volume restitution in rats with portal hypertension due to cirrhosis of the liver: Influence of the extent of portal systemic shunting. Hepatology 9: 808–814PubMedCrossRefGoogle Scholar
  34. 34.
    Kravetz D, Sikuler E, Groszmann R (1986) Splanchnic and systemic hemodynamics in portal hypertensive rats during hemorrhage and blood volume restitution. Gastroenterology 90: 1232–1240PubMedGoogle Scholar
  35. 35.
    Panos M, Moore K, Vlavianos P, Chambers J, Anderson J, Gimson A, Slater J, Rees L, Westaby D, Williams R (to be published) Sequential hemodynamic changes during single total paracentesis, and right atrial size in patients with tense ascites. Hepatology 1990, 11: 662–667PubMedCrossRefGoogle Scholar
  36. 36.
    Conn H, Ramsby G, Storer E, Mutchnick M, Joshi P, Phillips M, Cohen G, Fields G, Petroski D (1975) Intra-arterial vasopressin in the treatment of upper gastro-intestinal bleeding: A prospective, controlled clinical trial. Gastroenterology 68: 211–221PubMedGoogle Scholar
  37. 37.
    Fogel M, Knauer M, Kemeny J, Rinki M, Walker J, Siegmund D, Gregory P (1982) Continuous vasopressin in active upper gastrointestinal bleeding. Ann Intern Med 96: 565–569PubMedCrossRefGoogle Scholar
  38. 38.
    Mallory A, Schaefer J, Cohen J, Holt S, Norton L (1980) Selective intraarterial vasopressin infusion for upper gastro-intestinal tract hemorrhage. Arch Surg 115: 30–32PubMedCrossRefGoogle Scholar
  39. 39.
    Merigan T, Plotkin G, Davidson C (1962) Effect of intravenously administered posterior pituitary extract on hemorrhage from esophageal varices. N Engl J Med 266: 565–569CrossRefGoogle Scholar
  40. 40.
    Freeman J, Lishman A, Cobden I, Record C (1982) Controlled trial of terlipressin (glypressin) versus vasopressin in the early treatment of oesophageal varices. Lancet II, 66–68CrossRefGoogle Scholar
  41. 41.
    Freeman J, Cobden I, Record C (1989) Placebo controlled trial of glypressin in the management of acute variceal bleeding. J Clin Gastroenterol 11: 58–60PubMedCrossRefGoogle Scholar
  42. 42.
    Kravetz D, Bosch J, Teres J, Bruix J, Rimola A, Rodes J (1984) Comparison of intravenous somatostatin and vasopressin infusions in treatment of acute variceal hemorrhage. Hepatology 4: 442–446PubMedCrossRefGoogle Scholar
  43. 43.
    Conn H (1982) A plethora of therapies. In: Westaby D, MacDougall B, Williams R (eds) Variceal bleeding. Pitman, London pp 221–252Google Scholar
  44. 44.
    Groszmann R, Kravetz D, Bosch J, Glickman M, Bruix J, Bredfeldt J, Conn H, Ródes J, Storer E (1982) Nitroglycerin improves hemodynamic response to vasopressin in portal hypertension. Hepatology 2: 757–762PubMedCrossRefGoogle Scholar
  45. 45.
    Mols P, Hallemans R, Van Kuyk M, Melot C, Lejeune P, Ham H, Vertongen F, Naeije R (1984) Hemodynamic effects of vasopressin, alone and in combination with nitroprusside in patients with liver cirrhosis and portal hypertension. Ann Surg 199: 176–181PubMedCrossRefGoogle Scholar
  46. 46.
    Westaby D, Gimson A, Hayes P, Williams R (1988) Haemodynamic response to intravenous vasopressin and nitroglycerin in portal hypertension. Gut 29: 372–377PubMedCrossRefGoogle Scholar
  47. 47.
    Bosch J, Groszmann R, Garcia-Pagan J, Teres J, Garcia-Tsoa G, Navasa M, Mas A, Rodes J (1989) Association of transdermal nitroglycerin to vasopressin infusion in the treatment of variceal hemorrhage: A placebo-controlled clinical trial. Hepatology 10: 962–968PubMedCrossRefGoogle Scholar
  48. 48.
    Gimson A, Westaby D, Hegarty J, Watson A, Williams R (1986) A randomized trial of vasopressin and vasopressin plus nitroglycerin in the control of acute variceal hemorrhage. Hepatology 6: 410–413PubMedCrossRefGoogle Scholar
  49. 49.
