[Treatment of portal hypertension]

Injection sclerotherapy is the mainstay of treatment for acute variceal bleeding and for long-term management after a variceal bleed in 1993. However, the new technique of oesophageal variceal ligation may prove to be superior, either alone or in combination with low dose sclerotherapy. Pharmacological therapy for acute variceal bleeding is widely used and somatostatin appears to be the most effective agent. Long-term pharmacological therapy with beta-blockade is becoming increasingly accepted and some centres even use it as the primary therapy instead of sclerotherapy. Surgical shunts and major devascularization and transection procedures are mostly reserved for the failures of sclerotherapy, although certain groups utilize the Warren distal splenorenal shunt for the majority of fitter patients. Shunting may well prove to be more effective in long-term management than extensive devascularization and transection operations. The new interventional radiological technique, TIPS, is an exciting alternative procedure but it is unlikely to be accepted for widespread use because of increasing reports of encephalopathy and of late occlusion due to neointimal hyperplasia. TIPS's main role is as a bridge to transplantation for the failures of sclerotherapy oesophageal variceal banding.