Veno-occlusive disease occurs in the small hepatic veins. The Child Pugh classification is a useful way to grade liver failure and is also used to predict operative mortality. Approach to Treatment of Portal Hypertension Treatment of portal hypertension may involve endoscopic intervention, pharmacologic measures, radiologic approaches, surgery, or transplantation. Endoscopy Endoscopic evaluation and intervention is accomplished by gastroenterologists. Endoscopy is generally considered first line therapy for patients with active bleeding as it is used to both diagnose and treat the bleeding.
Diagnostic endoscopy is performed to diagnose esophageal varices and bleeding esophageal varices.
Sclerotherapy is used to treat bleeding esophageal varices. Multiple treatments are usually required to reach all the bleeding varices. Possible complications include scarring which can result in ischemia, strictures, and esophageal perforation. Sclerotherapy also has a significant risk of rebleeding. Banding may be used as an alternative to sclerotherapy and avoids some risks of sclerotherapy such as esophageal stricture and perforation.