    Tsai Y, Lay K, Ng W, Yeh Y, Wang J, Chiang T, Lee S, Chiang B, Lo K (1986) Controlled trial of vasopressin plus nitroglycerin Vs vasopressin alone in the treatment of bleeding esophageal varices. Hepatology 6: 406–409PubMedCrossRefGoogle Scholar
  50. 50.
    Blei A, Freiman S, Gottstein J, Robertson G, Fung H (1985) Pharmokinetic-hemodynamic interactions between vasopressin and nitroglycerin: comparison between intravenous and cutaneous routes of nitrate delivery. Hepatology 5: 264–270PubMedCrossRefGoogle Scholar
  51. 51.
    Cort J, Albrect I, Novakova J, Muller J, Jost K (1975) Regional and systemic haemodynamic effects of some vasopressins. Structural features of the hormones which prolong activity. Eur J Clin Invest 5: 165–175PubMedGoogle Scholar
  52. 52.
    Vosmik J, Jedlicka K, Mulder J, Cort J (1977) Action of the triglycyl hormonogen of vasopressin (glypressin) in patients with liver cirrhosis and bleeding esophageal varices. Gastroenterology 72: 605–609PubMedGoogle Scholar
  53. 53.
    Walker S, Stiehl A, Raedsch R, Kommereil B (1986) Terlipressin in bleeding esophageal varices, a placebo-controlled, double-blind study. Hepatology 6: 112–115PubMedCrossRefGoogle Scholar
  54. 54.
    Bosch J, Kravetz D, Ródes J (1981) Effects of somatostatin on hepatic and systemic hemodynamics in patients with cirrhosis of the liver, comparison with vasopressin. Gastroenterology 80: 518–525PubMedGoogle Scholar
  55. 55.
    Bosch J (1985) Effect of pharmacological agents on portal hypertension: A haemodynamic appraisal. Clin Gastroenterol 14: 169–201PubMedGoogle Scholar
  56. 56.
    Kleber G, Sauerbruch T, Fisher G, Paumgartner G (1988) Somatostatin does not reduce oesophageal variceal pressure in liver cirrhotics. Gut 29: 153–156PubMedCrossRefGoogle Scholar
  57. 57.
    Jenkins S, Baxter J, Corbett W, Dewitt P, Ware J, Shields R (1985) A prospective randomised controlled clinical trial coparing somatostatin and vasopressin in controlling acute variceal haemorrhage. Br Med J 290: 275–278CrossRefGoogle Scholar
  58. 58.
    Burroughs A, Sprengers D, Hughs M, D’Heygere F, McCormick A, McIntyre N (1988) Randomised, double-blind placebo controlled trial of somatostatin for control of variceal bleeding (abstract). J Hepatol 7 (Suppl 1): S14CrossRefGoogle Scholar
  59. 59.
    Valenzuela J, Schubert T, Fogel R, Strong R, Levine J, Mills P, Fabry T, Taylor L, Conn H, Possilico J, and amulticenter study group (1989) A multicenter randomized, double-blind trial of somatostatin in the management of acute hemorrhage from esophageal varices. Hepatology 10: 958–961PubMedCrossRefGoogle Scholar
  60. 60.
    Mastai R, Grande L, Bosch J, Bruix J, Rigau J, Kravetz D, Navasa M, Pera C, Rodes J (1986) Effects of metoclopramide and domperidone on azygos venous blood flow in patients with cirrhosis and portal hypertension. Hepatology 6: 1244–1247PubMedCrossRefGoogle Scholar
  61. 61.
    Hosking S, Doss W, El-Zeiny H, Robinson P, Barsoum M, Johnson A (1988) Pharmacological constriction of the lower oesophageal sphincter, a simple method of arresting variceal haemorrhage. Gut 28: 1098–1102CrossRefGoogle Scholar
  62. 62.
    Rowntree L, Zimmerman E, Todd M, Ajac J (1947) Intra-esophageal venous tamponage. Its use in a case of variceal hemorrhage from the esophagus. JAMA 135: 630–631CrossRefGoogle Scholar
  63. 63.
    Vlavianos P, Gimson A, Westaby D, Williams R (1989) Balloon tamponade in variceal bleeding: Use and misuse. Br Med J 298: 1158CrossRefGoogle Scholar
  64. 64.
    Mitchell K, Silk D, Williams R (1980) Prospective comparison of two Sengstaken tubes in the management of patients with variceal haemorrhage. Gut 21: 570–573PubMedCrossRefGoogle Scholar
  65. 65.
