Regional survey on the management of oesophageal variceal haemorrhage.

A questionnaire was sent to 116 consultant gastroenterologists in Scotland and North-East England to assess their management of oesophageal variceal haemorrhage. Most respondents (58%) dealt with < 10 variceal bleeds per year. Sclerotherapy, tamponade, vasoconstrictor therapy and oesophageal transection were available to 87.5-97.5% clinicians, compared with trans-jugular intrahepatic porto-systemic shunts (TIPSS) (39.5%) and band ligation (27%). To arrest bleeding, sclerotherapy, tamponade, octreotide/somatostatin and vasopressin/glypressin were used by 75.5%, 44.5%, 37% and 32% respectively (many used > 1 treatment) and if bleeding continued, transection, TIPSS and shunt surgery were considered by 44.5%, 27% and 6%. Sclerotherapy was used for primary and secondary prophylaxis by 11% and 75.5%, and beta-blockers by 17.5% and 49.5% respectively. A wide variation in the management of variceal haemorrhage therefore exists. Most clinicians do not attempt to prevent primary variceal bleeds, with only a minority using beta-blockers but a significant number using sclerotherapy in this situation.