{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T19:34:37Z","timestamp":1757619277161,"version":"3.44.0"},"reference-count":30,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2014,5,26]]},"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:p>Mortality from acute variceal bleeding (AVB) has improved markedly over the last 2\u20133 decades due to increased specialisation and standardisation of medical and endoscopic practice culminating in the production of consensus guidance based on expert opinion. Nonetheless, despite greater exposure, training and endoscopic practices, 30-day mortality still remains high at around 30%. This is a reflection of the high morbidity with liver disease, and limited endoscopic experience and\/or endoscopic techniques used by the majority of general endoscopists. Clinical necessity defines our drive for further endoscopic innovation to improve \u2018best practice\u2019 and, therefore, clinical outcomes accordingly. Sclerotherpy, variceal band ligation and\/or rescue balloon tamponade have been entrenched in most treatment algorithms over the decades. However, in recent years and albeit limited to specialised liver centres, cyanoacrylate glue injection therapy (for oesophageal and gastric varices), and the placement of a self-expanding metallic stent for oesophageal varices have begun to offer improved endoscopic care in experienced hands. Yet even in specialised centres, their application is sporadic and operator dependent. Here, we discuss the evidence of these newer endoscopic approaches, and hope to propose their inclusion in endoscopic therapy algorithms for \u2018best practice\u2019 management of AVB in all appropriately supported endoscopy units.<\/jats:p>","DOI":"10.1136\/flgastro-2013-100428","type":"journal-article","created":{"date-parts":[[2014,6,24]],"date-time":"2014-06-24T03:52:12Z","timestamp":1403581932000},"page":"208-216","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Endoscopy management algorithms: role of cyanoacrylate glue injection and self-expanding metal stents in acute variceal haemorrhage"],"prefix":"10.1136","volume":"6","author":[{"given":"G","family":"El Sayed","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Basildon & Thurock University Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Tarff","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Basildon & Thurock University Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"O'Beirne","sequence":"additional","affiliation":[{"name":"Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Basildon & Thurock University Hospital, London, UK"},{"name":"Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,6,23]]},"reference":[{"key":"2025090709181939000_6.3.208.1","first-page":"1213","article-title":"Management of variceal bleeding","volume":"308","author":"Williams","year":"1994","journal-title":"BMJ"},{"key":"2025090709181939000_6.3.208.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra003007"},{"key":"2025090709181939000_6.3.208.3","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510290608"},{"key":"2025090709181939000_6.3.208.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2007.02.029"},{"issue":"(Suppl 3\u20134)","key":"2025090709181939000_6.3.208.5","first-page":"III1","article-title":"UK guidelines on the management of variceal haemorrhage in cirrhotic patients. 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