    Sarin S, Nandy S (1984) Balloon tamponade in the management of bleeding oesophageal varices. Ann R Coll Surg Engl 66: 30–32PubMedGoogle Scholar
  66. 66.
    Teres J, Cecilia A, Panes J, Rimola A, Bru C, Rodes J (1978) Esophageal tamponade for bleeding varices. Controlled trial between Sengstaken-Blakemore Tube and the Linton-Nachlas Tube. Gastroenterology 75: 566–569PubMedGoogle Scholar
  67. 67.
    Johnston G, Rodgers H (1973) A review of 15 years experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices. Br J Surg 60: 797–800PubMedCrossRefGoogle Scholar
  68. 68.
    Terblanche J, Yakoob H, Bornman P, Stiegman G, Bawe R, Jonker M, Wright J, Kirsch R (1981) Acute bleeding varices. A 5-year prospective evaluation of tamponade and sclerotherapy. Ann Surg 194: 521–530PubMedCrossRefGoogle Scholar
  69. 69.
    Moreto M, Zaballa M, Bernal A, Ibanez S, Ojembarrena E, Rodriguez A (1988) A randomised trial of tamponade or sclerotherapy as immediate treatment for bleeding esophageal varices. Surg Gynecol Obstet 167: 331–334PubMedGoogle Scholar
  70. 70.
    Paquet K-J, Feussner H (1985) Endoscopic sclerosis and esophageal tamponade in acute hemorrhage from esophago-gastric varices: A prospective controlled randomised trial. Hepatology 5: 580–583PubMedCrossRefGoogle Scholar
  71. 71.
    Yassin Y, Sherif S (1983) Randomised controlled trial of injection sclerotherapy for bleeding oesophageal varices—an interim report. Br J Surg 70: 20–22PubMedCrossRefGoogle Scholar
  72. 72.
    Larson A, Cohen H, Zweiban B, Chapman D, Gourdji M, Korula J, Weiner J (1986) Acute esophageal sclerotherapy. JAMA 255: 497–500PubMedCrossRefGoogle Scholar
  73. 73.
    Soderland C, Ihre T (1985) Endoscopic sclerotherapy vs conservative management of bleeding oesophageal varices. Acta Chir Scand 151: 449–456Google Scholar
  74. 74.
    Westaby D, Hayes P, Gimson A, Poison R, Williams R (1989) Controlled trial of injection sclerotherapy for active variceal bleeding. Hepatology 9: 274–277PubMedCrossRefGoogle Scholar
  75. 75.
    Rose J, Crane M, Smith P (1983) Factors effecting successful sclerotherapy for oesophageal varices. Gut 24: 946–949PubMedCrossRefGoogle Scholar
  76. 76.
    Sarin S, Nanda R, Sachdev G, Chari S, Anand S, Broor S (1987) Intravariceal vs paravariceal sclerotherapy, a prospective, controlled, randomised trial. Gut 28: 657–662PubMedCrossRefGoogle Scholar
  77. 77.
    Bornmann P, Kahn D, Terblanche J, Worthley C, Spence R, Krigge J (1988) Rigid versus fiberoptic endoscopic injection sclerotherapy: A prospective randomised controlled trial in patients with bleeding esophageal varices. Ann Surg 208: 175–178CrossRefGoogle Scholar
  78. 78.
    Kitano S, Koyanagi N, Iso Y, Higashi H, Sugimachi K (1987) Prevention of recurrence of esophageal varices after endoscopie injection sclerotherapy with ethanolamine oleate. Hepatology 7: 810–815PubMedCrossRefGoogle Scholar
  79. 79.
    Williams K and Dawson J (1979) Fibreoptic injection of oesophageal varices. Br Med J 2: 766–767PubMedCrossRefGoogle Scholar
  80. 80.
    Van Stiegman G and Goff J (1988) Endoscopic esophageal varix ligation, preliminary clinical experience. Gastrointest Endosc 34: 113–117CrossRefGoogle Scholar
  81. 81.
    Gimson A, Westaby D, Williams R (to be published) Endoscopic therapy in the management of gastric variceal haemorrhage. J HepatolGoogle Scholar
  82. 82.
    Hosking S, Johnson A (1988) Gastric varices, a proposed classification leading to management. Br J Surg 75: 747–750CrossRefGoogle Scholar
  83. 83.
    Soehendra N, Grimm H, Nam V, Berger B (1987) N-Butyl-2-Cyanoacrylate, A supplement to endoscopic sclerotherapy. Endoscopy 19: 221–224PubMedCrossRefGoogle Scholar
  84. 84.
