Management of gastro-oesophageal varices.

In common with the management of any gastrointestinal (GI) haemorrhage, the first step in the management of acute variceal bleeding is adequate resuscitation and airway protection to prevent aspiration. Coagulation abnormalities are normally corrected. Early endoscopy (as soon as the patient is haemodynamically stable) is recommended because it not only enables accurate diagnosis but also allows the deployment of effective therapeutic intervention, namely, variceal band ligation or sclerosant injection (Table 1). We recommend the algorithm published in the British Society of Gastroenterology guidelines for the management of variceal haemorrhage (reproduced in Fig 1)3.