COMPLICATIONS AND LIMITATIONS OF INJECTION SCLEROTHERAPY IN PORTAL-HYPERTENSION

The pioneering work of Whipple in 1945(1) began an era of portosystemic shunt surgery for portal hypertension which remained the primary form of treatment for nearly 30 years even though the consequences of portal diversion such as liver atrophy and encephalopathy were soon recognised.2 Repeated trials in patients with bleeding varices confirmed that the complications of medical management were related to recurrent bleeding whereas surgical treatment was followed by liver failure and encephalopathy. Refinements of surgical technique eventually culminated in the selective shunt procedures developed by Warren et al3 which were designed to decompress the gastro-oesophageal varices while preserving portal blood flow and liver function. Endoscopic sclerotherapy as an alternative form of treatment for bleeding varices was first reported in 1939(4) in a young patient with extrahepatic portal vein occlusion and was eventually popularised as an alternative to surgery by the work of Johnston and Rodgers.5 A number of controlled trials rapidly established the effectiveness of this treatment and the value of sclerotherapy in the initial management of bleeding varices, particularly in the cirrhotic patient, is now generally recognised.6 10 The variety of complications that may be associated with sclerotherapy is less well known, and the role of surgery in the management of recurrent bleeding and other sequelae is not always appreciated.