    Lunderquist A, Vang J (1974) Transhepatic catheterisation and obliteration of the coronary vein in patients with portal hypertension and esophageal varices. N Engl J Med 291: 646–649PubMedCrossRefGoogle Scholar
  85. 85.
    Hervieu C, Levade M, Pascal J-P (1982) Embolisation par voie transcutanee des varices oesophagiennes. Gastroenterol Clin Biol 6: 692–698PubMedGoogle Scholar
  86. 86.
    Smith-Laing G, Scott J, Long R, Dick R, Sherlock S (1981) Role of percutaneous transhepatic obliteration of varices in the management of haemorrhage from gastro-oesophageal varices. Gastroenterology 80: 1031–1036PubMedGoogle Scholar
  87. 87.
    Keady B, Schwartz J, Johnson G (1985) Should ablative operations be used for bleeding esophageal varices. Ann Surg 203: 463–467Google Scholar
  88. 88.
    Van Kemmel M (1974) Reésction-anastomose de I’oesophage sus-cardial pour rupture de varices oesophagiennes. Nouve Press Med 5: 1123–1124Google Scholar
  89. 89.
    Orloff M, Bell R, Hyde P, Skivolocki W (1980) Long-term results of emergency portacaval shunt for bleeding esophageal varices in unselected patients with alcoholic cirrhosis. Ann Surg 192: 325–340PubMedCrossRefGoogle Scholar
  90. 90.
    Orloff M, Bell R, Greenburg A (1986) Prospective randomized trial of emergency portacaval shunt and medical therapy in unselected cirrhotic patients with bleeding varices (abstact). Gastroenterology 90, 1754Google Scholar
  91. 91.
    Cello J, Grendall J, Crass R, Weber T, Trunkey D (1987) Endoscopic sclerotherapy versus portacaval shunt in patients with severe cirrhosis and acute variceal hemorrhage, long-term follow up. N Engl J Med 316: 11–15PubMedCrossRefGoogle Scholar
  92. 92.
    Warren D, Henderson M, Millikan W, Galambos J, Scott-Brooks W, Riepe S, Salam A, Kutner M (1986) Distal splenorenal shunt vs endoscopic sclerotherapy for the long-term management of variceal bleeding. Ann Surg 203: 454–461PubMedCrossRefGoogle Scholar
  93. 93.
    Shaw B, Wood P, Gordon R, Iwatzuki S, Gillquist W, Starzl T (1985) Influence of selected patient variables and operative blood loss on 6 month survival following liver transplantation. Sem Liver Dis 5: 385–393CrossRefGoogle Scholar
  94. 94.
    Boerema I, Klopper P, Holscher A (1970) Trans-abdominal ligation-resection of the esophagus in cases of bleeding esophageal varices. Surgery 67: 409–413PubMedGoogle Scholar
  95. 95.
    Hassab M (1970) Non-shunt operations in portal hypertension without cirrhosis. Surg Gynecol Obstet 131: 648–654PubMedGoogle Scholar
  96. 96.
    Tanner N (1954) Discussion on portal hypertension. Proc R Soc Med 47: 475–478PubMedGoogle Scholar
  97. 97.
    Suguira M, Futagawa S (1984) Results of six hundred and thirty-six esophageal transections with paraesophagogastric devascularisation in the treatment of esophageal varices. J Vasc Surg 1: 254–260Google Scholar
  98. 98.
    Spence R, Johnston G (1985) Results in 100 consecutive patients with stapled esophageal transection for varices. Surg Gynecol Obstet 160: 323–329PubMedGoogle Scholar
  99. 99.
    Burroughs A, Hamilton G, Phillips A, Mezzanotte G, McIntyre N, Hobbs K (1989) A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophageal varices. N Engl J Med 321: 857–862PubMedCrossRefGoogle Scholar
  100. 100.
    Huizinga W, Angorn I, Baker L (1985) Esophageal transection versus injection sclerotherapy in the management of bleeding esophageal varices in patients at high risk. Surg Gynecol Obstet 160: 539–546PubMedGoogle Scholar
  101. 101.
    Teres J, Baroni R, Bordas J, Visa J, Pera C, Ródes J (1987) Randomised trial of portacaval shunt, stapling transection and endoscopic sclerotherapy in uncontrolled variceal bleeding. J Hepatol 4: 159–167PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 1991

Authors and Affiliations

  • David Westaby
    • 1
  1. 1.King’s College Hospital and School of Medicine and DentistryInstitute of Liver StudiesLondonUK

Personalised recommendations