Emergency endoscopic treatment of oesophageal varices

Since oesophageal varices usually originate in the stomach, tamponade of the varices at the gastrooesophageal junction by inflation of the gastric balloon is usually effective in controlling haemorrhage. Inflation of the oesophageal balloon is rarely required and risks necrosis of the oesophageal wall, necessitating regular reduction of the pressure. Regular aspiration of the appropriate ports prevents build-up of secretions; the gastric aspirate port may be used as a nasogastric tube for delivery of essential oral medication, such as lactulose for the treatment of encephalopathy.
Aspiration pneumonia is a major cause of death and significant morbidity in these patients; the risk is particularly high in confused or encephalopathic patients who should be intubated for airway protection prior to insertion of the tube.