The specific approach is dependent in part on the availability of sclerotherapy and appropriate surgical expertise. Recurrent bleeding from varices during the same hospitalization calls for surgical consultation and a second or even a third attempt at emergency sclerosis. If bleeding is not controlled, other methods, including surgery, should be considered. If bleeding does not recur, one or two sessions of elective sclerosis should be done prior to discharge. Repeated sclerotherapy sessions can then be done in the outpatient setting at two to four week intervals until varices appear obliterated.
Varices recur in a significant percentage of patients.
Gastric varices close to the esophagogastric junction can be handled in much the same way as esophageal varices. Extensive gastric varices are not amenable to scierotherapy. There are many variables in the performance of sclerotherapy. It is not clear that any one is distinctly superior. Injections may be either intravariceal, paravariceal or both.