Review

Bleeding from oesophageal varices is the most serious complication of portal hypertension and is the leading cause of cirrhosis-related deaths.1-3 One-quarter of cirrhotic patients who present with a first major variceal bleed die as a consequence of the bleed.3 After control of the index bleed, there is a 70 % chance of rebleeding with a similar mor-tality.4-6 Survival after variceal bleeding depends largely on the rapidity and efficacy of control of the initial bleed, the presence and severity of underlying liver disease, and hepatic functional reserve.7,8 Endoscopic injection sclerotherapy became an established method of controlling variceal bleeding worldwide following the initial prospective studies9,10 which were started in Cape Town in 1975, and the subsequent first randomised trial initiated in our unit.11 Endoscopic injection of tissue adhesive was pioneered by Gotlib and Zimmerman12 in 1984 and Soehendra in Germany in 1986.13 Endoscopic variceal ligation was introduced by Stiegmann14 in 1986 in Denver