Bleeding esophageal varices. How to treat this dreaded complication of portal hypertension.

Bleeding esophageal varices, one of the most feared complications of portal hypertension, contribute to the estimated 32,000 deaths annually attributed to cirrhosis. Successful control requires knowledge of the pertinent anatomy, underlying pathophysiology of portal hypertension, and natural history of gastro-esophageal varices. Drs Hegab and Luketic review these topics and discuss the various prophylactic and therapeutic approaches to management, including pharmacologic agents, endoscopic sclerotherapy, and trans-jugular intrahepatic portosystemic shunt (TIPS).