The emergency management of bleeding esophageal varices should be successful in at least 50% of cases. The sequence of medical steps instituted will vary depending on the resources of the center. The prevention of exsanguination is paramount initially and then bleeding must be stopped. Replacement of blood, intravenous vasopressin, and balloon tamponade, carried out in an intensive care unit, remain the mainstay of medical therapy. The increasing availability of endoscopic sclerotherapy with flexible instruments has more recently introduced a more direct means for stopping the hemorrhage as well as preventing recurrences.
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